SAN FRANCISCO -- Mood stabilizing drugs effectively target the impulsivity that constitutes a core symptom domain common to a wide range of personality disorders and impulse-control disorders, Dr. Eric Hollander said at a satellite symposium held with the annual meeting of the American Psychiatric Association.
Of course, the mood stabilizers also improve affective instability. And affective instability turns out to be an underappreciated hallmark of the cluster B personality disorders and the impulse-control disorders.
This dual effect on impulsivity and affective instability explains the therapeutic efficacy mood stabilizing agents such as lithium and divalproex display across what at first glance may seem a disparate range of psychiatric diagnoses, according to Dr. Hollander, director of the Compulsive, Impulsive, and Anxiety Disorders Clinic at Mount Sinai Medical Center, New York.
The impulse-control disorders are characterized by the buildup of an irresistible impulse, followed by an action to relieve it, then guilt or remorse. There is a gender split in the occurrence of these disorders, with pathologic gambling, sexual addictions, pyromania, and intermittent explosive behavior being more prevalent in men, while binge eating, trichotillomania, kleptomania, and compulsive shopping occur more commonly among women.
Impulsivity also figures prominently in the whole spectrum of bipolar disease.
"Many people who deal with bipolar illness find that impulsivity is part and parcel of it, and that irrespective of the subtype of mania there are often high levels of impulsivity which persist even when patients are in a euthymic state," the psychiatrist observed at the symposium sponsored by Solvay Pharmaceuticals Inc.
As director of the compulsive, impulsive, and anxiety disorders program at Mount Sinai, Dr. Hollander has been a pioneer in the pharmacologic treatment of impulsivity, an application which is entirely off-label. …