fluvoxamine and Disruptive--Impulse-Control--and-Conduct-Disorders

Medication treatment studies have demonstrated short-term efficacy of various SRIs, opioid antagonists, and mood stabilizers in sub-samples of adult treatment seeking pathological gamblers. Pathological gambling is frequently comorbid with bipolar spectrum disorders, substance abuse/dependence, and attention-deficit/hyperactivity disorder (ADHD), and comorbidity may influence treatment response in pathological gambling. This review focuses on recent research examining the treatment of pathological gambling and highlights methodological challenges for future studies.

Topics: Antidepressive Agents, Second-Generation; Behavior, Addictive; Bupropion; Comorbidity; Disruptive, Impulse Control, and Conduct Disorders; Dose-Response Relationship, Drug; Fluvoxamine; Gambling; Humans; Naltrexone; Outcome Assessment, Health Care; Paroxetine; Piperazines; Research Design; Selective Serotonin Reuptake Inhibitors; Substance-Related Disorders; Triazoles

The mainstay of the pharmacologic treatment of obsessive-compulsive disorder (OCD) is a 10- to 12-week trial of a potent serotonin reuptake inhibitor (SRI) at an adequate dose. Double-blind, placebo-controlled trials have established the anti-obsessive-compulsive (OC) efficacy of five different SRIs. One of the most thoroughly studied of these SRIs is fluvoxamine, the focus of this article. Fluvoxamine's pharmacologic and pharmacokinetic properties, its efficacy, and guidelines for its clinical use in OCD and related disorders are briefly reviewed. Potential drug-drug interactions are discussed and placed in clinical perspective. The management of common SRI-induced side effects is also addressed. Recent comparative studies suggest that fluvoxamine may be equivalent in efficacy to clomipramine, yet better tolerated. Fluvoxamine shows promise in the treatment of several so-called OC-spectrum disorders, but additional controlled trials are needed.

Topics: Adolescent; Child; Clinical Trials as Topic; Clomipramine; Compulsive Behavior; Disruptive, Impulse Control, and Conduct Disorders; Drug Administration Schedule; Drug Interactions; Fluvoxamine; Humans; Obsessive Behavior; Obsessive-Compulsive Disorder; Recurrence; Selective Serotonin Reuptake Inhibitors; Somatoform Disorders; Tourette Syndrome

Compulsive buying has a long history. Described nearly a century ago by Kraepelin, and later by Bleuler, the disorder has been of interest to psychoanalysts and to the popular media. Recent interest has been rekindled by consumer behavior research that shows it to be widespread and psychiatric research that shows it to have the earmarks of a psychiatric disorder. The author reviews the history, definition, epidemiology, family history, etiology, clinical symptoms, and treatments of compulsive buying. Preliminary data from an open-label study in which subjects received fluvoxamine are also presented.

Topics: Adult; Age of Onset; Comorbidity; Compulsive Behavior; Disruptive, Impulse Control, and Conduct Disorders; Female; Fluvoxamine; Humans; Male; Mental Disorders; Sex Factors; Treatment Outcome

Pathological gambling is a disabling disorder that affects at least 2 1/2 million Americans and their families. Although pathological gambling has been characterized as an impulse control disorder, it has also been associated with compulsivity. Essential features of pathological gambling include constantly recurring gambling behavior that is maladaptive, in that personal, familial, and/or vocational endeavors are disrupted. Affective disorders and substance abuse often co-occur. Incidence of suicidality is extremely high. Despite the fact that this disorder is a widespread public health problem, few controlled studies of causes or treatment have been conducted. Preliminary neurobiological studies implicate serotonergic dysfunction in pathological gamblers. Treatment with serotonin reuptake inhibitors, such as clomipramine and fluvoxamine, may be effective in treating this disorder. Well-defined and controlled clinical trials in large samples of pathological gamblers are needed.

Topics: Adolescent; Adult; Comorbidity; Compulsive Behavior; Disruptive, Impulse Control, and Conduct Disorders; Female; Fluvoxamine; Gambling; Humans; Lithium Carbonate; Male; Middle Aged; Mood Disorders; Obsessive-Compulsive Disorder; Placebo Effect; Psychotherapy; Selective Serotonin Reuptake Inhibitors; Self-Help Groups; Serotonin; Substance-Related Disorders; Treatment Outcome

The objective of this study was to evaluate the efficacy of fluvoxamine in the treatment of pathological gambling. Thirty-two patients were treated for 6 months in a double-blind, placebo-controlled study of fluvoxamine 200 mg/day. Outcome measures included reduction in money and time spent gambling per week. Longitudinal mixed effects models and completers analyses were used for estimation and hypothesis testing. Fluvoxamine was not statistically significantly different from placebo in the overall sample. However, fluvoxamine was statistically significantly superior to placebo in males and in younger patients. The power of the study was limited by the high (59%) placebo-response rate. Fluvoxamine may be a useful treatment for certain subgroups of patients with pathological gambling. Several methodological recommendations are made for future pharmacological trials of pathological gambling.

Topics: Adult; Age Factors; Disruptive, Impulse Control, and Conduct Disorders; Double-Blind Method; Female; Fluvoxamine; Gambling; Humans; Male; Pilot Projects; Selective Serotonin Reuptake Inhibitors; Sex Factors; Treatment Outcome

The authors' goal was to assess the efficacy and tolerability of the selective serotonin reuptake inhibitor fluvoxamine in the treatment of pathological gambling.. Sixteen patients with pathological gambling entered an 8-week placebo lead-in phase, and 10 of these patients completed an 8-week single-blind fluvoxamine trial.. Seven of the 10 patients who completed the fluvoxamine trial were judged treatment responders at the end of the study: 1) they had greater than 25% decreases in their gambling behavior scores on the pathological gambling modification of the Yale-Brown Obsessive Compulsive Scale, and 2) their clinician-rated Clinical Global Impression scores for gambling severity were very much improved or much improved. Fluvoxamine treatment resulted in gambling abstinence in seven of the 10 patients.. Findings from this preliminary study suggest that fluvoxamine may be effective in reducing the urge to gamble. Randomized placebo-controlled and maintenance trials are required to confirm these findings and to determine whether improvement persists.

Topics: Adult; Disruptive, Impulse Control, and Conduct Disorders; Drug Administration Schedule; Female; Fluvoxamine; Gambling; Humans; Male; Middle Aged; Placebos; Psychiatric Status Rating Scales; Selective Serotonin Reuptake Inhibitors; Single-Blind Method; Treatment Outcome

The Yale Brown Obsessive Compulsive Scale adapted for Pathological Gambling (PG-YBOCS) was developed to measure the severity and change in severity of pathological gambling symptoms. The PG-YBOCS is a 10-item clinician-administered questionnaire that measures the severity of PG over a recent time interval (usually within the past one/two week(s)). In order to assess and validate the scale, it was administered to 337 subjects: 188 pathological gamblers and 149 healthy controls. Internal consistency and correlations between individual items and total score were assessed for various permutations of the sample. Other scales were administered to assess convergent, discriminant and content validity. Sensitivity to change was evaluated in treatment studies with fluovoxamine, lithium, and valproate. Each item was frequently endorsed across a range of severity. Good inter-rater reliability and internal consistency were obtained. The PG-YBOCS showed high validity and reliability for total score, item-total correlations, and for each subscale (Thoughts/Urges and Behavior). PG-YBOCS scores correlated with global severity and South Oaks Gambling Screen (SOGS) scores. The scale was also sensitive to change in pathological gambling severity. PG-YBOCS thus appears to be a reliable and valid measure of pathological gambling severity, and can be regarded as an important tool for clinicians and researchers treating pathological gamblers.

Topics: Adult; Disruptive, Impulse Control, and Conduct Disorders; Female; Fluvoxamine; Gambling; Humans; Lithium; Male; Obsessive-Compulsive Disorder; Psychometrics; Reproducibility of Results; Sensitivity and Specificity; Severity of Illness Index; Surveys and Questionnaires; Valproic Acid

Compulsive buying (oniomania) is a disorder that has begun to receive attention from researchers in recent years. It has been estimated that disorder affects from 2 to 8% of the general adult population in the US (official data for Croatia are not available). About 90% of those affected are female. Onset occurs in the late teens or early twenties, and the disorder is generally chronic. Psychiatric comorbidity is frequent, particularly mood, anxiety, substance use, eating and personality disorders. Treatment has not been well delineated, but individual and group psychodynamic psychotherapy, cognitive-behavioural therapy and 12-step programmes may be helpful. Serotonin (5-hydroxytryptamine; 5-HT) re-uptake inhibitors may help some patients regulate their buying impulses. We have presented the case of a 32-year old woman with a history of excessive pathological buying treated successfully with combined therapy (fluvoxamine and cognitive-behavioral psychotherapy).

Topics: Adult; Cognitive Behavioral Therapy; Combined Modality Therapy; Comorbidity; Compulsive Behavior; Depression; Disruptive, Impulse Control, and Conduct Disorders; Female; Fluvoxamine; Follow-Up Studies; Humans; Selective Serotonin Reuptake Inhibitors; Treatment Outcome

Kleptomania, one of the rare impulse-control disorders, is characterized by an irresistible impulse to steal objects not needed for personal use or monetary value. There is a comorbidity between mood disorders, eating disorders, anxiety disorders, personality disorders, and kleptomania. Several recent case reports have suggested that serotonin reuptake inhibitors could be effective in the treatment of obsessive-compulsive spectrum disorders and specifically in kleptomania. We describe three depressed patients who paradoxically experienced kleptomanic behavior during treatment with serotonin selective reuptake inhibitors.

Topics: Aged; Antidepressive Agents, Second-Generation; Depressive Disorder; Disruptive, Impulse Control, and Conduct Disorders; Female; Fluoxetine; Fluvoxamine; Humans; Male; Middle Aged; Selective Serotonin Reuptake Inhibitors

Topics: Adult; Buspirone; Disruptive, Impulse Control, and Conduct Disorders; Drug Administration Schedule; Drug Therapy, Combination; Fluvoxamine; Hospitalization; Humans; Male

Kleptomania is currently classified in psychiatric nomenclature as one of the impulse control disorders (DSM-IV, 1994). It is characterized by repeated failure to resist impulses to steal objects, not for personal use or monetary gain. The objects are therefore discarded, given away, or hoarded (ICD-10, 1992). This disorder is known since the early 18th century from the phenomenological and clinical viewpoints, yet is still debated with regard to therapeutic strategies and criminal liability. Although there are usually complications associated with the legal consequences of being caught and arrested, subjects continue to violate the law despite repeated arrests and convictions. In a 28-year old man suffering from kleptomania, years of psychodynamic psychotherapy were ineffective. Only when he was treated as suffering from an impulse control disorder or a variant of obsessive-compulsive disorder, was there significant improvement. The positive response to buspirone (5-HT1A) augmentation of fluvoxamine (SSRI) suggested that disturbed central serotonergic neurotransmission might play an important role in the pathogenesis of kleptomania. This concept is strengthened by the comorbidity of the syndrome with depression and by its compulsive traits. We stress that although kleptomaniacs cannot differentiate between right and wrong, testing shows that their sense of reality is intact, but they act under the influence of drives they cannot resist.

Topics: Adult; Buspirone; Disruptive, Impulse Control, and Conduct Disorders; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Psychotherapy; Syndrome; Theft

We report a patient fulfilling DSM-IV criteria for kleptomania who failed to respond to psychotherapy, behavioural therapy and pharmacotherapy with clomipramine, imipramine and lithium. He was successfully treated with the serotonergic agent fluvoxamine.

Topics: Adult; Disruptive, Impulse Control, and Conduct Disorders; Fluvoxamine; Humans; Male; Selective Serotonin Reuptake Inhibitors