Obsessive compulsive disorder and impulse control disorder comorbidity and evaluation of impulsivity and compulsivity in alcohol dependent patientsObjective: The aim of this study was to investigate the comorbidity of obsessive compulsive disorder and impulse control disorders in patients with alcoholism and evaluate the effects of impulsivity and compulsivity on the severity of alcohol dependence.Methods: Using SCID-I, we investigated impulse control disorder (ICD) and obsessive compulsive disorder (OCD) in 81 male patients diagnosed with alcohol dependence. Impulsivity was evaluated using the Barratt Impulsiveness Scale (BIS-11). The Maudsley Obsessive Compulsive Inventory (MOCI) and the Michigan Alcoholism Screening Test (MAST) were used to evaluate compulsivity and severity of alcohol dependence, respectively.Results: There was at least one ICD in 24.6% of the alcohol dependent patients. The most commonly encountered subtype was pathological gambling (16.0%) which was followed by intermittent explosive disorder (6.1%) and compulsive shopping (3.7%). 13.5% of the patients were diagnosed with OCD while OCD at a subclinical level was found in 19.8% of them. 46.9% of the patients presented either with "obsessive compulsive traits" or ICD or both.
Conclusion:In addition to the evaluation of impulsivity and compulsivity with using scales, OCD and ICD comorbidity was investigated in alcohol dependent patients. Together with the not otherwise specified impulse control disorders, at least one ICD was found in 24.6% of the addicts while 13.5% presented with OCD comorbidity. Bulgular: Alkol bağımlısı bireylerin %24.6'sında en az bir DKB ek tanısı saptandı. En sık rastladığımız alttipi %16.0'lık oranla patolojik kumar oynama olurken, ikinci sıklıkta %6.1 oranıyla aralıklı patlayıcı bozukluk, üçüncü sırada %3.7 sıklıkta bulunan kompulsif alışveriş idi. Hastaların %13.5'i OKB tanısı alırken, %19.8'inde subklinik düzeyde OKB saptandı. Hastaların %46.9'undü 'obsesif kompulsif özellik' ya da DKB'den herhangi biri ya da her ikisi birden bulunmaktaydı.Sonuç: Alkol bağımlılarında dürtüsellik ve kompülsivitenin ölçeklerle değerlendirilmesinin yanında OKB ve DKB ek tanıları da araştırıldı. BTA dürtü kontrol bozuklukları da eklendiğinde alkol bağımlılarının %24.6'sında en az bir DKB ve %13.5'inde OKB ek tanısı eşlik etmekteydi.
Interferon alfa has antiviral, anti-proliferative and immunomodulatory effects. Treatment with interferon is related to many psychiatric side effects like depression, depressive mood, suicidal thoughts, irritability, tiredness, cognitive impairment, mania and psychosis 1 . These psychiatric side effects are related to duration and dose, and when severe, usually lead to discontinuation of interferon treatment.
CASEOur case study is a 17-year-old male patient. Due to frequent crying, suicidal thoughts and feelings of guilt, he was hospitalized. He had been diagnosed with chronic hepatitis B four months previously, and had been receiving 30 MIU interferon alfa 2b three times a week plus 100 mg lamivudine. Depressive symptoms like lack of interest and mental dullness began after 8 weeks of treatment. On psychiatric examination, he showed slumped posture, dullness and slowed speech. Thought content included delusions of being harmed and guilt. His affect was depressed and sometimes dysphoric. He showed decreased appetite and sleep and slowed psychomotor activity. Routine hematological and biochemical test results were normal. His cranial MR and EEG revealed no pathology. On the first day of his hospitalization, interferon and lamivudine treatment were discontinued.The patient was diagnosed with depressive d i s o r d e r w i t h p s y c h o t i c f e a t u r e s , a n d escitalopram 10 mg and risperidone 3 mg p.o.
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