Neuropsychological functioning in kleptomania

Kleptomania is characterized by the failure to resist impulses to steal objects not needed for personal use or their monetary value. The objective of this study was to examine cognitive and executive functioning in subjects with kleptomania. Fifteen women with a primary DSM-IV diagnosis of kleptomania underwent a detailed psychiatric examination, including measures of kleptomania severity, and a battery of neuropsychological tests that emphasized executive functions. Correlational analyses were computed between measures of kleptomania severity and tests of executive functioning. Kleptomania subjects reported a mean duration of illness of 17.9 years and shoplifting a mean of 1.7 times per week. All subjects reported an inability to resist urges to shoplift. Neuropsychological testing revealed group mean test scores within 0.5 standard deviations of normative standards for age. Five subjects (33.3%), however, had below-average performance on at least one measure of executive functioning, and 4 (26.7%) had below-average scores on two executive measures. Correlational analyses revealed a statistically significant correlation between kleptomania severity and Wisconsin Card Sorting Test performance (r=-0.693, p=0.004). As a group, subjects with kleptomania did not demonstrate deficits on neuropsychological testing. Greater kleptomania symptom severity, however, was correlated with impairment in executive functioning.     

Kleptomanie und Ladendiebstahl: Ein historischer Überblick

The phenomenon of illness-indicating theft acts committed by apparently psychologically normal offenders engages psychiatry since the beginning of the 19^th century. With the specialist term kleptomania therefore an independent syndrome was created, which was seen as an isolated disturbance of the will (monomania). Structural abnormalities of the brain, women-specific life conditions, problems in early childhood development and the seductions of offensive advertisement strategies of modern big stores were esteemed as causally responsible. In spite of often voiced criticism, the conception of a mental disorder, which is expressed only by theft acts had outlasted more than 150 years. In the currently valid classification systems of mental diseases, kleptomania as well as the leading symptoms are classified as an impulse control disorder. This fact by all appearances has awarded them the grade of detectability. However, in fact these criteria prove as unspecific. The problem with it is that the question of an illness background of theft acts is posed mostly in the context of assessing the criminal responsibility. In fact illness-conditioned stealing is found only as a symptom among other quite different mental diseases and extraordinary situational charges. The concentration to the only theft act carries the risk of disregarding the careful exploration and preparation of the real psychological problem.     

Kleptomania: A Review of the Research

Research on kleptomania is limited. Earlier views and recent reports of treatment are reviewed in this article. More study is needed to delineate this impulse-control disorder.     

Kleptomania: a review of the research.

Research on kleptomania is limited. Earlier views and recent reports of treatment are reviewed in this article. More study is needed to delineate this impulse-control disorder.     

Bulimia: psychoanalytic perspectives

Bulimia, the syndrome of food binging often followed by purging has been reported to be increasing in recent years. This communication reviews the psychoanalytic understanding of eating disorders, focusing on the pathology of early object relations and later intrapsychic conflicts over incestuous impregnation fantasies. Ancillary symptoms of kleptomania, laxative abuse, and vegetarianism are discussed, and associations with masturbatory conflicts and early adolescent phallic activity, i.e., horseback riding, are elaborated.     

Elucidating the Relation of Hoarding to Obsessive Compulsive Disorder and Impulse Control Disorders

Hoarding has historically been conceptualized as a symptom of Obsessive Compulsive Disorder (OCD); however, data demonstrate important differences between hoarding and OC symptoms (for discussion, see Grisham et al. Anxiety Disorders, 19, 767‑779. 2005). Hoarding has also been observed in disorders besides OCD, including specific Impulse Control Disorders (ICDs; e.g., kleptomania, trichotillomania, pathological gambling, compulsive buying). Therefore, the current study tested the hypothesis that hoarding would be as strongly related to symptoms of ICDs as it is to OCD and that these relationships would be medium to strong in magnitude. Results from an undergraduate sample showed hoarding behaviors were strongly related to symptoms of OCD, moderately related to symptoms of compulsive buying, and more modestly related to symptoms of pathological gambling, trichotillomania, and kleptomania. Finally, findings suggest indecisiveness may be a particularly important underlying feature in hoarding behaviors. These results support the consideration of hoarding outside the confines of OCD.

Moral Responsibility, Psychiatric Disorders and Duress

ABSTRACT  The paper is a discussion of moral responsibility and excuses in regard to psychiatric disorders involving abnormal desires (e.g. impulse control disorders such as kleptomania and pyromania, psychosexual disorders such as exhibitionism, obsessive-compulsive disorder and others). It points out problems with previous approaches to the question of whether or not to excuse persons with these disorders, and offers a new approach based on the concept of duress. There is a discussion of duress in regard to non-psychiatric cases based on the core notion of duress involving a choice between undesirables, and the paper concludes with an argument that moral blame for individuals with these sorts of disorders should often be lessened and in some cases removed entirely.     

Association between problematic Internet use and impulse control disorders among Iranian university students

Previous studies have examined the relationship between problematic Internet use (PIU) with pathological gambling and impulsivity. However, few studies have investigated the association between PIU and other impulse control disorders. This study aimed to assess whether PIU is related to compulsive buying, kleptomania, trichotillomania, intermittent explosive disorder, and pyromania, among a sample of Iranian university students. A cross-sectional study design was used among a random sample of (n=950) university students. Self-reported questionnaires, including demographic, Problematic Internet Use Questionnaire (PIUQ) and Minnesota Impulse Disorders Interview were utilized. The prevalence of PIU was 21.2 percent. Students with diagnosis of either compulsive buying, or intermittent explosive disorder, or pyromania had significantly higher scores on PIUQ compared to the students without the diagnosis. Multivariate regression analyses indicated that in the male gender, the diagnosis of either compulsive buying or intermittent explosive disorder were significant predictors of the risk of the PIU. The results support the proposal that PIU should be considered as a spectrum of impulse control disorder.     

The neurobiology of substance and behavioral addictions

Behavioral addictions, such as pathological gambling, kleptomania, pyromania, compulsive buying, and compulsive sexual behavior, represent significant public health concerns and are associated with high rates of psychiatric comorbidity and mortality. Although research into the biology of these behaviors is still in the early stages, recent advances in the understanding of motivation, reward, and addiction have provided insight into the possible pathophysiology of these disorders. Biochemical, functional neuroimaging, genetic studies, and treatment research have suggested a strong neurobiological link between behavioral addictions and substance use disorders. Given the substantial co-occurrence of these groups of disorders, improved understanding of their relationship has important implications not only for further understanding the neurobiology of both categories of disorders but also for improving prevention and treatment strategies.     

Temporal parameters as cues to phrasal boundaries: a comparison of processing by left- and right-hemisphere brain-damaged individuals

Two experiments were conducted to examine the ability of left- (LHD) and right-hemisphere-damaged (RHD) patients and normal controls to use temporal cues in rendering phrase grouping decisions. The phrase "pink and black and green" was manipulated to signal a boundary after "pink" or after "black" by altering pre-boundary word durations and pause durations at the boundary in a stepwise fashion. Stimuli were presented to listeners auditorily along with a card with three alternative groupings of colored squares from which to select the presented alternative. Results revealed that normal controls were able to use both temporal cues to identify the intended grouping. In contrast, LHD patients required longer than normal pause durations to consistently identify the intended grouping, suggesting a higher than normal threshold for perception of temporal prosodic cues. Surprisingly, the RHD patients exhibited great difficulty with the task, perhaps due to the limited acoustic cues available in the stimuli.     

Attentional bias to threat in clinical anxiety states

Abstract

Attentional responses to threat stimuli were assessed in anxious patients, normal controls, and subjects who had recovered from a clinical anxiety state. The main aims of the study were: (1) to replicate MacLeod, Mathews, and Tata's (1986) finding of an attentional bias to threat in currently anxious patients compared with normal control subjects; (2) to assess whether the bias is related to the predominant worries of anxious patients; and (3) to investigate whether the bias is present in recovered anxious patients. The original finding of an anxiety-related attentional bias was replicated. The results indicated that the extent to which anxious patients selectively attended to social threat words was associated with the seventy of their social worries. The attentional responses of the recovered anxious group were not significantly differentiated from those of the currently anxious or normal control groups.     

Grasping the Impalpable: The Role of Endogenous Reward in Choices,Including Process Addictions

ABSTRACT

The list of proposed addictions has recently grown to include television, videogames, shopping, day trading, kleptomania, and use of the Internet. These activities share with a more established entry, gambling, the property that they require no delivery of a biological stimulus that might be thought to unlock a hardwired brain process. I propose a framework for analyzing that class of incentives that do not depend on the prediction of physically privileged environmental events: people have a great capacity to coin endogenous reward; we learn to cultivate it, and, where it is entrapping, to minimize it, by managing internally generated appetites for it. The basic method of cultivating endogenous reward is to learn cues that predict when best to harvest the reward that has been made possible by the growth of these appetites. This hedonic management occurs in the same motivational marketplace as the instrumental planning that seeks environmental goods in the conventional manner, and presumably obeys the same laws of temporal difference learning; but these laws are no longer limiting. Furthermore, instrumental contingencies often provide the most productive structure for hedonic management as well, for reasons that I discuss; but the needs of hedonic management create incentives both to pursue instrumental goals in a suboptimal manner and to avoid noticing how the hedonic incentive affects this pursuit. The result is the apparent irrationality that is often observed in process addictions.     

遗忘症患者外显与内隐记忆实验研究:语义性启动效应任务

采用ＷＭＳ—ＣＲ和ＭＭＳＥ对临床脑损伤患者进行了认知功能与记忆功能两方面的筛选,获得９名遗忘症患者。然后采用偏好和自由联想两项语义性启动效应任务进行测验,发现遗忘症患者在外显记忆受损情况下,的确存在语义性启动效应,且与正常对照相近。推论语义性启动效应任务与遗忘患者损伤的颞叶或间脑结构无关。同时还讨论了启动效应任务,认为偏好任务采用言语性材料不是理想的方法。     

Use of semantic context by patients with Alzheimer's disease

In this study we used semantic-priming procedures to examine limitations in the use of semantic context by patients with Alzheimer's disease. We also tried to determine whether any such contextual effects were mediated solely through automatic processes or whether attentional processes were also involved. Three tasks were applied to examine the effect of semantic context on the performance of 18 normal elderly and 18 normal young subjects, and on 18 patients with Alzheimer's disease. When normal and demented subjects were asked to decide whether a given item was a member of a certain category, results showed that their response times were equally affected by the item's dominance in the category. The time that demented patients took to recognize a word was actually affected more by the semantic context provided by a priming sentence than was that of normal subjects. When asked to generate the final word of an incomplete sentence, demented subjects performed very poorly unless potential responses were highly constrained by sentence context.     

Dissociations among memory measures in memory-impaired subjects: Evidence for a processing account of memory

Deficits in conceptual transfer on both implicit and explicit memory tests were obtained for memory-impaired temporal lobe epileptic (TLE) subjects in three studies. In Experiment 1, in which a generate-read paradigm was employed, memory-impaired TLEs failed to show normal generation effects on conceptually driven tests of semantic cued recall and general knowledge questions, although their data-driven memory as measured by word-fragment completion and graphemic cued recall tasks was normal. In Experiment 2, memory-impaired patients having left temporal lobe seizure foci were tested on these four tasks and compared with nonimpaired TLEs having right temporal foci. The left TLEs showed deficits on conceptually driven tasks and normal memory for data-driven tests. These findings were extended in Experiment 3, in which left TLE patients failed to show any benefit from blocked study, as compared with random study, on category production and semantic cued-recall tests, although right TLEs and normal controls showed blocking effects on both tasks. These findings may be accommodated by a processing framework of memory in which memory-impaired patients are characterized as having deficits in conceptual, but not in data-driven, processing capabilities.     

Pragmatics of measuring recognition memory: applications to dementia and amnesia

This article has two purposes. The first is to describe four theoretical models of yes-no recognition memory and present their associated measures of discrimination and response bias. These models are then applied to a set of data from normal subjects to determine which pairs of discrimination and bias indices show independence between discrimination and bias. The following models demonstrated independence: a two-high-threshold model, a signal detection model with normal distributions using d' and C (rather than beta), and a signal detection model with logistic distributions and a bias measure analogous to C. C is defined as the distance of criterion from the intersection of the two underlying distributions. The second purpose is to use the indices from the acceptable models to characterize recognition memory deficits in dementia and amnesia. Young normal subjects, Alzheimer's disease patients, and parkinsonian dementia patients were tested with picture recognition tasks with repeated study-test trials. Huntington's disease patients, mixed etiology amnesics, and age-matched normals were tested by Butters, Wolfe, Martone, Granholm, and Cermak (1985) using the same paradigm with word stimuli. Demented and amnesic patients produced distinctly different patterns of abnormal memory performance. Both groups of demented patients showed poor discrimination and abnormally liberal response bias for words (Huntington's disease) and pictures (Alzheimer's disease and parkinsonian dementia), whereas the amnesic patients showed the worst discrimination but normal response bias for words. Although both signal detection theory and two-high-threshold discrimination parameters showed identical results, the bias measure from the two-high-threshold model was more sensitive to change than the bias measure (C) from signal detection theory. Three major points are emphasized. First, any index of recognition memory performance assumes an underlying model. Second, even acceptable models can lead to different conclusions about patterns of learning and forgetting. Third, efforts to characterize and ameliorate abnormal memory should address both discrimination and bias deficits.     

Investment behavior and the negative side of emotion

Can dysfunction in neural systems subserving emotion lead, under certain circumstances, to more advantageous decisions? To answer this question, we investigated how normal participants, patients with stable focal lesions in brain regions related to emotion (target patients), and patients with stable focal lesions in brain regions unrelated to emotion (control patients) made 20 rounds of investment decisions. Target patients made more advantageous decisions and ultimately earned more money from their investments than the normal participants and control patients. When normal participants and control patients either won or lost money on an investment round, they adopted a conservative strategy and became more reluctant to invest on the subsequent round; these results suggest that they were more affected than target patients by the outcomes of decisions made in the previous rounds.     

Feature analysis and the token test

In a picture-matching task pictures of objects had to be arranged into pairs by aphasic and nonaphasic patients and normal controls. Aphasic patients were also given the Token Test. Correlation between the rank order of error scores in both tests was highly significant in aphasic patients. The pictures were also given to a normal group for free matching. Overlapping of normal performance on free matching and aphasic performance on bound matching occurred. We hypothesized that aphasic impairment was due to a difficulty in calling up associations, difficulty in feature analysis, and in moving from one concept to another. These findings are discussed in the light of abilities needed for Token Test performance. The results indicate that the traditionally presumed fundamental difference between verbal and nonverbal cognitive tasks is rather unsatisfactory.     

Orienting-reflex behavior and clinical psychopathology

The effects of diagnosis, sex, age and medication on the orienting-reflex behavior of 263 psychiatric patients and 58 normal subjects were studied. Significant differences between the normal and patient groups and within the patient groups in different diagnostic categories were found. In the patient populations, further variations by types of medication received were found, whereas sex and age did not affect the orienting reflex. On the basis of frequency of response only normal subjects and patients could be distinguished, whereas amplitude analysis revealed a continuum in which the highest responses were given by normal subjects and the lowest by patients with chronic organic brain damage. In all subgroups the amplitudes of the responses of patients receiving antidepressant medication were higher than those of patients receiving antipsychotic medication.     

Phonemic imperception in aphasia

This study investigated characteristics of 14 aphasics with impaired phoneme discrimination identified from a population of 100 patients with left hemisphere lesions. All patients with impaired phoneme discrimination were significantly impaired in aural comprehension, but many showed intact sound recognition and some showed normal reading comprehension. Defects in phoneme discrimination were typically seen in the acute stage of aphasia resulting from stroke; and in most instances, defects in phoneme discrimination were no longer apparent 4 months postonset. All patients who recovered normal phoneme discrimination also made significant improvement in aural comprehension. The findings support the concept that some aural comprehension defects result from a specific disturbance in phoneme discrimination.