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Single Case Study: Neuropsychological Functioning in a Patient Diagnosed with Intermittent Explosive Disorder Pre and Post Neurosurgery

Published online by Cambridge University Press:  10 May 2016

María José Alvarez-Alonso ,
Isabel Morales-Muñoz ,
Ana María Castaño-León ,
Alfonso Lagares ,
Gabriel Rubio  and
Rosa Jurado-Barba
María José Alvarez-Alonso*
Affiliation:
Hospital 12 de Octubre (Spain)
Isabel Morales-Muñoz
Affiliation:
University of Helsinki (Finland)
Ana María Castaño-León
Affiliation:
Hospital 12 de Octubre (Spain)
Alfonso Lagares
Affiliation:
Hospital 12 de Octubre (Spain)
Gabriel Rubio
Affiliation:
Hospital 12 de Octubre (Spain)
Rosa Jurado-Barba
Affiliation:
Hospital 12 de Octubre (Spain)
*
*Correspondence concerning this article should be addressed to María José Alvarez-Alonso. Hospital 12 de Octubre. Madrid (Spain). E-mail: [email protected]
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Abstract

Intermittent explosive disorder (IED) is characterized by a difficulty to resist the urge to carry out a recognized harmful behavior. The central symptom is aggressiveness, expressed in isolated episodes. Executive function impairments are habitually found in impulse control disorders. Neuropsychology of impulsivity is related to dysfunctions in the orbito-frontal cortex, dorsolateral cortex and anterior-cingulated regions, being consequently involved in cognitive mechanisms of inhibition. Lesions in those areas are common in IED. In the most severe cases of IED, surgical procedures are required for treatment. In this study, we examined JML; a patient suffering from a severe case of IED. He experienced frequent episodes of auto and heteroaggression and multiple psychiatric admissions, and thus stereotactic surgery was the recommended treatment. The procedure consisted of an electrode situated lateral to the lateral ventricle, targeting the projections between frontal and subcortical affected regions. We aimed to study the neuropsychological functioning of JML, before and after electrode implantation. Our results suggested that surgery in IED improves cognitive performance at some levels. JML significantly improved his cognitive flexibility, measured with WCST, and alternate attention assessed with CPT and TMT-B tests, after electrode implantation. Cognitive flexibility deficits may be also related to increased aggressiveness. Therefore, improvements at this level may involve a reduction of impulsivity and aggressive behavior.

Keywords

aggressive behaviourcognitive impairmentimpulsivityintermittent explosive disorderneuropsychological assessment
Type
Research Article
Information
The Spanish Journal of Psychology , Volume 19 , 2016 , E21
Copyright
Copyright © Universidad Complutense de Madrid and Colegio Oficial de Psicólogos de Madrid 2016 

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References

Alcazar-Corcoles, M. A., Verdejo-Garcia, A., Bouso-Saiz, J. C., & Bezos-Saldana, L. (2010). Neuropsychology of impulsive aggression. Revista de Neurología, 50, 291–299.CrossRefGoogle ScholarPubMed
Amara, G., Richa, S., & Bayle, F. J. (2007). Intermittent explosive disorder: Current status. Encephale, 33, 339–345.CrossRefGoogle ScholarPubMed
American Psychiatric Association (1980). Diagnostical and statistical manual of mental disorders, III (DSM-III). Washington, DC: Author.Google Scholar
American Psychiatric Association (2000). Manual diagnóstico y estadístico de los trastornos mentales. [Diagnostic and statistical manual of mental disorders]. (4th Ed. Revised Text). Barcelona, Spain: Masson.Google Scholar
Coccaro, E. F. (2000). Intermittent explosive disorder. Current Psychiatry Reports, 2(1), 67–71. http://dx.doi.org/10.1007/s11920-000-0045-z CrossRefGoogle ScholarPubMed
Coccaro, E. F. (2011). Intermittent explosive disorder: Development of integrated research criteria for Diagnostic and Statistical Manual of Mental Disorders, 5th Ed. Comprehensive Psychiatry, 52, 119–125. http://dx.doi.org/10.1016/j.comppsych.2010.05.006 CrossRefGoogle ScholarPubMed
Coccaro, E. F. (2012). Intermittent explosive disorder as a disorder of impulsive aggression for DSM-5. The American Journal of Psychiatry, 169, 577–588. http://dx.doi.org/10.1176/appi.ajp.2012.11081259 CrossRefGoogle ScholarPubMed
Coccaro, E. F., McCloskey, M. S., Fitzgerald, D. A., & Phan, K. L. (2007). Amygdala and orbitofrontal reactivity to social threat in individuals with impulsive aggression. Biological Psychiatry, 62, 168–178. http://dx.doi.org/10.1016/j.biopsych.2006.08.024 CrossRefGoogle ScholarPubMed
Conners, C. (2004). Conner's Continous Performance Test II (CPT II V.5). Toronto, Canada: Multy-Health Systems Inc.Google Scholar
Eddy, C. M., Rizzo, R., & Cavanna, A. E. (2009). Neuropsychological aspects of Tourette Syndrome: A review. Journal of Psychosomatic Research. 67, 503–513. http://dx.doi.org/10.1016/j.jpsychores.2009.08.001 CrossRefGoogle ScholarPubMed
Faria, M. A. (2013). Violence, mental illness, and the brain - A brief history of psychosurgery: Part 3 - From deep brain stimulation to amygdalotomy for violent behavior, seizures, and pathological aggression in humans. Surgical Neurology International, 4, 91.CrossRefGoogle Scholar
Golden, C. J. (2010). STROOP: Test de Colores y Palabras. [The STROOP Color and World Test] (5th Ed.). Madrid, Spain: TEA Ediciones.Google Scholar
Hassan, N., & Cavanna, A. E. (2012). The prognosis of Tourette Syndrome: Implications for clinical practice. Functional Neurology, 27(1), 23–27.Google ScholarPubMed
Heaton, R., Chelune, G. J., Talley, J. L., Kay, G. G., & Curtiss, G. (2009). Test de Clasificación de Tarjetas de Wisconsin. [Wisconsin Card Sorting Test WCST]. Madrid, Spain: TEA Ediciones.Google Scholar
Hollander, E., & Rosen, J. (2000). Impulsivity. Journal of Psychopharmacology, 14, 39–44. http://dx.doi.org/10.1177/02698811000142S106 CrossRefGoogle ScholarPubMed
Kertzman, S., Grinspan, H., Birger, M., & Kotler, M. (2006). Computerized neuropsychological examination of impulsiveness: A selective review. Israel Journal of Psychiatry & Related Sciences, 43, 74–80.Google ScholarPubMed
Kessler, R. C., Coccaro, E. F., Fava, M., Jaeger, S., Jin, R., & Walters, E. (2006). The prevalence and correlates of DSM-IV intermittent explosive disorder in the national comorbidity survey replication. Archives of General Psychiatry, 63, 669–678. http://dx.doi.org/10.1001/archpsyc.63.6.669 CrossRefGoogle ScholarPubMed
Kim, M. C., & Lee, T. K. (2008). Stereotactic lesioning for mental illness. Acta Neurochirurgica Supplement, 101, 39–43. http://dx.doi.org/10.1007/978-3-211-78205-7_7 CrossRefGoogle ScholarPubMed
Maley, J. H., Alvernia, J. E., Valle, E. P., & Richardson, D. (2010). Deep brain stimulation of the orbitofrontal projections for the treatment of intermittent explosive disorder. Neurosurgical Focus, 29, E11. http://dx.doi.org/10.3171/2010.5.FOCUS10102 CrossRefGoogle ScholarPubMed
McCloskey, M. S., Lee, R., Berman, M. E., Noblett, K. L., & Coccaro, E. F. (2008). The relationship between impulsive verbal aggression and intermittent explosive disorder. Aggressive Behavior, 34(1), 51–60. http://dx.doi.org/10.1002/ab.20216 CrossRefGoogle ScholarPubMed
McElroy, S. L. (1999). Recognition and treatment of DSM-IV intermittent explosive disorder. Journal of Clinical Psychiatry, 60, 12–16.Google ScholarPubMed
Mpakopoulou, M., Gatos, H., Brotis, A., Paterakis, K. N., & Fountas, K. N. (2008). Stereotactic amygdalotomy in the management of severe aggressive behavioral disorders. Neurosurgical Focus, 25(1), E6. http://dx.doi.org/10.3171/FOC/2008/25/7/E6 CrossRefGoogle ScholarPubMed
New, A. S., Hazlett, E. A., Newmark, R. E., Zhang, J., Triebwasser, J., Meyerson, D., … Buchsbaum, M. S. (2009). Laboratory induced aggression: A positron emission tomography study of aggressive individuals with borderline personality disorder. Biological Psychiatry, 66, 1107–1114. http://dx.doi.org/10.1016/j.biopsych.2009.07.015 CrossRefGoogle ScholarPubMed
Nuttin, B., Gabriels, L., Cosyns, P., & Gybels, J. (2000). Electrical stimulation of the brain for psychiatric disorders. CNS Spectrums, 5, 35–39. http://dx.doi.org/10.1017/S1092852900021908 CrossRefGoogle ScholarPubMed
Patel, S. R., Aronson, J. P., Sheth, S. A., & Eskandar, E. N. (2013). Lesion procedures in psychiatric neurosurgery. World Neurosurgery, 80, e9–e16 http://dx.doi.org/10.1016/j.wneu.2012.11.038 CrossRefGoogle ScholarPubMed
Porta, M., Cavanna, A. E., Zekaj, E., D’Adda, F., & Servello, D. (2013). Selection of patients with Tourette syndrome for deep brain stimulation surgery. Behavioural Neurology, 27(1), 125–131. http://dx.doi.org/10.1155/2013/306541 CrossRefGoogle ScholarPubMed
Potenza, M. N., Koran, L. M., & Pallanti, S. (2009). The relationship between impulse control disorders and obsessive-compulsive disorder: A current understanding and future research directions. Psychiatry Research, 170(1), 22–31. http://dx.doi.org/10.1016/j.psychres.2008.06.036 CrossRefGoogle ScholarPubMed
Rey, A. (1994). Test de Copia y de Reproduccion de Memoria de Figuras Geométricas Complejas. [Rey–Osterrieth Complex Figure]. (6th Ed.). Madrid, Spain: TEA Ediciones.Google Scholar
Rosell, D. R., & Siever, L. J. (2015). The neurobiology of aggression and violence. CNS Spectrums, 20, 254–279. http://dx.doi.org/10.1017/S109285291500019X CrossRefGoogle ScholarPubMed
Siever, L. J. (2008). Neurobiology of aggression and violence. The American Journal of Psychiatry, 165, 429–442. http://dx.doi.org/10.1176/appi.ajp.2008.07111774 CrossRefGoogle ScholarPubMed
Spreen, O., & Strauss, E. (Eds.). (1998). A compendium of neuropsychological tests: Administration, norms and commentary. New York, NY: Oxford University Press.Google Scholar
van de Giessen, E., Rosell, D. R., Thompson, J. L., Xu, X., Girgis, R. R., Ehrlich, Y., … Siever, L. J. (2014). Serotonin transporter availability in impulsive aggressive personality disordered patients: A PET study with [11C]DASB. Journal of Psychiatry Research, 58, 147–154. http://dx.doi.org/10.1016/j.jpsychires.2014.07.025 CrossRefGoogle ScholarPubMed
Wechsler, D. (2012). WAIS-IV Escala de Inteligencia de Wechsler para adultos – IV (4th Ed.) [Wechsler Adult Intelligence Scale WAIS-IV]. Madrid, Spain: NCS Pearson, Inc.Google Scholar
Wilson, B., Alderman, N., Burgess, P. W., Emslie, H., & Evans, J. J. (1996). Behavioral Assessment of Dysexecutive Syndrome (BADS). London, UK: Pearson.Google Scholar
Wright, A., Rickards, H., & Cavanna, A. E. (2012). Impulse-control disorders in Gilles de la Tourette Syndrome. The Journal of Neuropsychiatry & Clinical Neurosciences , 24(1), 16–27. http://dx.doi.org/10.1176/appi.neuropsych.10010013 CrossRefGoogle ScholarPubMed