Episodic dyscontrol syndrome

Episodic dyscontrol syndrome (EDS), otherwise known as intermittent explosive disorder (IED)[1] or sometimes just dyscontrol, is a pattern of abnormal, episodic, and frequently violent and uncontrollable social behavior[2] in the absence of significant provocation;[3] it can result from limbic system diseases, disorders of the temporal lobe,[4] or abuse of alcohol or other psychoactive substances.[5][6]

Episodic dyscontrol syndrome
SpecialtyPsychiatry

EDS is a clearly identified category in the Diagnostic and Statistical Manual of Mental Disorders (DSM IV).[7] EDS may affect children or adults.[8][9][10] Children are often considered to have epilepsy or a mental health problem. The episodes consist of recurrent attacks of uncontrollable rage, usually after minimal provocation, and may last up to an hour. Following an episode, children are frequently exhausted, may sleep and will usually have no recall.[11]

Treatment

Treatment for EDS usually involves treating the underlying causative factor(s). This may involve psychotherapy, or medical treatment for diseases.[12]

EDS has been successfully controlled in clinical trials using prescribed medications, including carbamazepine,[13][14] ethosuximide,[15] and propranolol.[16]

There have been few randomised controlled trials of treatment of EDS/IED. Antidepressants and mood-stabilisers including lithium, sodium valproate and carbamazepine have been used in adults, and occasionally in children with oppositional defiant disorder or conduct disorder to reduce aggression. Cognitive behavioural therapy (CBT) is effective in the treatment of anger. A recent trial randomised adults with IED to 12 weeks of individual therapy, group therapy or waiting list (no therapy). Intervention resulted in an improvement in anger and aggression levels, with no difference between group and individual CBT (Cognitive behavioural therapy). Adolescents and young adults may experience educational and social consequences but also mental health problems, including parasuicide, if IED/EDS is undiagnosed in early childhood.[17]

A diagnosis of EDS has been used as a defense in court for persons accused of committing violent crimes including murder.[18][19][20]

See also

References
  1. McTague, A.; Appleton, R. (1 June 2010). "Episodic dyscontrol syndrome". Archives of Disease in Childhood. 95 (10): 841–842. doi:10.1136/adc.2009.171850. PMID 20515972. ProQuest 1828696754.
  2. Elliott FA. (1984) The episodic dyscontrol syndrome and aggression. Neurologic Clinics 2: 113–25.
  3. Maletzky BM. (1973) The episodic dyscontrol syndrome. Disorders of the Nervous System 34: 178–85.
  4. Tebartz van Elst, Dr. L.; F. G. Woermann; L. Lemieux; P. J. Thompson; M. R. Trimble (February 2000). "Affective aggression in patients with temporal lobe epilepsy A quantitative MRI study of the amygdala". Brain. Oxford UK: Oxford University Press. 123 (2): 234–243. doi:10.1093/brain/123.2.234. PMID 10648432.
  5. Drake ME, Hietter SA, Pakalnis A. (1992) EEG and evoked potentials in episodic-dyscontrol syndrome. Neuropsychobiology 26: 125–8.
  6. Harbin HT. (1977) Episodic dyscontrol and family dynamics. American Journal of Psychiatry 134: 1113–6.
  7. McTague, A.; Appleton, R. (1 June 2010). "Episodic dyscontrol syndrome". Archives of Disease in Childhood. 95 (10): 841–842. doi:10.1136/adc.2009.171850. PMID 20515972. ProQuest 1828696754.
  8. Nunn K. (1986) The episodic dyscontrol syndrome in childhood. Journal of Child Psychology and Psychiatry 27: 439–46.
  9. Bach-y-Rita G, Lion JR, Climent CE, Ervin FR. (1971) Episodic (1986) dyscontrol: a study of 130 violent patients. American Journal of Psychiatry 127: 49–54.
  10. Elliott FA. (1982) Neurological findings in adult minimal brain dysfunction and the dyscontrol syndrome. Journal of Nervous and Mental Disease 170: 680–7.
  11. McTague, A.; Appleton, R. (1 June 2010). "Episodic dyscontrol syndrome". Archives of Disease in Childhood. 95 (10): 841–842. doi:10.1136/adc.2009.171850. PMID 20515972. ProQuest 1828696754.
  12. McTague, A.; Appleton, R. (1 June 2010). "Episodic dyscontrol syndrome". Archives of Disease in Childhood. 95 (10): 841–842. doi:10.1136/adc.2009.171850. PMID 20515972.
  13. Tunks ER, Dermer SW. (1977) Carbamazepine in the dyscontrol syndrome associated with limbic system dysfunction. Journal of Nervous and Mental Disease 164: 56–63.
  14. Lewin J, Sumners D. (1992) Successful treatment of episodic dyscontrol with carbamazepine. British Journal of Psychiatry 161: 261–2.
  15. Andrulonis PA, Donnelly J, Glueck BC, Stroebel CF, Szarek BL. (1990) Preliminary data on ethosuximide and the episodic dyscontrol syndrome. American Journal of Psychiatry 137: 1455–6.
  16. Grizenko N, Vida S. (1988) Propranolol treatment of episodic dyscontrol and aggressive behaviour in children. Canadian Journal of Psychiatry 33: 776–8.
  17. McTague, A.; Appleton, R. (1 June 2010). "Episodic dyscontrol syndrome". Archives of Disease in Childhood. 95 (10): 841–842. doi:10.1136/adc.2009.171850. PMID 20515972. ProQuest 1828696754.
  18. Myers WC, Vondruska MA. (1998) Murder, minors, selective serotonin reuptake inhibitors, and the involuntary intoxication defence. Journal of the American Academy of Psychiatry and the Law 26: 487–96.
  19. Simon, Robert I. (1990-12-01). "A Canadian Perspective (p. 392)". Review of Clinical Psychiatry and the Law (Hardback) (Version 2 ed.). Arlington: American Psychiatric Pub, Inc. p. 424. ISBN 0-88048-376-8. The decision in a case concerning episodic dyscontrol syndrome seems to have expanded the definition of "diseases of the mind". In R. v. Butler, the accused had a history of injuries to the head. He was charged with aggravated assault of his wife's infant son. The child had been badly beaten on the head, and the accused, while admitting that he was alone at home with the child, had no memory of beating the child on the head. The medical history of the accused was brought forward at the trial, and a neurologist ventured the opinion that he sufferred from episodic dyscontrol syndrome, entailing an interruption of normal control mechanisms. His other violent acts were symptomatic. In the court decision, it was noted that disease of the mind had both a legal and medical component.
  20. Tiffany, Lawrence P.; Tiffany, Mary (1990-09-11). "5". The Legal Defense of Pathological Intoxication With Related Issues of Temporary and Self-Inflicted Insanity (Hardcover). New York: Quorum Books. pp. 560. doi:10.1336/0899305482. ISBN 0-89930-548-2.
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