Compulsive sexual behavior: Prefrontal and limbic volume and interactions

BACKGROUNDS: The concepts of addictions and impulse control disorders are changing as reflected in the 11thversion of International Classification of Disorders (ICD-11, WHO, 2018). However, studies focusing on direct comparison of structural brain differences in behavioral and substance addictions are limited.AIM: Here we contrast gray matter volumes (GMVs) across groups of individuals with compulsive sexual behaviordisorder (CSBD), gambling disorder (GD), and alcohol use disorder (AUD) with those with none of these disorders(healthy controls participants; HCs).METHODS: Voxel-based morphometry (VBM) was employed to study brain structure and severities of addictions symptoms were assessed with questionnaires. To identify brain regions related to severities of addictions,correlations between questionnaires scores and GMVs were computed.MAIN OUTCOME: We collected MRI (GMVs) data from 26 CSBD patients, 26 GD patients, 21 AUD patients and25 HC participants (all heterosexual males; age: 24-60; M = 34.5, SD = 6.48).RESULTS: Affected individuals (CSBD, GD, AUD) compared to HC participants showed smaller GMVs in the leftfrontal pole, specifically in the orbitofrontal cortex. The most pronounced differences were observed in the GD andAUD groups, and the least in the CSBD group. There was a negative correlation between GMVs and disorderseverity in the CSBD group. Higher severity of CSBD symptoms was correlated with decreased GMV in the rightanterior cingulate gyrus.CLINICAL IMPLICATIONS: Our findings suggest similarities between specific impulse control disorders andaddictions.STRENGHS AND LIMITIATIONS:This study is the first showing smaller GMVs in 3 clinical groups of CSBD, GD and AUD. But the study was limitedonly to heterosexual men. Longitudinal studies should examine the extent to which ventral prefrontal decrements in volume may represent preexisting vulnerability factors or whether they may develop with disorder progression.CONCLUSIONS: Our research extends prior findings in substance use disorders of lower GMV in prefrontalcortical volumes among 3 clinical groups of patients with specific impulse control and behavioral and substanceaddictive disorders. The negative correlation between GMVs and CSBD symptoms and right anterior cingulate gyrus suggests a link with clinical symptomatology.

More than half of Parkinson's disease patients with dyskinesia have impulse control disorders and related behaviors, which are frequently clinically significant. Dopaminergic therapy total dose is associated with their severity. Clinicians should carefully assess patients with maladaptive behaviors and dyskinesia because they do not properly evaluate their motor and nonmotor status. © 2017 International Parkinson and Movement Disorder Society.

Kalıcı cinsel uyarılma bozukluğu (KCUB) dış uyaran olmaksızın, kendiliğinden başlayan, tek ya da çoklu orgazmla doyurulamayan kalıcı cinsel uyarılma hissidir. Günümüzde bu durumun nedeni hakkında çok az şey bilinmektedir. Bu yazıda, tipik KCUB belirtileri olan 37 yaşında kadın hasta sunuldu. Sağ meziyal temporal skleroz tanısıyla sağ selektif amigdalohipokampektomi yapılana kadar 17 yıl ilaç tedavisine dirençli epilepsi tanısıyla takip edilmekteydi. Cerrahiden yaklaşık yedi yıl sonra obsesif kompulsif bozukluk ve aşırı cinsel davranışlar sergilemeye başladı. Bu dirençli cinsel uyarılma hisleri cerrahi öncesi epileptik nöbetleri ile uyumlu değildi. Son elektroensefalografi incelemesinde epileptiform anormallik görülmedi. Hastanın ameliyat sonrası nöbeti yoktu. Halen okskarbazepin 900 mg/gün kullanmaktaydı. Bu yakınmaları eklenen risperidon 2 mg/gün, paroksetin 30 mg/gün tedavisi ve psikoterapiyle tama yakın düzeldi. Amacımız epilepsi cerrahisinden yedi yıl sonra oluşmuş KCUB olgusunu sunmak ve bu nadir bozukluğa dikkati çekmektir. Bu tablonun tedavisi çok yönlü yaklaşım, geri döndürülebilir sebeplerin bulunması ve kognitif-davranışçı terapiyle mümkündür.