Amara G, Richa S, Baylé F-J
CHU Farhat Hached, Service de Psychiatrie, avenue Ibn El Jazzar, 4000, Sousse, Tunisie.
Encephale. 2007 May-Jun;33(3 Pt 1):339-45. doi: 10.1016/s0013-7006(07)92048-5.
Intermittent Explosive Disorder (IED) is a recently reported mental disorder. It was introduced in the edition of the Diagnostic and Statistical Manual of mental disorders. Since then, the clinical criteria have developed, but some ambiguity has remained.
In fact, the utility of excluding this diagnosis in the presence of some personality disorders (antisocial and borderline personalities) is being discussed. On the one hand, the recurrence of violent behaviour is not always found among these personalities and, on the other, to accept both diagnoses of personality disorder and IED would permit one to distinguish a subgroup of patients to whom it would be possible to offer appropriate treatment. However, some criteria could be introduced among those needed for the diagnosis. These criteria include signs of tension, immediately preceding the assaults, as well as signs of release, or even pleasure, after performing the act. These symptoms are frequently reported by IED patients and they are still found in the diagnosis criteria of other impulse control disorders. IED starts during adolescence and it is more frequent among boys. Due to the criteria restrictions, its prevalence is considered as low. However, violent behaviour and impulsivity among psychiatric patients are frequent. The comorbidity of IED has been studied without taking these restrictions into account. A high level of comorbidity is noted with mood disorder. Some reports agree with the hypothesis of a disorder included in the spectrum of a mood disorder. The other psychiatric disorders, frequently associated with IED, are cluster B personality disorders and anxious disorders. There are few studies on the etiopathogeny of IED. However, some results warrant more attention. They concern the deregulation of the serotoninergic system and mild brain injuries. The etiopathogenic hypotheses have influenced the choice of the drugs offered to IED patients, which are mainly selective serotonin reuptake inhibitors, mood stabilisers, and beta-blockers. The efficacy of these treatments was determined essentially by case reports. Some controlled trials are needed to confirm the utility of these molecules in this disorder. In spite of the frequency and the seriousness of violent impulsive behaviour, it is still studied much less than mood or anxious symptoms.
We believe that IED diagnosis permits the categorization of such violent behaviour in many psychiatric pathologies. The evolution of IED diagnostic criteria should permit psychiatrists to recognise and handle recognition and management of violent behaviour better.
间歇性爆发性障碍（IED）是一种最近报道的精神障碍。它在《精神障碍诊断与统计手册》中被引入。从那时起，临床标准不断发展，但仍存在一些模糊之处。
事实上，在存在某些人格障碍（反社会和边缘型人格）的情况下排除该诊断的实用性正在被讨论。一方面，在这些人格类型中并非总能发现暴力行为的复发，另一方面，接受人格障碍和IED的双重诊断将有助于区分出一组可以给予适当治疗的患者。然而，在诊断所需的标准中可以引入一些标准。这些标准包括在攻击行为即将发生之前的紧张迹象，以及在实施行为之后的放松甚至愉悦迹象。这些症状在IED患者中经常被报告，并且在其他冲动控制障碍的诊断标准中仍然存在。IED始于青春期，在男孩中更为常见。由于标准的限制，其患病率被认为较低。然而，精神科患者中的暴力行为和冲动性很常见。IED的共病情况在没有考虑这些限制的情况下进行了研究。发现与情绪障碍的共病率很高。一些报告认同它是情绪障碍谱系中一种障碍的假设。其他经常与IED相关的精神障碍是B类人格障碍和焦虑症。关于IED的病因学研究很少。然而，一些结果值得更多关注。它们涉及血清素能系统的失调和轻度脑损伤。病因学假设影响了给予IED患者的药物选择，这些药物主要是选择性5-羟色胺再摄取抑制剂、情绪稳定剂和β受体阻滞剂。这些治疗的疗效基本上由病例报告确定。需要一些对照试验来证实这些药物在这种疾病中的效用。尽管暴力冲动行为频繁且严重，但对它的研究仍远少于对情绪或焦虑症状的研究。
我们认为IED诊断有助于在许多精神疾病中对这种暴力行为进行分类。IED诊断标准的演变应使精神科医生能够更好地识别和处理暴力行为的识别与管理。
