Loss of impulse control in psychotic disorders

Abstract

In this presentation we will explore the different psychopathologic presentations and meanings of impulsive behaviour in psychotic patients. A first distinction will be made in schizophrenic patients between impulsive acts (previously conceptualized as impulsions), whose paroxysmal, automatic psychomotoric and internally generated nature could be close to catatatonic behaviour or immediate reflexive actions, and from other type of aggressive impulsivity, secondary to delusions or hallucinations with a strong self- implication. Quite a different phenomenon is observed in Bipolar patients (phase dependent) in which goal-directed impulsivity can assume two expressions: a “pure” appetitive impulsivity form connected with euphoric or dysphoric mood and a desinhibited impulsivity one close to a more labile mood. The later expressive behaviour is distinct from reckless and desinihibited impulsivity common to ADHD and hypertimic bipolar patients.

In schizophrenic psychotic patients, impulsive acts can be understood as psychopathological expressions of a morbid process at the same level of other psychotic symptoms. On contrary, in mood psychotic disorders the main emphasis is both on the role of self awareness and control, as well as on the understating of several types of impulsivity in a continuum between normal primary emotions and excessive emotional experiences and drives.