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New U research boosts hopes for people with impulse control disorders

Kleptomania, compulsive hair pulling, gambling addiction, and other impulse control disorders are notoriously difficult to diagnose and treat. Recent research through the University of Minnesota’s Impulse Control Disorders Clinic offers hope to people suffering from these debilitating and often embarrassing behaviors.

Jon Grant, M.D., M.P.H., J.D., led a study targeting trichotillomania, or compulsive hair pulling, that was published in the July issue of the Archives of General Psychiatry. It tested the effectiveness of a widely available amino acid used in health food supplements, N-acetylcysteine, in reducing the hairpulling urges of 50 people enrolled in a double-blind study.

“N-acetylcysteine has been around for years,” says Grant, an associate professor of psychiatry at the University. “In liquid form, it’s often used to help the liver bounce back from Tylenol overdose. It was recently investigated as a means of reducing the desires of rats addicted to cocaine, so we thought it might be useful for a range of compulsive problems.”

Grant and his research team decided to explore N-acetylcysteine as an approach to curbing hair-pulling compulsion because trichotillomania—which Grant believes affects 2 to 4 percent of the population at some level—lacks any effective treatment and is poorly understood, even among physicians.

“It’s been known since Hippocrates, but patients often come into the clinic saying, ‘My doctor told me simply to stop doing it.’ There’s a lack of awareness that it’s a psychiatric disorder,” Grant says.

The study found that 56 percent of participants had significantly reduced their hair pulling after 12 weeks on a daily dose of N-acetylcysteine. By comparison, 16 percent taking a placebo reported less pulling.

Grant finds this outcome valuable in itself, but he is even more enthusiastic about the chemical lessons of the research. His team hypothesized that N-acetylcysteine would work by reducing the brain levels of glutamate, a chemical that triggers excitement. Most medications for trichotillomania instead alter levels of serotonin, a chemical thought to influence compulsive behavior.

“The study suggests that targeting glutamate can be an improvement over serotonin-based treatments,” Grant says.

This research conveyed an enormous message of hope to people with trichotillomania around the world, Grant says. Since his study was published, he has received hundreds of e-mails from people who were desperate for any encouraging news about their disorder.

Even though health food stores commonly stock N-acetylcysteine supplements, Grant cautions against taking the antioxidant without medical supervision.

“Patients should contact their primarycare doctors about contraindications, and they should remember that even if a little bit of a supplement is helpful, a bucket-load of it won’t help more,” he says.

During the past decade, the Impulse Control Disorders Clinic—the first of a handful of academic centers nationwide focusing on compulsive conditions—has treated more than 200 patients annually for gambling addiction, shoplifting, obsessive-compulsive disorder, and body dysmorphic disorder, as well as other compulsive behaviors, including shopping, firesetting, sexual addiction, alcohol dependency, and skin-picking.

Research conducted by the center’s investigators complements this clinical work. A possible new treatment for compulsive stealing, or kleptomania, shows promise in another of Grant’s studies.

Kleptomania, like other impulse control disorders, has no FDA-approved drug treatment.

Twenty-five people with a history of weekly stealing took part in Grant’s double-blind study, published in the April 1 issue of the Journal of Biological Psychiatry, which measured the effectiveness of a drug often used to treat alcohol and opiate addiction.

“When you talk to people who have kleptomania, they often describe it like a drug addiction,” Grant says. “They feel a high from the stealing behavior, and when they try to stop, they go through withdrawal-like symptoms that include irritability and restlessness. Often a good place to start is a medication useful for treating similar disorders. So we decided to try naltrexone, an alcohol-addiction drug that’s been in use for 28 years.”

The results of this small study were encouraging. Over eight weeks, those who took naltrexone stole significantly less than those who took a placebo.

“A pill won’t stop anyone from stealing,” Grant says, “because people with kleptomania can always override the pill and take something when they desire to. But ideally, a medication that reduces cravings can be used in combination with therapy, much as we do with other addictions.”

Ultimately these studies may lead to treatments for trichotillomania and kleptomania, and Grant sees more help ahead for sufferers of impulse control disorders as primary-care doctors increasingly learn to screen their patients.

“[Physicians] already screen for smoking and drinking, and it doesn’t take much more time to ask about other behaviors that seem out of control,” he says.

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