IED

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I am probably (one of) the most skeptical of psychiatric diagnoses on this forum, but I do believe that there is a useful entity called intermittent explosive disorder - it is just very rare. People who rage are usually narcissicists, people who beat their wives are usually simply unpleasant people, people who are hot headed usually have poor impulse control in general.
We can see this occur in neurological disease (I have a patient with temporal lobe epilepsy who meets criteria for IED although it is likely some sort of epileptiform thing - he has no recollection of these events). Actually responded very well to high dose prozac (depakote alone was not helpful nor were antipsychotics). We know that impulsivity correlates with low 5-HIAA CSF levels (one of the most reproducible biomarkers in psychiatry) so it is not surprising perhaps that some of these impulse control disorders like intermittent explosive disorder responds well to SSRIs.

Incidentally, the ICD-10 does not have the diagnosis, the closest is emotionally unstable personality disorder, impulsive type.
 
splik said:
I am probably (one of) the most skeptical of psychiatric diagnoses on this forum, but I do believe that there is a useful entity called intermittent explosive disorder - it is just very rare. People who rage are usually narcissicists, people who beat their wives are usually simply unpleasant people, people who are hot headed usually have poor impulse control in general.
We can see this occur in neurological disease (I have a patient with temporal lobe epilepsy who meets criteria for IED although it is likely some sort of epileptiform thing - he has no recollection of these events). Actually responded very well to high dose prozac (depakote alone was not helpful nor were antipsychotics). We know that impulsivity correlates with low 5-HIAA CSF levels (one of the most reproducible biomarkers in psychiatry) so it is not surprising perhaps that some of these impulse control disorders like intermittent explosive disorder responds well to SSRIs.

Incidentally, the ICD-10 does not have the diagnosis, the closest is emotionally unstable personality disorder, impulsive type.
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I have IED as F63.81.
 
Carefully look for motivation of the outbursts. In most patients who are tagged with IED, their explosive outbursts serve a purpose and often a premeditated one. And premeditation encapsulates anything other than in the moment.

I bristle at IED because it gets misapplied and you run into it in forensic settings. IED, while real, is a diagnosis of exclusion. My guess would be that 95% of cases I've seen that were diagnosed with IED were in actuality Personality Disorders, typically NPD or ASPD (in my small n).

The author's claim that it has a prevalence of 5% should be viewed with suspicion. Poor coping mechanisms does not IED make.
 
I used to work on an inpatient child unit (12 and under) and about 80-90% of all the boys were tagged with IED. They were all aggressive. What would you surmise was the actual diagnosis? I'd think the impulsivity could be thought of as a component of likely ADHD, but the aggressive element leads me to think there was more going on.
 
PistolPete said:
I used to work on an inpatient child unit (12 and under) and about 80-90% of all the boys were tagged with IED. They were all aggressive. What would you surmise was the actual diagnosis? I'd think the impulsivity could be thought of as a component of likely ADHD, but the aggressive element leads me to think there was more going on.
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What is Conduct Disorder, Alex?
 
splik said:
I am probably (one of) the most skeptical of psychiatric diagnoses on this forum, but I do believe that there is a useful entity called intermittent explosive disorder - it is just very rare. People who rage are usually narcissicists, people who beat their wives are usually simply unpleasant people, people who are hot headed usually have poor impulse control in general.
We can see this occur in neurological disease (I have a patient with temporal lobe epilepsy who meets criteria for IED although it is likely some sort of epileptiform thing - he has no recollection of these events). Actually responded very well to high dose prozac (depakote alone was not helpful nor were antipsychotics). We know that impulsivity correlates with low 5-HIAA CSF levels (one of the most reproducible biomarkers in psychiatry) so it is not surprising perhaps that some of these impulse control disorders like intermittent explosive disorder responds well to SSRIs.

Incidentally, the ICD-10 does not have the diagnosis, the closest is emotionally unstable personality disorder, impulsive type.
Click to expand...

Was there a physical outburst? These seems more like some variant of pseudobulbar affect (minus the amnesia/LOC).
 
yes there were multiple physical outbursts where he would throw knives, had hit his wife etc. I ask pointed questions about PBA and the wife helpfully told me "he doesn't have PBA" (she had seen the nudexta ads haha)
 
Ah, yes. I get many referrals from primary care asking me to manage what is essentially a person's "Sh**ty Life Syndrome." I have told more than one patient I have no medication for poverty or abusive family members.
 
I've never used IED, even in CAPS. It really isn't even a diagnosis, it's just a description of behavior. I have never not been able to identify some type of precipitant or other diagnosis that better explains the behavior. "Unspecified Mental Disorder" is probably the most infinitely useful diagnosis available.
 
notdeadyet said:
Carefully look for motivation of the outbursts. In most patients who are tagged with IED, their explosive outbursts serve a purpose and often a premeditated one. And premeditation encapsulates anything other than in the moment.

I bristle at IED because it gets misapplied and you run into it in forensic settings. IED, while real, is a diagnosis of exclusion. My guess would be that 95% of cases I've seen that were diagnosed with IED were in actuality Personality Disorders, typically NPD or ASPD (in my small n).

The author's claim that it has a prevalence of 5% should be viewed with suspicion. Poor coping mechanisms does not IED make.
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Do you see alcoholics with this?
 
HooahDOc said:
I've never used IED, even in CAPS. It really isn't even a diagnosis, it's just a description of behavior. I have never not been able to identify some type of precipitant or other diagnosis that better explains the behavior. "Unspecified Mental Disorder" is probably the most infinitely useful diagnosis available.
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I once saw a patient at the VA that transferred in from a nursing home, and notes said "mental disorder NOS." They really narrowed that one down for us...
 
And you must always be wary of cacogens. Anytime an inexplicable row occurs between two friends, a cacogen is surely hiding in the corner having started the mischief.
 
hamstergang said:
Welcome to Psychiatry.
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Yes, good point, but some of our labels are more useful than others. Either way, this is the reason I don't get too caught up in what I label someone and focus more on the conceptualization.

The general approach is pretty straightforward, really. (1) pt identifies sxs of concern (2) ask pt how these specific sxs affect their life (3) target those sxs with whatever the appropriate modality of treatment is and monitor impaired areas for improvement as an outcome measure (4) Profit!
 
Shikima said:
So that explains raging..... How many are using this Dx in charts?

http://newyork.cbslocal.com/2016/05/19/adult-temper-tantrums-disorder/
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Occam's razor...

Doesn't the psychiatrist in that article know what personality disorders are? If not that, why cant we just accept that some people have low frustration tolerance and/or poor coping. What ever happened to owning your behavior?

Treating adults like children is likely to create more childlike behavior, if you ask me.
 
erg923 said:
Occam's razor...

Doesn't the psychiatrist in that article know what personality disorders are? If not that, why cant we just accept that some people have low frustration tolerance and/or poor coping. What ever happened to owning your behavior?

Treating adults like children is likely to create more childlike behavior, if you ask me.
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So, I just was having this discussion with a Pt where I decreased her Paxil from 40mg to 30mg and the return of anxiety was a shock to her.

The question I posed to her, and perhaps the group at large, when did we learn to be uncomfortable with our emotional state?
 
erg923 said:
Occam's razor...

Doesn't the psychiatrist in that article know what personality disorders are? If not that, why cant we just accept that some people have low frustration tolerance and/or poor coping. What ever happened to owning your behavior?

Treating adults like children is likely to create more childlike behavior, if you ask me.
Click to expand...
Apparently, he is one of the top psychiatrists at The House of God http://bpfamily.org/staff
Loved that book and always follow rule #5, placement comes first. Saves me all kinds of time working out diagnostic differentials to slap silly labels like IED on patients. Rule #8, they can always hurt you more might apply to these patients he is diagnosing. Also, I just have to wonder if it is Eye-gor or Eee-gor and if he is the associate chairman, is the chairman Dr. Frankenstein?
Marty-Feldman-and-Abby-Normal.jpg

(obviously one of my all-time favorite movies)
 
Sadly I've coined "VA patient NOS" in the past.
It's sort of like: review of systems is "positive".
 
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