[Intermittent explosive disorder: current status].
BACKGROUND
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.


RESULTS
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.


CONCLUSIONS
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.
CHU Farhat Hached, Service de Psychiatrie, avenue Ibn El Jazzar, 4000, Sousse, Tunisie.
G
G
Amara
S
S
Richa
F-J
FJ
Baylé
D000293:Adolescent; D000328:Adult; D015897:Comorbidity; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology*; D006801:Humans; D010554:Personality Disorders / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D012720:Severity of Illness Index; D014754:Violence / Q000706:statistics & numerical data
D017367:Selective Serotonin Reuptake Inhibitors