10/18 Conduct Disorders - Upadhyay

Question 1

disruptive, impulse control, conduct disorders

common feature

5 types

Answer 1

all display impaired self-regulation

• intermittent explosive disorder
• pyromania
• kleptomania
• oppositional defiant disorder (ODD)
• conduct disorder

Question 2

intermittent explosive disorder

Answer 2

• recurrent behavioral outbursts represting failiure to control aggressive impulses, manifested as:

1. verbal aggression or physical aggrssion towards others/animals/property
   
   • occuring avg 2x/wk for 3 mo
   • aggression does not result in damage/destruction of property or physical injury to victum
2. behavioral outbursts
   
   • damage/destruction of prop or physical assault involving physical injuries
   • 3 episodes within 12mo period

• aggression in ourburts is grossly out of proportion
• outbursts not premeditated
• outbursts cause impairment in occupational/interpersonal fx, personal distress, or have financial/legal conseqs
• age at least 6yo
• outbursts not better explained by another disorder

Question 3

intermittend explosive disorder

Answer 3

SSRI

mood stabiliziers

2gen antipsychotics

CBT

• helps identify stressors that trigger outbursts → pts can then recognize and defuse situation
• aims to help pts understand that they are resp for consequences of actions

Question 4

pyromania

Answer 4

deliberate and purposeful fire-setting on multiple ocasions

• tension/arousal before act
• fascination/curiosity with act
• pleasure/gratification from act

Question 5

kleptomania

Answer 5

recurrent failure to resist impulses to steal objects that are not needed for personal use or their monetary value

• tension before act
• pleasure/gratification at time of act/after act

Question 6

other addiction/compulsive behaviors

• internet addiction
• compulsive shoppingi

Answer 6

internet addiction: excessive or poorly controlled comp use → impairment or distress

• urges to use
• tension/arousal before
• depressed/guilty after spending too much time

compulsive shopping: irresistible urge to buy items that are unneeded or unwanted

• often young women

Question 7

tx for compulsive behavior

Answer 7

SSRIs!

Question 8

oppositional defiant disorder

symptoms (3 categories)

specifiers

criteria for 5/below and 5+

comorbidities

Answer 8

recurrent pattern of at least 4sx for 6months

• angry/irritable mood
  
  • losing temper, touchiness, easily annoyed, angry, resentful
• argumentative/defiant behavior
  
  • arguing with auth figures, refusal to comply with rules/requests, blaming others for mistakes/misbehavior
• vindictiveness
  
  • spiteful/vindictive >2x in past 6mo

specifier: mild (1 setting), moderate (2 settings), severe (3 settings)

• behaviors lead to distress in individ or others in immediate social context or negatively impact important area of fx

5yo and under: most days for 6mo

5yo+: once a week for 6mo

comorbidities: ADHD, conduct disorder

• assoc with incr risk of suicide

Question 9

ODD treatment

Answer 9

tx targeting both child and family

• family tx essential bc parents need help understanding/managing child
• combo of psychotx and medication
  
  • social skills training
  • cognitive problem solving training

Question 10

conduct disorder

4 categories: 15sx within

criteria for dx

specifiers

Answer 10

repetitive and persistent behavior pattern in which basic rights of others or major age-approp social norms or rules violated

1. aggressive conduct to people/animals
   
   • bullies, threatens, intimidates others
   • initiates fights
   • used a weapon that can cause serious physical harm
   • physically cruel to ppl
   • physically cruel to animals
   • forced another into sexual activity
   • stolen during confrontation
2. destruction of property
   
   • deliberately engaged in fire setting
   • deliberately destroyed property of others
3. deceitfulness or theft
   
   • broken into house/car
   • lies to obtain goods/favors or to avoid obligation
   • stonel items of nontrivial value without confrontation
4. serious rule violations (runaway, truancy)
   
   • stays out at night despite parental prohibition
   • run away from home overnight at least 2x
   • often truant

sx must cause impairment in social/academic fx

three or more sx present in 12mo, at least 1 in 6mo

specifiers:

• onset
  
  • childhood onset type (prior to 10)
  • adolescent onset type (no sx before 10)
  • unspecified
• limited prosocial emotions (2 or more)
  
  • lack of remorse/guilt
  • callous - lack of empathy
  • unconcerned about performance
  • shallow or deficient affect
• severity
  
  • mild (minor harm to others)
  • moderate
  • severe

Question 11

tx for conduct disorder

Answer 11

very difficult to treat

mild cases may respond to psychotherapy

consider: meds to reduce anger, irritability, mood issues

treat comorbidities

family tx essential

• parents need help understanding, managing, supervising, monitoring children/adolescents with other team members