6 Impulse Control Disorders

Question 1

What is the basic premise of Cognitive Behavioral Therapy (CBT)

Answer 1

Thoughts influence feelings which alter behavior (essentially, limbic system is overriding frontal lobe)

Changing the thought process is the basis of CBT

Question 2

What sorts of techniques can be used in CBT?

Answer 2

Challenge beliefs - “What is your evidence that…”
• “…you’re being judged when you speak publicly”
• “…you are a failure at ______?”
• “…your performance is a measure of your character?”

Homework, bibliography, self reflection, journaling also helpful

Question 3

Impulse control disorders are …

Answer 3

On a continuum rather than a progression

Question 4

What is the addiction cycle like?

Answer 4

Preoccupation/anticipation —> Binge intoxication —> Withdrawal/Negative Affect —> back to Preoccupation/anticipation

Question 5

What is the DSM-5 for Intermittent Explosive Disorder

Answer 5

(DDX should include ASPD and CD - but IED has no psychotic Sx)

1. Recurrent episodes of aggressive behavior or verbal aggression
2. Aggressiveness out of proportion to precipitating psychosocial stressors
3. NOT premeditated, not to obtain some reward
4. Causes distress, impairment or financial/legal consequences
5. At least 6 years old
6. Behavior NOT accounted for by another mental disorder

Outbursts last <30 min, usually caused by minor provocation by acquaintance

Starts in late childhood, early adolescence

Question 6

Risk factors for Intermittent explosive disorder

Answer 6

Trauma
Genetically linked
Serotonin disruption in limbic system and frontal/limbic cortex

Question 7

Treatment for intermittent explosive disorder

Answer 7

SSRIs
Mood stabilizers
Benzos
Anticonvulsants
Antipsychotics

Behavior mods (desensitization)

Question 8

Facts about conduct disorder

Answer 8

Age ≥7, Sx similar to ADHD

Risk factors include parental rejection or neglect, difficult infant temperament, harsh discipline, physical or sexual abuse, unstable family role models, familial psychopathology

Lifetime prevalence: 1-10%

One of the most common pediatric psych disorders

Question 9

DSM-5 criteria for Conduct Disorder

Answer 9

A. Major rights of others or societal norms are violated (3 in past 12 months)
• Aggression to people/animals
• Destruction of property
• Deceitfulness or theft
• Serious violation of rules

B. Behavior causes significant impairment in social, academic, or occupational functioning

C. If 18 yo or older, does not meet criteria for ASPD

Question 10

Specifiers for CD

Answer 10

Childhood, adolescent, or unknown onset

Lack of pro social emotions
• Lack of remorse/guilt
• Callous - lack of empathy
• Unconcerned about school performance
ª Shallow or deficient affect

Mild, moderate, or severe

Question 11

Treatment for CD?

Answer 11

Individual and group therapy

Parental behavioral therapy

Pharmacotherapy (ADHD drugs, antidepressants, mood stabilizers, antipsychotics)

Question 12

Recurrent pattern of negativistic, defiant, disobedient, and hostile behavior towards authority figures

More common in disruptive households, and can be associated with ADHD

Answer 12

Oppositional Defiant Disorder

Question 13

______ defiance is normal but if Sx increase assessment for ______ is warranted

Answer 13

Preschool

ODD

Question 14

ODD usually starts before _____ yo

Answer 14

8

May lead into childhood-onset CD

Question 15

ODD Sx are less severe than ____

Answer 15

CD, but CD diagnosis will take precedent over ODD

Question 16

There is a familial link to …

Answer 16

Mood disorders, ODD, CD, ADHD, ASPD, and substance abuse

Question 17

What is the treatment for ODD?

Answer 17

Behavioral mods, family therapy

Question 18

What is the DSM-5 for ODD?

Answer 18

A. Negativistic, hostile, and defiant behavior, >6 months with 4+ of the following:

1. Often loses temper
2. Often argues with adults
3. Defies adults’ requests or rules
4. Deliberatively annoys people
5. Blames others for their behavior
6. Easily annoyed
7. Often angry or resentful
8. Often spiteful or vindictive

B. Clinically significant impairment in social, academic, or occupational functioning

C. Behaviors do not occur during psychotic or mood disorder

D. Criteria not met for CD and if they are >18, criteria not met for ASPD

Question 19

What is the only addictive disorder in the DSM5?

Answer 19

Pathological Gambling

Question 20

Individuals with pathological gambling have increased rates of

Answer 20

Stress-related physiological comorbities

Mood d/o, ADHD, substance abuse, other ICDs, and Cluster B personality d/o

Question 21

What is the phase progression in pathological gambling?

Answer 21

Winning phase —> losing phase —> desperation phase

Mimics curve for alcohol and drug dependency

Question 22

DSM5 for pathological gambling

Answer 22

A. Persistent and recurrent maladaptive gambling behavior as indicated by 4+ of the following in a 12 month period:

1. PREOCCUPATION with gambling
2. Desired excitement achieved with inc amount of money gambled
3. Unable to stop or cutback
4. Restless or irritable when trying to cut down
5. May serve to escape problems or relieve dysphoric mood
6. After losing money comes back to gamble to get even (“chasing losses”)
7. Lies to family members, therapists, and others
8. Has jeopardized relationships, employment, or career
9. Relies on others to provide money to relieve desperate financial situation

B. Behavior is not better accounted for by a manic episode

Question 23

Specifiers for Pathological gambling

Answer 23

Episodic or persistent

Early, sustained, or absent remission

Severity

Question 24

Treatment for pathological gambling

Answer 24

Psychotherapy (moderate benefit)
• Behavioral mods
•CBT (addresses erroneous beliefs, role of chance)

Group support
• Gamblers anonymous

Meds (Mild to moderate benefit)
• When treating OCD, anxiety, or mood disorder Sx (SSRIs, anxiolytics, mood stabilizers)
• Some promise with opiate antagonists (naltrexone)