6 Impulse Control Disorders Flashcards
What is the basic premise of Cognitive Behavioral Therapy (CBT)
Thoughts influence feelings which alter behavior (essentially, limbic system is overriding frontal lobe)
Changing the thought process is the basis of CBT
What sorts of techniques can be used in CBT?
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
Impulse control disorders are …
On a continuum rather than a progression
What is the addiction cycle like?
Preoccupation/anticipation —> Binge intoxication —> Withdrawal/Negative Affect —> back to Preoccupation/anticipation
What is the DSM-5 for Intermittent Explosive Disorder
(DDX should include ASPD and CD - but IED has no psychotic Sx)
- Recurrent episodes of aggressive behavior or verbal aggression
- Aggressiveness out of proportion to precipitating psychosocial stressors
- NOT premeditated, not to obtain some reward
- Causes distress, impairment or financial/legal consequences
- At least 6 years old
- 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
Risk factors for Intermittent explosive disorder
Trauma
Genetically linked
Serotonin disruption in limbic system and frontal/limbic cortex
Treatment for intermittent explosive disorder
SSRIs Mood stabilizers Benzos Anticonvulsants Antipsychotics
Behavior mods (desensitization)
Facts about conduct disorder
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
DSM-5 criteria for Conduct Disorder
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
Specifiers for CD
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
Treatment for CD?
Individual and group therapy
Parental behavioral therapy
Pharmacotherapy (ADHD drugs, antidepressants, mood stabilizers, antipsychotics)
Recurrent pattern of negativistic, defiant, disobedient, and hostile behavior towards authority figures
More common in disruptive households, and can be associated with ADHD
Oppositional Defiant Disorder
______ defiance is normal but if Sx increase assessment for ______ is warranted
Preschool
ODD
ODD usually starts before _____ yo
8
May lead into childhood-onset CD
ODD Sx are less severe than ____
CD, but CD diagnosis will take precedent over ODD
There is a familial link to …
Mood disorders, ODD, CD, ADHD, ASPD, and substance abuse
What is the treatment for ODD?
Behavioral mods, family therapy
What is the DSM-5 for ODD?
A. Negativistic, hostile, and defiant behavior, >6 months with 4+ of the following:
- Often loses temper
- Often argues with adults
- Defies adults’ requests or rules
- Deliberatively annoys people
- Blames others for their behavior
- Easily annoyed
- Often angry or resentful
- 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
What is the only addictive disorder in the DSM5?
Pathological Gambling
Individuals with pathological gambling have increased rates of
Stress-related physiological comorbities
Mood d/o, ADHD, substance abuse, other ICDs, and Cluster B personality d/o
What is the phase progression in pathological gambling?
Winning phase —> losing phase —> desperation phase
Mimics curve for alcohol and drug dependency
DSM5 for pathological gambling
A. Persistent and recurrent maladaptive gambling behavior as indicated by 4+ of the following in a 12 month period:
- PREOCCUPATION with gambling
- Desired excitement achieved with inc amount of money gambled
- Unable to stop or cutback
- Restless or irritable when trying to cut down
- May serve to escape problems or relieve dysphoric mood
- After losing money comes back to gamble to get even (“chasing losses”)
- Lies to family members, therapists, and others
- Has jeopardized relationships, employment, or career
- Relies on others to provide money to relieve desperate financial situation
B. Behavior is not better accounted for by a manic episode
Specifiers for Pathological gambling
Episodic or persistent
Early, sustained, or absent remission
Severity
Treatment for pathological gambling
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)
