Behavioural problems

Question 1

What signs may be seen in a patient with behavioural problems?

Answer 1

• Threatening towards others
• Others feel fear of escalating aggressive behaviour
• Behaviour becomes more threatening when boundaries are put in place
• Known to keep and carry weapons
• Damage to property
• Lying
• Going missing
• Cruelty to animals

Question 2

What initial investigations should be done for patients with suspected behavioural problems?

Answer 2

Biological

• Full physical examination including all observations
• Relevant blood tests based on the findings from physical exam
• Screening bloods: FBC, U&Es, LFTs, Vitamin D, TFTs
• Urine drug screen

Psychological

• Full psychiatric history
• Think about attachments

Social
Gather information:
- Health visitors
- GP
- School
- PRU
- CAMHS
- Youth Offending Team
- Foster carers
- Social workers
- Staff at current care home

Question 3

What must be considered in a risk assessment?

Answer 3

Risk assessment:

Risk to self

• Risk of developing a mental disorder
• Risk of retaliation from others
• Substance misuse increasing vulnerability

Risk to others
- Risk to others due to aggressive behaviour

Question 4

What is the ICD-10 criteria for a conduct disorder

Answer 4

Repetitive and persistent pattern of behaviour lasting at least 6 months, during which some of the following as present.

The individual:

• Has unusually frequent or severe temper tantrums for their developmental level
• Often argues with adults
• Often actively refuses adults requests or defies rules
• Often, apparently deliberately, does things that annoy other people
• Often blames others for their own mistakes or misbehaviour
• Is often ‘touchy’ or easily annoyed by others
• Is often angry or resentful
• Is often spiteful and vindictive
• Often lies or breaks promises to obtain goods or favour ours or to avoid obligations
• Frequently initiates physical fights (this does not include fights with siblings)
• Has used a weapon that can cause serious physical harm to others
• Despite parental prohibition, often stays out after dark (beginning before age 13)
• Exhibits physical cruelty to other people
• Exhibits physical cruelty to animals
• Deliberately destroys the property of others (other than fire setting)
• Deliberately sets fires with a risk or intention of causing serious damage
• Steals objects of non-trivial value without confronting the victim either with in the home or outside
• Is frequently truant from school beginning from the age of 13
• Has run away from parental or parental surrogate home at least twice or has run away for more than a single night
• Commits a crime involving confrontation with the victim (i.e. mugging)
• Forces another person into sexual activities
• Frequently bullies others
• Breaks into someone else’s house/ building or car

Question 5

What is the management for behavioural problems?

Answer 5

• Refer for multisystemic therapy (MST)
• Commence/continue sessions with Youth Offenders Team (YOT)
  1. To work on voctim empathy
  2. To encourage the patient to join in with pro-social activities
  3. To work on substance misuse
• Continue assessment of his mental state should there be concerns regarding developing a co-morbid mental disorder