Chapter 21 - Impulse Control Disorders

Question 1

What is Oppositional Defiant Disorder (ODD)?

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Answer 1

Defiant & Vindictive Behavior

• Social difficulties
• Conflict with authority figures
• Academic problems

Usually diagnosed between 8 - 10 years of age

Comorbidities: ADHD

Question 2

Risk factors for Oppositional Defiant Disorder (ODD)

Answer 2

• Genetics: family hx of mental illness
• Neurobiological Factors
• Physiological: reduced cortisol reactivity to stress
• Cognitive: negative symptoms (negative self-talk, pessimism, etc.) are aquired
• Enviornmental: family disfunction can play a role

Question 3

Jeff, who is diagnoed with conduct disorder, is taken to the principal’s office after assaulting & injuring another student. Which comment is this adolescent most likely to make?

a.) “I lost my temper, but it will not happen again”
b.) “I’m sorry & embarrased that this happened”
c.) “I failed my math test, & guess I was just having a bad day”
d.) “So what if that kid was hurt? I should have beaten him more”

Answer 3

d.) “So what if that kid was hurt? I should have beaten him more”

Question 4

What is conduct disorder?

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Answer 4

!!Aggressive & destructive behaviors!!
* Lack of remorse
* The rules don’t apply to me
* “ I’m going to do what I want to get what I want”

Complications: Academic fialure, school suspensions & dropouts, juvenile delinquency, drug & alcohol use, & juvenile court involvement

Usually diagnosed in adolescence (teenager)

Question 5

What is intermittent explosive disorder (IED)?

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Answer 5

Inability to control aggressive impulses
* Has difficulty controlling aggressive impulses
* Gets really mad & their anger seems out of proportion

Diagnosed in adulthood (18+)

Question 6

What are comorbidities & risk factors of Intermittent Explosive Disorder?

Answer 6

Comorbidities:
* Depressive, anxiety, & substance use disorders
* Antisocial & borderline personality disorders
* ADHD & other disruptive disorders

Risk Factors:
* Biological & Enviornmental

Question 7

What are Pyromania & Kleptomania & what type of diagnosis are these?

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Answer 7

Pyromania: fire setting
Kleptomania: Habitual stealing of unneeded objects (I wanted it so I took it)

Type of Impulse Control Disorder

Question 8

What medications are used for oppositional defiant disorder (ODD)?

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Answer 8

NONE for the diagnosis itself

• symptoms like aggression might be treated with beta-blockers, mood staiblizers, TCAs, anxiolytics, etc.

Question 9

What medications are used to treat Intermittent Explosive Disorder (IED)?

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Answer 9

• SSRIs
• Mood Stabilizers
• Beta-Blockers (can help calm agitation)

Question 10

What medications are used for Conduct Disorder?

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Answer 10

• Antipsychotics (2nd & 3rd generation)

Question 11

What types of therapies are used for Impulse Control Disorders like Oppositional Defiant Disorder, Intermittent Explosive Disorder, & Conduct Disorders?

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Answer 11

• Family Therapy
• CBT
• DBT
• Parent-child interaction therapy (PCIT)
• Parent management training (PMT)
• Social skills training
• Multisystemic therapy (MST)

Question 12

Jeff, who has oppositional defiant disorder, says “My therapist doesn’t understand me. I want to see someone else”. Should this patient have the option to change therapists?

a.) Always
b.) Sometimes (depends on the situation)
c.) Never (since manipulation is part of the disorder)
d.) Not sure

Answer 12

b.) Sometimes (depends on the situation)

• Discuss potential dilemmas associated with this problem
• An effective therapist is needed & yet should the child be permitted to control the environment?
• Consider a patient’s rights