conduct disorders Flashcards
Diagnoses for children and adolescents
Difficult and challenging behaviors
NOT generally physically violent/dangerous or illegal
Angry/irritable, argumentative/defiant, vindictive
oppositional defiant disorder
what are the 8 symptoms of oppositional defiant disorder
1) often loses temper
2) touchy or easily annoyed
3) angry and resentful
4) argues with authority figures
5) actively defies or refuses to comply to requests from authority figures
6) deliberately annoys others
7) blames others for mistakes or misbehaviors
8) spiteful or vindictive 2x in past 6 months
how many of the 8 symptoms is needed to have oppositional defiant disorder
4 out of 8 for > or = 6 months
when does oppositional defiant disorder typical present
during preschool
t/f not all children with ODD progress to a conduct disorder
true
what is oppositional defiant disorder comorbid with
ADHD
treatment for oppositional defiant disorder
Rule out medical illness
Child therapy
Family therapy
CBT, anger management,
improve problem solving skills, techniques to delay impulsive responses
School-based programs
Manage co-morbid illnesses (ADHD)
No pharmaceutical treatment
characterized by chronic, severe and persistent irritability
Symptoms start before age 10 and last >12 months
Symptoms must occur both at home and in school
Disruptive Mood Dysregulation Disorder
Added to the DSM-5 in part to help distinguish between children with chronic irritability/mood swings versus children with classic early onset bipolar disease.
Disruptive Mood Dysregulation Disorder
Disruptive Mood Dysregulation Disorder tx
Mainly supportive, no medications
Individual and family therapy, CBT
Manage comorbid illnesses
Can diagnose in ages 6 and up
Verbal aggression or behavioral outbursts due to a failure to control aggressive impulses
Out of proportion to the psychological stressor
Out of character for the individual’s usual behavior (not a pattern of overreacting)
Intermittent Explosive Disorder
Intermittent Explosive Disorder dx criteria
verbal agression
actions are not premeditated
three behavioral outbursts inolving:
damage or destruction of property
physical assault to animals or people
t/f Intermittent Explosive Disorder must Rule out other disorders, antisocial, borderline, mania, psychotic disorder
true
Diagnosis can only be given between ages 6 and 18
Temper outbursts are severe, regular and inconsistent with circumstances
Child is persistently angry and irritable and it is not a “passing thing”
Disruptive Mood Dysregulation Disorder
Most commonly diagnosed in young men, 7% prevalence; younger individuals, lower education level
Intermittent Explosive Disorder
Intermittent Explosive Disorder tx
No FDA approved medications
SSRIs and oxcarbazepine help control symptoms
2nd generation anti-psychotics such as risperidone have also been used for aggressive symptoms
Avoid benzodiazepines, reduce anxiety and “release” impulse behaviors
Cognitive behavioral therapy
Basic rights of others or rules/norms violated
Considered precursor to antisocial personality disorder
Children and adolescents, under age 18
3 of 15 behaviors over 12 month period
Four domains of behavior: Aggression towards people and animals Destruction of property Deceitfulness/theft Serious violations of rules
conduct disorder
conduct disorder Childhood-onset before 10 years - prognosis?
worse
the longer you are mean more mean you will be
conduct disorder Adolescent-onset between 10 and 18 years - prognosis
better
what is the social aspect of conduct disorder
(lack of remorse, callousness, no fear of consequences. )
Limited prosocial emotions in severe cases:
Lack of remorse or guilt
Callous- lack of empathy
Unconcerned about performance
Shallow or deficient affect
t/f medications in general are indicated for conduct disorder
false they are not you are stuck with a meanie pants
t/f conduct disorder has High comorbidity rate with ADHD, mood and anxiety disorders, and learning disorders
true
conduct disorder tx
Mild cases: individual and family therapy
Best approach is to educate/help the parents
Parental management training communicate more effectively, appropriate discipline, cull peer groups; intensive
cognitive/behavioral therapy
Treat comorbid illnesses (ADHD)
Aggressive symptoms may be treated off-label with lithium, haloperidol, 2nd generation anti-psychotics
More extreme cases usually end up involving violations of the law and patients end up in group homes or juvenile detention facilities
conduct disorder
Deliberate fire setting on more than one occasion
Fascination with fire (fire is pretty cool)
Tension or affective arousal before the act
Pleasure, gratification or relief when setting fires…or…when witnessing the aftermath
pyromania
t/f arsonists with monetary/political agenda qualify as pyro maniacs
f but in batman they do!
t/f Patients who reach criteria for antisocial PD, conduct disorder, mania are pyromaniacs
false
they may set fires but lack the fascination with fire and don’t necessarily experience tension/arousal and relief with the act. Usually fires are set with a motivation of destruction, anger or revenge.
onset of pyromania
Onset usually late teens or early 20s
comorbid conditions of pyromania
mood disorder, substance abuse and impulsive behavior
gender equal with pyromania?
yes
pyromania tx
Treat any co-existing disorder
No clear role for medications
Educate parents on non-punitive discipline measures
Individual and family therapy
Cannot resist impulses to steal objects
Objects are not needed for personal use or monetary gain
Increased sense of tension before committing crime
Pleasure, gratification or relief when committing theft
Not done out of anger or aggression
kleptomania
kleptomania comorbid conditions
Mood and anxiety disorders are frequently comorbid
age of onset for kleptomania
begins in adolescence or early adulthood and remains chronic
kleptomania mainly f or m
75 % female (my wife and my daughter stole my heart, they may be kleptos)
kleptomania tx
No standard treatment exists
Medication has been helpful for some patients including SSRIs and naltrexone (unclear mechanism)
Treat any underlying comorbid disorders
CBT/individual therapy
On an anecdotal basis, being caught and “humiliated” is an effective deterrent for some people
Irresistible urge to buy unnecessary things
Tension and gratification, before and during
Typically starts late teens/early 20s and is chronic
No standard treatments, SSRIs may be helpful, CBT
Compulsive shopping
Excessive computer use leading to distress
Tension, arousal before logging on
Guilt or depression when using too long
No consensus on treatment
Self-limitation, safeguards best bet, CBT
Internet addiction
