conduct disorders

Question 1

Diagnoses for children and adolescents

Difficult and challenging behaviors

NOT generally physically violent/dangerous or illegal

Angry/irritable, argumentative/defiant, vindictive

Answer 1

oppositional defiant disorder

Question 2

what are the 8 symptoms of oppositional defiant disorder

Answer 2

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

Question 3

how many of the 8 symptoms is needed to have oppositional defiant disorder

Answer 3

4 out of 8 for > or = 6 months

Question 4

when does oppositional defiant disorder typical present

Answer 4

during preschool

Question 5

t/f not all children with ODD progress to a conduct disorder

Answer 5

true

Question 6

what is oppositional defiant disorder comorbid with

Answer 6

ADHD

Question 7

treatment for oppositional defiant disorder

Answer 7

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

Question 8

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

Answer 8

Disruptive Mood Dysregulation Disorder

Question 9

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.

Answer 9

Disruptive Mood Dysregulation Disorder

Question 10

Disruptive Mood Dysregulation Disorder tx

Answer 10

Mainly supportive, no medications

Individual and family therapy, CBT

Manage comorbid illnesses

Question 11

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)

Answer 11

Intermittent Explosive Disorder

Question 12

Intermittent Explosive Disorder dx criteria

Answer 12

verbal agression

actions are not premeditated

three behavioral outbursts inolving:

damage or destruction of property

physical assault to animals or people

Question 13

t/f Intermittent Explosive Disorder must Rule out other disorders, antisocial, borderline, mania, psychotic disorder

Answer 13

true

Question 14

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”

Answer 14

Disruptive Mood Dysregulation Disorder

Question 15

Most commonly diagnosed in young men, 7% prevalence; younger individuals, lower education level

Answer 15

Intermittent Explosive Disorder

Question 16

Intermittent Explosive Disorder tx

Answer 16

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

Question 17

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

Answer 17

conduct disorder

Question 18

conduct disorder Childhood-onset before 10 years - prognosis?

Answer 18

worse

the longer you are mean more mean you will be

Question 19

conduct disorder Adolescent-onset between 10 and 18 years - prognosis

Answer 19

better

Question 20

what is the social aspect of conduct disorder

Answer 20

(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

Question 21

t/f medications in general are indicated for conduct disorder

Answer 21

false they are not you are stuck with a meanie pants

Question 22

t/f conduct disorder has High comorbidity rate with ADHD, mood and anxiety disorders, and learning disorders

Answer 22

true

Question 23

conduct disorder tx

Answer 23

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

Question 24

More extreme cases usually end up involving violations of the law and patients end up in group homes or juvenile detention facilities

Answer 24

conduct disorder

Question 25

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

Answer 25

pyromania

Question 26

t/f arsonists with monetary/political agenda qualify as pyro maniacs

Answer 26

f but in batman they do!

Question 27

t/f Patients who reach criteria for antisocial PD, conduct disorder, mania are pyromaniacs

Answer 27

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.

Question 28

onset of pyromania

Answer 28

Onset usually late teens or early 20s

Question 29

comorbid conditions of pyromania

Answer 29

mood disorder, substance abuse and impulsive behavior

Question 30

gender equal with pyromania?

Answer 30

yes

Question 31

pyromania tx

Answer 31

Treat any co-existing disorder No clear role for medications Educate parents on non-punitive discipline measures Individual and family therapy

Question 32

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

Answer 32

kleptomania

Question 33

kleptomania comorbid conditions

Answer 33

Mood and anxiety disorders are frequently comorbid

Question 34

age of onset for kleptomania

Answer 34

begins in adolescence or early adulthood and remains chronic

Question 35

kleptomania mainly f or m

Answer 35

75 % female (my wife and my daughter stole my heart, they may be kleptos)

Question 36

kleptomania tx

Answer 36

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

Question 37

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

Answer 37

Compulsive shopping

Question 38

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

Answer 38

Internet addiction