Conduct Disorders, Juvenile Deliquency, Adolescent Drug & Alcohol Probs - Allen Flashcards
What is the difference between an Internalizing Disorder and an Externalizing Disorder?
- Externalizing disorder - conduct disorder, “acting out” feelings of aggression
- Internalizing disorders - depression, keeping things internal
What is the DSM-5 Diagnostic Criteria for Conduct Disorder?
- A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated
- What is at the core of the person to make the incapable of forming relationship with others → lack empathy
- As manifested by the presence of three (or more) of the following criteria in the past 12 months, with at least one present in the past 6 months
- Aggression to people and animals
- Destruction of property
- Fire setting is a diagnostic behavior
- Deceitfulness or theft
- Serious violations of rules
What are the gender differences in prevalence rates of Conduct Disorder?
- 9-10% in boys
- 3-4% in girls
- Males prevalence predominates prior to adolescents, but prevalence rates between genders are closer by age 15
- Girls are more likely to follow the nonaggressive pathway with late onset, covert offenses, and greater likelihood of recovery
- Indirect aggression (spreading malicious rumors) is more common in girls
What are the core features of Conduct Disorder?
- Little/No empathy and concern for the feelings of others
- Lack of conscience
- Failure to learn from experience
What is the DSM-5 Diagnostic Criteria for Oppositional Defiant Disorder?
- A pattern of negative, hostile, and defiant behavior lasting at least 6 months, during which 4 or more of following included
- Loses temper, argues, defies request, deliberately annoys people, blames others, touch or easily annoyed, angry, resentful
What etiologic factors are similar in infants between ODD and CD?
- Temperamentally hyperreactive
- Irritable
- Difficult to soothe
- Slow to adapt to new circumstances
What etiologic factors are similar in families between ODD and CD?
- Highly stressed environment
- Marital discord
- Parental psychopathology (parent is pre-occupied with own problems)
- Socioeconomic disadvantage
- Inconsistent limit setting - ignored with sporadic repetitive cycles of hard coercive punishment
What is the developmental psychopathology of ODD/CD?
Normal youth acting out intensifies → ODD (25%) → CD (25-40%) → Antisocial Personality Disorder
How should ODD/CD be assessed?
- Multiple sources/informants (pt, parent, teacher, coach, etc.)
- Multiple observations (home, school, community)
- Multiple methods (interviews, checklists, observations)
What is the best treatment for ODD?
- Positive parenting program
- Problem-solving communication training
- Look for teachable moments when the child is being good and praise the child for that
- Reward/award for compliance
What is the treatment for CD?
- Multisystemic Family Therapy (MST)
- positive strengths bsed
- promotes responsible behavior
- identify & target sequences of behavior
- requires daily effort of family members
What is the DSM-5 Diagnostic Criteria for Substance-Related Disorders in Adolescents?
- Maladaptive pattern of substance use leading to the clinically significant impairment or distress, as manifested by two or three of the following symptoms within 12 month period:
- Recurrent substance use resulting in failure to fulfill major role (school)
- Recurrent substance use in situations in which it is physically hazardous
- Recurrent substance-related legal problems
- Continued substance use despite having persistent or recurrent social or interpersonal problem
How did DSM-5 change the criteria for Substance-Related Disorders?
- Combined substance abuse and substance dependence to Substance Use Disorder
- Strengthened threshold for diagnostic criteria
- DSM-IV - required only 1 symptom
- DSM-5 - requires 2-3 symptoms
What are the consequences of alcohol and other drug use among adolescents?
- Associated with the three leading causes of mortality among adolescents
- Motor vehicle accidents, homicide, & suicide
- Associated with violent behavior, rape, and unprotected sex
What are the experimental substance use statistics by age 18 years?
- 80% have drunk alcohol
- 2/3 have smoked cigarettes
- 50% have used at least one illicut drug once (marijuana primarily)
Maturational changes in what part of the brain can explain adolescant impulsivity and novelty seeking?
Prefrontal Cortex
What is the Diathesis-Stress Model?
- Diathesis - predisposing biology, including genetic factors
- Stress - environmental factors
- If these 2 together exceed threshold = person with disorder
- G x E - gene by environment interactions that lead to disorder
What are protective factors? What can they do?
decrease likelihood of getting disorder (parents, physicians, etc)
What are the “CRAFFT” questions when interviewing an adolescant about drinking?
Things to ask if they do this stuff while drinking:
- Car - use in a car
- Relax - use it to relax
- Alone - drink alone
- Family/friends - problem with family/friends
- Forget - forget responsibilities
- Trouble - gotten in trouble
T/F Psychiatric comorbidity is the rule rather than the exception.
True
- Conduct disorder + adolescant SUD (50-80%)
- ADHD → SUD
- CD + ADHD
- Mood disorder/Depression → SUD
How can we prevent Substance-Use Disorders?
- Reduce supply
- Reduce demand
- With adolescents → use life skill training and motivational interviewing with harm reduction
What is the typical treatment for adolescant patients with SUD?
- 80% of adolescents with SUD are treated in outpatient settings instead of being sent to inpatient treatment
- Addiction treatment is a linear process requiring a continuum of case management and case monitoring akin to that in chronic disease management
