Disruptive Behavior and SUDS

Question 1

What is a disruptive behavior disorder?

Answer 1

• These disorders are all characterized by problems in self-control of emotions and behaviors.
• A minimum age of 6 years (equivalent dev. level) is required.
• ADHD (a neurodevelopmental disorder) is frequently comorbid.

Question 2

What are the 3 types of oppositional defiant disorder?

Answer 2

1. Angry/irritable mood
   - Loses temper.
   - Touchy or easily annoyed.
   - Angry and resentful
2. Argumentative/defiant behavior
   - Argues with authority figures (in children/adolescents—with adults)
   - Actively defies or refuses to comply with requests from authority figures/rules.
   - Deliberately annoys others.
   - Blames others for their mistakes or misbehavior.
3. Vindictiveness
   - Spiteful or vindictive at least twice within past 6 months

Question 3

How is ODD diagnosed?

3 criteria

Answer 3

1. A pattern lasting at least 6 months as evidenced by at least 4 symptoms from any of the categories from the previous slide and exhibited during interaction with at least 1 individual who is not a sibling.
2. Disturbance in behavior is associated with distress in the individual or others in immediate social context (family, peer group, work colleagues) or it impacts negatively on social, educational, occupational, or other important areas of functioning.
3. Behaviors do not occur exclusively during a psychotic, substance use, depressive, or bipolar disorder.

Question 4

What are the severity levels of ODD?

Answer 4

Mild: symptoms confined to 1 setting
Moderate: symptoms are present in at least two settings
Severe: symptoms are present in 3 or more settings

Question 5

What are the features of ODD?

Answer 5

Key considerations: threshold of 4 or more symptoms within the preceding 6 months
Individuals with disorder often justify their behavior as a response to unreasonable demands or circumstances.

Question 6

What is the diagnostic criteria for conduct disorder?

Answer 6

Repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by at least 3 of the following 15 criteria in the past 12 months from any of the categories listed, with at least 1 present in the past 6 months:
- Aggression to people or animals
- Destruction of property
- Deceitfulness or theft
- Serious violations of rules

Question 7

What are the levels of severity with conduct disorder?

Answer 7

Mild: lying, truancy, staying out after dark without permission, other rule breaking
Moderate: stealing without confronting a victim, vandalism
Severe: forced sex, physical cruelty, use of a weapon, breaking and entering

Question 8

What is the prevalence of conduct disorder?

Answer 8

• Fairly consistent across countries that differ in race and ethnicity.
• Rates rise from childhood to adolescence.
• Higher among males than females
• Few children with impairing conduct disorder receive treatment.
• Onset: Rare after age 16

Question 9

What risk and prognostic factors are associated with conduct disorder?

Answer 9

• Temperamental: difficult under controlled infant temperament, lower than average intelligence (verbal IQ)
• Environmental: family level & community level risk factors; both common in childhood onset subtype
• Genetic and physiological: influenced by genetic and environmental factors; increased risk in kids with biological or adoptive parent or a sibling with conduct disorder; biological parent having a severe alcohol use disorder, depressive and disorders, or schizophrenia or biological parents who have a history of ADHD or conduct disorder; slower resting heart rate is noted; reduced autonomic fear conditioning is also well documented.
• Males with diagnosis - frequent exhibit fighting, stealing, vandalism, and school discipline problems (both physical and relational aggression)
• Females with diagnosis – exhibit lying, truancy, running away, substance use, and prostitution (more relational aggression)

Question 10

What is antisocial personality disorder?

Answer 10

• This disorder is closely connected to the spectrum of “externalizing” conduct disorders.
• It involves a pattern of disregard for, and violation of, the rights of others. It is classified as a personality disorder.

Question 11

What is pyromania?

Question 12

What is kleptomania?

Question 13

What are the 10 classes of substance?

Answer 13

1. Alcohol
2. Caffeine
3. Cannabis
4. Hallucinogens
5. Inhalants
6. Opioids
   a. Fentanyl (contact)
7. Sedatives
8. Stimulants
9. Tobacco
10. Other (or unknown): gambling

Question 14

How are substances categorized?

Answer 14

Substance use disorders
Substance –induced disorders

Question 15

The following conditions may be categorized as substance-induced:

Answer 15

Intoxication
Withdrawal
Other substance/medication induced mental disorders (psychotic disorders, bipolar and related, depressive disorders, anxiety disorders, obsessive-compulsive and related, sleep disorders, sexual dysfunctions, delirium, and neurocognitive disorders)

Question 16

What is substance use?

Answer 16

The intake of the substance (orally, intravenously, via smoking, or inhaling, contact).

Question 17

Substance use results in…

Answer 17

cognitive, behavioral, and physiological symptoms, with apparent changes in brain circuits that last beyond immediate intake

Question 18

These criteria apply in diagnosing a substance use disorder:

Answer 18

Impaired control
Social impairment
Risky use
Pharmacological criteria

Question 19

What is intoxication?

Answer 19

refers to and describes the immediate effects of the substance

Question 20

What is tolerance?

Answer 20

a need to increase the dose as the body accommodates to the substance

Question 21

What is withdrawal?

Answer 21

physiological symptoms that can accompany reduced use of the substance or the gradual decrease of the substance in the body as it is eliminated

Question 22

What is addiction?

Answer 22

when both tolerance and withdrawal symptoms are present
- Some medically necessary drugs may lead to tolerance that requires gradually increased dosage, and a number have withdrawal symptoms as well; they do not fall into the substance-related disorders as conceptualized in the DSM framework.

Question 23

What is alcohol?

Answer 23

A CNS depressant
Causes brief sense of excitement; ultimately has the effect of slowing responses over time.

Question 24

Describe alcohol use.

Answer 24

A common disorder
In U.S., 12-month prevalence of alcohol use disorder is 4.6% among 12- to 17-year-olds and 8.5% among 18 years and older.
First episode occurs during mid-teens.
Characterized by periods of remission and relapse.
Typical individual with the disorder has a more promising prognosis.
Adolescents: co-occur with conduct disorder and repeated antisocial behavior.

Question 25

What are risk and prognosis factors of alcohol use?

Answer 25

Environmental: cultural attitude toward drinking and intoxication, availability of alcohol (including price), acquired personal experience w/alcohol, & stress levels
Genetic and physiological: runs in families with 40-60% of risk explained by genetic influences; low-risk phenotypes are the acute alcohol-related skin flush.
Males have higher rates of drinking and related disorders.
Females generally weigh less than males, have more fat and less water in their bodies, and metabolize less alcohol in their esophagus and stomach—likely to develop higher blood alcohol levels per drink than males, heavy drinking more vulnerable to liver disease.

Question 26

What is alcohol intoxication?

Answer 26

Clinically significant problematic behavioral or psychological changes that develop during or shortly after alcohol ingestion.
- Inappropriate sexual or aggressive behavior
- Mood lability
- Impaired judgment
- Impaired social or occupational functioning
One or more symptom:
- Slurred speech
- Incoordination
- Unsteady gait
- Nystagmus
- Impairment in attention or memory
- Stupor or coma

Question 27

What is the most use psychoactive substance around the world?

Answer 27

caffeine

Question 28

What is cannabis?

Answer 28

For many years in the U.S., it has been illegal, and its use highly discouraged because of perceived problems associated with ingestion and its reputation as a “gateway drug.”
In 2013, 20 states plus D.C. made cannabis legal for medicinal purposes.

Question 29

What are hallucinogens?

Answer 29

Includes LSD and PCP
Familiar names: angel dust, super grass, killer weed
Ecstasy is a more recent addition to the list.
Salvia is a newly emerging drug and is marketed as an “herbal high.”

Question 30

What are inhalants?

Answer 30

Readily available: makes them the substance of choice for teens.
Significant medical and psychological consequences: can lead to depression, suicide, and long-term impaired memory and learning.
Examples: spray paint, glue, nail polish remover

Question 31

What are opioids?

Answer 31

This is a public health crisis.
Includes some that are illicit and others that include prescribed analgesics, anesthetics, and cough suppressants, lean.
Heroin is used less frequently than many of the other before mentioned drugs.

Question 32

What are stimulants?

Answer 32

Stimulant use disorder is like alcohol use, but with stimulants.
Two major categories: amphetamines and cocaine
Pattern of onset tend to be different (between prescription amphetamines (Adderall and others used to treat ADHD) and methamphetamine and cocaine (illicit drugs)
As a rule, users increase use over time, a significant number eventually self-limit.

Question 33

What is stimulant intoxication?

Answer 33

Immediate, current use can cause signs of intoxication.
Stimulants can cause tachycardia, pupillary dilation, elevated or lowered blood pressure, perspiration or chills, nausea/vomiting, weight loss, psychomotor agitation or retardation, muscle weakness, impaired respiration, chest pain, cardiac arrhythmias, confusion, seizures, and coma.

Question 34

What is tobacco?

Answer 34

Tobacco use disorder is like alcohol use, but with tobacco.
Less likely to cause dysfunction.

Question 35

What is gambling?

Answer 35

Gambling disorder involves repeated, problem gambling behavior. The behavior leads to problems for the individual, families, and society. Adults and adolescents with gambling disorder have trouble controlling their gambling. They will continue even when it causes significant problems.