Disruptive, Impulse, Conduct Disorders

Question 1

Oppositional defiant disorder general description

Answer 1

Persistent pattern of hostile, angry, argumentative, and defiant behaviors, more than typical for age/developmental status, causing significant impairment.

Question 2

Diagnostic criteria for oppositional defiant disorder

Answer 2

• More days than not for 6 months if < 5 years old
• At least once per week for 6 months if 5 years or older
• Must exhibit at least 4 symptoms in an interaction with a non-sibling
• Cross-situational experiences indicate greater severity

Question 3

Signs/symptoms of ODD

Answer 3

1) Angry/Irritable mood
2) Argumentative/defiant: argues with authorities, defies requests for compliance, deliberately annoys others, blames others
3) Vindictiveness: at least 2x within past 6 months

Question 4

Risk factors of ODD

Answer 4

marital discord, poor parenting practices/inconsistent limit setting, low family cohesion, parental mental disorder or substance abuse

Question 5

Usual onset of ODD

Answer 5

6-8 yo

Question 6

Most common comorbidity of ODD

Answer 6

ADHD

• also associated with anxiety, depression, learning or communication disorder

Question 7

Oppositional Defiance Disorder treatment

Answer 7

• Referral to psych for eval (psychotherapy, +/-CBT)
• Parent management training, peer training
• Meds used in treating other disorders (ADHD, depression, anxiety) sometimes helpful

Question 8

How is Disruptive Mood Dysregulation different than ODD?

Answer 8

• Baseline irritable mood

- Reckless aggression against people, animals, property (more physical)

Question 9

Intermittent Explosive Disorder

Answer 9

recurrent episodes of inability to control aggressive impulses

Question 10

Intermittent Explosive Disorder is not diagnosable before age ____.

Answer 10

6 yo

Question 11

Intermittent Explosive Disorder diagnostic criteria

Answer 11

verbal or physical aggression occurring 2x/week for 3 months
OR
3 outbursts involving damage, destruction, or injury

Question 12

Onset of IED

Answer 12

abrupt

peaks in adolescence

Question 13

IED treatment

Answer 13

• Refer for psychotherapy and pharm tx

- CBT sometimes helpful

Question 14

Symptom groupings of Conduct Disorder

Answer 14

at least 3 in the past year, and at least 1 in the past 6 months:

• Aggressive behavior that threatens or causes bodily harm to animals or other people
• Nonaggressive behavior that results in property damage or loss
• Theft or deceitfulness
• Significant breaches of rules and regulations

Question 15

Words that describe a person with conduct disorder?

Answer 15

bully, fighter, cruel, runaway, con people, thief, sexual predators

Question 16

Comorbidities with conduct disorder

Answer 16

ODD, ADHD, mood, anxiety, cognitive disability, substance use

Question 17

40% of children diagnosed with conduct disorder develop _______ as adults.

Answer 17

antisocial personality disorder

Question 18

General description of conduct disorder

Answer 18

• Persistent and recurrent behavior that violates accepted age-appropriate rules or societal norms
• Patterns present in multiple environments
• Not just a childhood diagnosis

Question 19

Conduct disorder treatment

Answer 19

Recognize comorbid psychiatric disorders- ODD, ADHD, IED, depression…

Therapeutic interventions:

• Parent management
• Problem-solving skills
• Multisystem therapies
• Difficult to choose meds because symptoms are generally vague -> refer

Question 20

pyromania signs/symptoms

Answer 20

• deliberate and purposeful fire-setting
• tension ro affective arousal preceding act
• fascination with fire
• pleasure, gratification, or relief when setting
• no monetary gain, expression of ideology, no criminal intentions

Question 21

How is arson different than pyromania?

Answer 21

An arsonist has criminal motivation or feelings of revenge

Pyromania is a psych disorder of fire obsession

Question 22

Treatment of pyromania

Answer 22

• Medications not approved
• Impulse control drugs may help (opioid antagonists, topiramate, SSRIs, and lithium)
• Fire Safety Education and CBT show good results in kids

Question 23

Definition of kleptomania

Answer 23

inability to resist repetitive urges to steal specific items

Question 24

signs/sx’s of kleptomania

Answer 24

• increasing sense of tension before act
• pleasure, gratification, or relief with theft
• not an expression of anger, vengeance, or for personal gain

Question 25

Possible physiological cause of kleptomania

Answer 25

lowered inhibition (poor serotonin inhibition), elevated urge (deficiency of dopamine reward)

Question 26

Kleptomania treatment

Answer 26

Off-label medications

• Opioid antagonists
• SSRIs
• Psychotherapy not well studied