Disruptive, Impulse Control, and Conduct Disorders Flashcards
Negativistic, hostile, and defiant behavior more severe than what is seen in most children of same mental age. Precursors appear between age 3 and 7 years. Disorder begins around age 8 years.
Oppositional Defiant Disorder (ODD)
Power struggle between parent and child sets stage for development of disorder. Early display of angry/irritable mood, argumentative/defiant behavior, and vindictiveness. More common in boys before puberty.
ODD
Clinical manifestations include: actively defies or refuses adult requests or rules, argumentative, angry, resentful, touchy or easily annoyed, easily loses temper, blames others for mistakes, deliberately annoys others, relationship and communication problems, eating and sleeping problems, may have encopresis or enuresis, passive-aggressive, defiant, runs away, school problems, and resistant to change.
ODD
Interventions include environmental manipulation to reduce variety of caregivers and minimize stimulation. Work on child accepting responsibility for behavior, increasing self-esteem, and improving social interactions. Work with parents on positive parenting strategies, consistency, and use skills of Parent Child Interactive Therapy (PCIT). Pharmacotherapy is NOT first-line treatment but risperidone (agitation), lithium (mood), methylphenidate (comorbid ADHD), and clonidine (aggression) may be used.
ODD
Persistent pattern of behavior in which person violates basic rights of others and major age-appropriate societal norms or rules. Onset of aggressive behavior may be observed in toddlerhood. Formal diagnosis made after age 7 but before age 18. More common in boys before and during puberty.
Conduct Disorder (CD)
Multifactorial etiology with possible genetic predisposition, difficult temperament, elevated levels of plasma testosterone, impaired social-cognition, rejection by peers, poor parenting skills, inconsistent discipline, overly aggressive/permissive discipline, changing caregivers, marital conflict, early institutionalization, socialization with delinquent social group, and ineffective communication patterns.
Conduct Disorder
Clinical manifestations include physical aggression toward people and animals, temper tantrums, annoying behaviors, disobedience to authorities, lying, cheating, covert stealing, truancy, running away, impaired social role function, poor academic performance, poor family/peer relationships, poor self-management, substance abuse, possible sexual promiscuity, use of projection as defense mechanism.
Conduct Disorder
Interventions similar to ODD but should include plan for protection for others from patient’s aggression. Skills teaching for patient and family, recreational therapies, medications for explosive aggression, and screening for comorbid conditions (depression).
Conduct Disorder
Recurrent behavior episodes of failure to control aggressive impulses which are grossly out of proportion to precipitating factors and not premeditated. Episodes result in verbal aggression or physical aggression toward individuals, animals, or property that does not result in damage or injury. Episodes occur on average twice weekly for 3 months or more. Episodes that do result in damage may happen 3x/year.
Intermittent Explosive Disorder
Age of onset may be 6 years old to early 20s and lifetime prevalence is similar for adults and adolescents (7-8%). Comorbidities seen with mood disorders, anxiety disorders, OCD, and substance use. Abnormalities seen in serotonin in limbic system. First-line treatment is CBT and medication use is often off-label: beta-blockers, SSRIs, anticonvulsants, atypicals, mood stabilizers.
IED
Stealing not committed to express anger or vengeance and not in response to delusion or hallucination but rather to relieve tension/anxiety. More common in females and age of onset is variable.
Kleptomania
Deliberate and purposeful fire setting on more than one occasion that results in pleasure in witnessing burning or participating in aftermath. Act is not done for monetary gain, to conceal criminal activity, express anger, or as a result of impaired judgement. Plan for act involves duty to warn.
Pyromania
