Disruptive, Impulse control and conduct disorders

Question 1

what is kleptomania

Answer 1

compulsive shoplifting/stealing
typically begins in adolescence or early childhood
typically a chronic condition

Question 2

what are the treatments for Kleptomania

Answer 2

SSRI or Naltrexone have been shown to help
treat other co-morbid conditions to reduce impulses
CBT to reduce behaviors

Question 3

what is pyromania

Answer 3

compulsive fire-starting
males> or = to females
typically starts in late teens to early 20s

Question 4

what is pyromania often associated with

Answer 4

SUD, mood disorders, other impulse disorders

Question 5

what is pyromania not done for

Answer 5

money
to make a statement
to conceal a crime
out of anger or for revenge
for material gain
as a result of impairment
secondary to a delusion/hallucination

Question 6

what are the treatment options for pyromania

Answer 6

no real pharmacologic options
treatment of co-occuring disorders can limit behaviors
exposure to victims/aftermath may discourage behavior
psychotherapy/CBT for stress management techniques

Question 7

what is intermittent explosive disorder

Answer 7

impaired ability to control aggressions
M»F
usually someone society would label as having an ‘anger problem’
symptoms often present with other psychiatric or medical disorders

Question 8

what is the treatment for intermittent explosive disorder

Answer 8

No FDA approved medications - SSRI, Oxcarbazepine (Trileptal), beta blockers, SGAs, BZDs all tried off label
CBT to help identify triggers and learning anger management techniques

Question 9

What is oppositional defiant disorder

Answer 9

characterized by defiant behaviors
diagnosis for children - as early as 3 years, as late as adolescence
boys> girls until puberty
may develop into conduct disorder
high risk of other mood/anxiety disorders

Question 10

what is the treatment for ODD

Answer 10

no specific pharmacotherapy
individual and family therapies
-child: learning to manage their responses to situation
- family: positive and negative reinforcement techniques
treatment of any co-morbid conditions can reduce behaviors

Question 11

what are the categories of ODD

Answer 11

angry/irritable
argumentative/defiant
vindictive

Question 12

what is angry/irritable ODD

Answer 12

looses temper frequently
‘touchy’ or easily annoyed
frequently angry/resentful

Question 13

what is argumentative/defiant ODD

Answer 13

argues with authority figures or adults (if child)
actively defies rules or refuses to comply
deliberately annoys others
blames others for their mistakes/behaviors

Question 14

what is vindictive ODD categorized by

Answer 14

spiteful or vindictive 2+ times in the last 6 months

Question 15

what is conduct disorder

Answer 15

big brother to ODD
recurrent aggressions that violate the rights of others or societal norms
the childhood form of antisocial personality disorder or psychopathy: 25-40% will progress to APD

Question 16

who is at risk for developing conduct disorder

Answer 16

history of physical or sexual abuse
adopted children
parental SUD
Parental separation
rejection/abandonment/neglect
overly harsh punishment

Question 17

What are the types of conduct disorders?

Answer 17

childhood: <10 years old, worse prognosis
Adolescent types: >10 years old, better prognosis

Question 18

what is the specifier of conduct disorder with the DSM-5 criteria

Answer 18

‘limited prosocial emotions’ (‘sociopath’ or ‘psychopath’)
2+ of the following over 12 months and in multiple settings: lack of remorse/guilt, lack of empathy, unconcerned about performance, shallow of deficient affects

Question 19

what are the levels of severity of conduct disorders

Answer 19

Mild - severe

Question 20

what is the treatment for conduct disorder

Answer 20

mild= individual and family therapy; parenting classes
if more severe, may also require residential treatment or juvenile detention
treat co-morbid disorders to help control aggressive behavior
no FDA approved pharmacologic agents: Haloperidol, Risperidone, SGAs and Lithium have been used

Question 21

how do you manage a patient/family with an impulse/control disorder?

Answer 21

be honest regarding prognosis
many patients will face legal/social/financial consequences
be aware patient AND PARENTS are at risk of SUD, Depression, PD
Effective management often requires parental and even teacher buy-in
communicate parental techniques effectively