Disruptive, impulse-control, and conduct disorders Flashcards
characteristic of aggression associated with intermittent explosive disorder in relation to stressor
out of proportion to stressor
what does a kleptomaniac typically do with stolen items
returns, gives away or hides them
what is defining about the objects stolen in kleptomania
they are not needed, typically have no value, and could have easily been afforded
what is characteristic about planning theft in kleptomania
not planned and does not involve others
characteristics of aggressive outbursts associated with intermittent explosive disorder
rapid onset, often without warning, which typically subsides in approximately 30 minutes
age to diagnose intermittent explosive disorder
at least 6
parental risk factors for intermittent explosive disorder
alcohol abuse
violence
emotional instability
poor work history
marital/legal problems
impulses in kleptomania
recurrent with inability to resist
what is characteristic about tension associated with impulse control disorders
tension before with immediate gratification after
what distinguishes pyromania from arson
they do not personally benefit from fire setting in pyromania
what are some tests to r/o other causes of aggression
liver/thyroid function tests
fasting glucose
electrolytes
UDS
what MRI finding is associated with loss of impulse control
changes in PFC
definition of impulse
tension state that exists without action
definition of compulsion
tension state that always has an action component
gratification associated with impulses and compulsions
impulses associated with gratification. Compulsions are generally unpleasant
conditions to r/o prior to dx intermittent explosive disorder
psychosis
antisocial personality disorder
borderline personality disorder
substance abuse
epilepsy
brain tumors
degenerative diseases
endocrine disorders
what differentiated intermittent explosive disorder from conduct disorder and antisocial personality disorder
episodic and discrete nature of outbursts
difference between theft in kleptomania and antisocial personality disorder
antisocial personality disorder is often premeditated and for personal gain, regularly involves threats of or actual harm, and lacks guilt/remorse
malingering in relation to kleptomania
claiming kleptomania to avoid punishment for stealing
what differentiates fire setting in pyromania from conduct or antisocial personality disorder
in conduct and antisocial personality disorder fire setting is deliberate and not the result of inability to control an impulse
percentage of comorbid mental disorders with intermittent explosive disorder
> 80%
onset/course of intermittent explosive disorder
usually in late adolescence/early adulthood and may be insidious. Severity tends to decrease with age
onset/course of kleptomania
onset usually in adolescence with chronic course that waxes and wanes
onset/course of pyromania
onset usually in adolescence with chronic course that may wax and wane
goal of therapy in the treatment of intermittent explosive disorder
for the patient to recognize and verbalize prior to acting on aggressive impulse
possible therapies that may be helpful in the treatment of intermittent explosive disorder
group/family
CBT
contingent management
medication management of intermittent explosive disorder
antipsychotics, SSRIs, buspirone, trazadone, lithium, anticonvulsants
benzodiazepines with intermittent explosive disorder
can cause behavioral inhibition which may worsen symptoms
therapies that may be useful in treating kleptomania
insight-oriented therapy and psychoanalysis as well as CBT depending on motivation
therapies that have been shown useful in the treatment of kleptomania regardless of motivation
systematic desensitization and aversive conditioning
medications that have been helpful in the treatment of kleptomania
fluvoxamine and fluoxetine
why is tx of pyromania so difficult
lack of patient motivation
tx approaches for pyromania when manifesting in children
family therapy and behavioral approaches that are preventative and not punitive
dysfunction of what area of the brain is associated with intermittent explosive disorder
PFC
relatives of those with kleptomania tend to have higher rates of which mental disorders
OCD
alcohol abuse
what type of behaviors are the most common reason for psychiatric referral in children
oppositional and aggressive
what differentiates ODD from conduct disorder
ODD usually is not aggressive or violent and typically do not violate the rights of others
main characteristics of ODD
hostility towards authority figures and inability to take responsibility for mistakes leads to blaming others for behavior
symptom categories for ODD
angry/irritable
argumentative/defiant
vindictive
manifestations of anger/irritability in ODD
often loses temper and are easily annoyed
irritable much of the time
5 argumentative/defiant symptoms of ODD
-arguing with authority figures
-refuse to comply with requests
-deliberately breaks rules
-annoys others intentionally
-blames others for misbehavior
vindictive sx of ODD
spiteful at least twice in 6 months
what other mental disorder automatically excludes ODD as a dx
disruptive dysregulation disorder
what is typically found in the psych hx of those dx with conduct disorder
ODD (maybe comorbid)
most effective treatment strategies for ODD
family interventions
family interventions that have been effective in treating ODD
-parent training in child management skills
-assessment of family interactions
-CBT for patient and family
goal of therapy for ODD
diminish bad behavior while simultaneously reinforcing prosocial behaviors
basic definition of disruptive mood dysregulation disorder
severe developmentally inappropriate recurrent temper outbursts at least three times weekly with persistently irritable mood between outbursts
onset and duration of sx for dx of disruptive mood dysregulation disorder
onset prior to age 10 with sx present for at least 1 year
sx must be present in how many settings for dx of disruptive mood dysregulation disorder
at least 2
age range for dx of disruptive mood dysregulation disorder
6-18
what differentiates disruptive mood dysregulation disorder from pediatric bipolar
irritability is persistent in disruptive mood dysregulation disorder
differentiating factors between disruptive mood dysregulation disorder and ODD
ODD includes sx of annoyance and defiance and only requires sx be present in 1 setting
what is the focus of treatment for disruptive mood dysregulation disorder
symptomatic interventions
CBT likely to be beneficial
mean age of onset for disruptive mood dysregulation disorder
5-11
what is the main characterization of conduct disorder
aggression and violation of the rights of others
4 categories of exhibited behaviors in conduct disorder
-physical aggression/threats of harm to people
-destruction of property
-theft or acts of deceit
-frequent violation of age appropriate rules
frequency of behaviors for dx of conduct disorder
3 persistent behaviors over 12 months with at least one being present for at least 6 months
when can conduct disorder be dx after age 18
when criteria not met for antisocial personality disorder
mild conduct disorder
few conduct problems beyond what is required for dx and behaviors cause only minor harm to others
moderate conduct disorder
sx exceed minimum requirements but there is less confrontation and harm to others than with severe forms
severe conduct disorder
many sx beyond requirements or behaviors cause significant harm to others
the specifier for “with limited prosocial emotions” applies to conduct disorder when there are at least 2 of what 4 sx
lack of remorse/guilt
callous lack of empathy
unconcerned about performance
shallow or deficient affect
what is more likely regarding onset and severity of conduct disorder when criteria is met for “limited prosocial emotions”
childhood onset and severe form of disorder
childhood onset conduct disorder
at least 1 sx manifests prior to age 10
adolescent onset conduct disorder
no sx prior to age 10
guilt/remorse in conduct disorder
often feel to some degree but try to blame others for behavior to avoid punishment
parenting styles that predispose to conduct disorder
excessively harsh parenting or lack of parental supervision
common comorbidities of conduct disorder
ADHD, learning, and substance use disorders
negative prognostic signs for conduct disorder
young age
high number of sx
severe sx
good prognostic signs for conduct disorder
mild sx
lack of comorbidities
normal intellectual function
CBT strategies that have proven efficacy in the treatment of conduct disorder
-problem solving skills training
-parent management training
-anger coping program
what sx of conduct disorder can be txd with psychosocial interventions
better at targeting overt (aggression) than covert (lying/stealing) sx
psychopharmacologic management of aggression in conduct disorder
risperidone
seroquel has shown some efficacy
medication management of impulsivity, irritability, and mood lability in conduct disorder
SSRIs
(fluoxetine, sertraline, paroxetine, citalopram)
what brain areas have decreased gray matter in conduct disorder
limbic structures
bilateral anterior insula
left amygdala
what is B-hydroxylase
enzyme that converts dopamine to norepinephrine
B hydroxylase in conduct disorder
low
