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Diagnosis_Management 1 > Disruptive, impulse-control, and conduct disorders > Flashcards

Disruptive, impulse-control, and conduct disorders Flashcards

1
Q

characteristic of aggression associated with intermittent explosive disorder in relation to stressor

A

out of proportion to stressor

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2
Q

what does a kleptomaniac typically do with stolen items

A

returns, gives away or hides them

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3
Q

what is defining about the objects stolen in kleptomania

A

they are not needed, typically have no value, and could have easily been afforded

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4
Q

what is characteristic about planning theft in kleptomania

A

not planned and does not involve others

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5
Q

characteristics of aggressive outbursts associated with intermittent explosive disorder

A

rapid onset, often without warning, which typically subsides in approximately 30 minutes

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6
Q

age to diagnose intermittent explosive disorder

A

at least 6

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7
Q

parental risk factors for intermittent explosive disorder

A

alcohol abuse
violence
emotional instability
poor work history
marital/legal problems

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8
Q

impulses in kleptomania

A

recurrent with inability to resist

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9
Q

what is characteristic about tension associated with impulse control disorders

A

tension before with immediate gratification after

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10
Q

what distinguishes pyromania from arson

A

they do not personally benefit from fire setting in pyromania

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11
Q

what are some tests to r/o other causes of aggression

A

liver/thyroid function tests
fasting glucose
electrolytes
UDS

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12
Q

what MRI finding is associated with loss of impulse control

A

changes in PFC

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13
Q

definition of impulse

A

tension state that exists without action

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14
Q

definition of compulsion

A

tension state that always has an action component

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15
Q

gratification associated with impulses and compulsions

A

impulses associated with gratification. Compulsions are generally unpleasant

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16
Q

conditions to r/o prior to dx intermittent explosive disorder

A

psychosis
antisocial personality disorder
borderline personality disorder
substance abuse
epilepsy
brain tumors
degenerative diseases
endocrine disorders

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17
Q

what differentiated intermittent explosive disorder from conduct disorder and antisocial personality disorder

A

episodic and discrete nature of outbursts

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18
Q

difference between theft in kleptomania and antisocial personality disorder

A

antisocial personality disorder is often premeditated and for personal gain, regularly involves threats of or actual harm, and lacks guilt/remorse

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19
Q

malingering in relation to kleptomania

A

claiming kleptomania to avoid punishment for stealing

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20
Q

what differentiates fire setting in pyromania from conduct or antisocial personality disorder

A

in conduct and antisocial personality disorder fire setting is deliberate and not the result of inability to control an impulse

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21
Q

percentage of comorbid mental disorders with intermittent explosive disorder

A

> 80%

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22
Q

onset/course of intermittent explosive disorder

A

usually in late adolescence/early adulthood and may be insidious. Severity tends to decrease with age

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23
Q

onset/course of kleptomania

A

onset usually in adolescence with chronic course that waxes and wanes

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24
Q

onset/course of pyromania

A

onset usually in adolescence with chronic course that may wax and wane

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25
Q

goal of therapy in the treatment of intermittent explosive disorder

A

for the patient to recognize and verbalize prior to acting on aggressive impulse

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26
Q

possible therapies that may be helpful in the treatment of intermittent explosive disorder

A

group/family
CBT
contingent management

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27
Q

medication management of intermittent explosive disorder

A

antipsychotics, SSRIs, buspirone, trazadone, lithium, anticonvulsants

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28
Q

benzodiazepines with intermittent explosive disorder

A

can cause behavioral inhibition which may worsen symptoms

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29
Q

therapies that may be useful in treating kleptomania

A

insight-oriented therapy and psychoanalysis as well as CBT depending on motivation

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30
Q

therapies that have been shown useful in the treatment of kleptomania regardless of motivation

A

systematic desensitization and aversive conditioning

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31
Q
A
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32
Q

medications that have been helpful in the treatment of kleptomania

A

fluvoxamine and fluoxetine

33
Q

why is tx of pyromania so difficult

A

lack of patient motivation

34
Q

tx approaches for pyromania when manifesting in children

A

family therapy and behavioral approaches that are preventative and not punitive

35
Q

dysfunction of what area of the brain is associated with intermittent explosive disorder

A

PFC

36
Q

relatives of those with kleptomania tend to have higher rates of which mental disorders

A

OCD
alcohol abuse

37
Q

what type of behaviors are the most common reason for psychiatric referral in children

A

oppositional and aggressive

38
Q

what differentiates ODD from conduct disorder

A

ODD usually is not aggressive or violent and typically do not violate the rights of others

39
Q

main characteristics of ODD

A

hostility towards authority figures and inability to take responsibility for mistakes leads to blaming others for behavior

40
Q

symptom categories for ODD

A

angry/irritable
argumentative/defiant
vindictive

41
Q

manifestations of anger/irritability in ODD

A

often loses temper and are easily annoyed
irritable much of the time

42
Q

5 argumentative/defiant symptoms of ODD

A

-arguing with authority figures
-refuse to comply with requests
-deliberately breaks rules
-annoys others intentionally
-blames others for misbehavior

43
Q

vindictive sx of ODD

A

spiteful at least twice in 6 months

44
Q

what other mental disorder automatically excludes ODD as a dx

A

disruptive dysregulation disorder

45
Q

what is typically found in the psych hx of those dx with conduct disorder

A

ODD (maybe comorbid)

46
Q

most effective treatment strategies for ODD

A

family interventions

47
Q

family interventions that have been effective in treating ODD

A

-parent training in child management skills
-assessment of family interactions
-CBT for patient and family

48
Q

goal of therapy for ODD

A

diminish bad behavior while simultaneously reinforcing prosocial behaviors

49
Q

basic definition of disruptive mood dysregulation disorder

A

severe developmentally inappropriate recurrent temper outbursts at least three times weekly with persistently irritable mood between outbursts

50
Q

onset and duration of sx for dx of disruptive mood dysregulation disorder

A

onset prior to age 10 with sx present for at least 1 year

51
Q

sx must be present in how many settings for dx of disruptive mood dysregulation disorder

A

at least 2

52
Q

age range for dx of disruptive mood dysregulation disorder

A

6-18

53
Q

what differentiates disruptive mood dysregulation disorder from pediatric bipolar

A

irritability is persistent in disruptive mood dysregulation disorder

54
Q

differentiating factors between disruptive mood dysregulation disorder and ODD

A

ODD includes sx of annoyance and defiance and only requires sx be present in 1 setting

55
Q

what is the focus of treatment for disruptive mood dysregulation disorder

A

symptomatic interventions
CBT likely to be beneficial

56
Q

mean age of onset for disruptive mood dysregulation disorder

A

5-11

57
Q

what is the main characterization of conduct disorder

A

aggression and violation of the rights of others

58
Q

4 categories of exhibited behaviors in conduct disorder

A

-physical aggression/threats of harm to people
-destruction of property
-theft or acts of deceit
-frequent violation of age appropriate rules

59
Q

frequency of behaviors for dx of conduct disorder

A

3 persistent behaviors over 12 months with at least one being present for at least 6 months

60
Q

when can conduct disorder be dx after age 18

A

when criteria not met for antisocial personality disorder

61
Q

mild conduct disorder

A

few conduct problems beyond what is required for dx and behaviors cause only minor harm to others

62
Q

moderate conduct disorder

A

sx exceed minimum requirements but there is less confrontation and harm to others than with severe forms

63
Q

severe conduct disorder

A

many sx beyond requirements or behaviors cause significant harm to others

64
Q

the specifier for “with limited prosocial emotions” applies to conduct disorder when there are at least 2 of what 4 sx

A

lack of remorse/guilt
callous lack of empathy
unconcerned about performance
shallow or deficient affect

65
Q

what is more likely regarding onset and severity of conduct disorder when criteria is met for “limited prosocial emotions”

A

childhood onset and severe form of disorder

66
Q

childhood onset conduct disorder

A

at least 1 sx manifests prior to age 10

67
Q

adolescent onset conduct disorder

A

no sx prior to age 10

68
Q

guilt/remorse in conduct disorder

A

often feel to some degree but try to blame others for behavior to avoid punishment

69
Q

parenting styles that predispose to conduct disorder

A

excessively harsh parenting or lack of parental supervision

70
Q

common comorbidities of conduct disorder

A

ADHD, learning, and substance use disorders

71
Q

negative prognostic signs for conduct disorder

A

young age
high number of sx
severe sx

72
Q

good prognostic signs for conduct disorder

A

mild sx
lack of comorbidities
normal intellectual function

73
Q

CBT strategies that have proven efficacy in the treatment of conduct disorder

A

-problem solving skills training
-parent management training
-anger coping program

74
Q

what sx of conduct disorder can be txd with psychosocial interventions

A

better at targeting overt (aggression) than covert (lying/stealing) sx

75
Q

psychopharmacologic management of aggression in conduct disorder

A

risperidone
seroquel has shown some efficacy

76
Q

medication management of impulsivity, irritability, and mood lability in conduct disorder

A

SSRIs
(fluoxetine, sertraline, paroxetine, citalopram)

77
Q

what brain areas have decreased gray matter in conduct disorder

A

limbic structures
bilateral anterior insula
left amygdala

78
Q

what is B-hydroxylase

A

enzyme that converts dopamine to norepinephrine

79
Q

B hydroxylase in conduct disorder

A

low

Diagnosis_Management 1 (16 decks)

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