Disruptuve Impulse Control

Question 0

bright and articulate
new student
ability to express on paper 
cannot take no for an answer
does not follow rules and directions
socially isolated
not many friends
starts fights
happens both at home and public
pt feels behavior is fine

Answer 0

Oppositional defiant disorder

Question 1

Oppositional defiant disorder?

Answer 1

persistent pattern of hostile, angry, argumentative and defiant behaviors

Question 2

Oppositional defiant disorder-time line?

Answer 2

6 mo or more

Question 3

Oppositional defiant disorder -dx?

Answer 3

angry irritable mood
argumentative
vindictiveness (seeking revenge)
NOT a sibling interaction
longer than 6 mo

Question 4

Oppositional defiant disorder-age?

Answer 4

5yo: can still dx but keep in mind children may not have coping mechanisms
5yo+: more than once a week

Question 5

Oppositional Defiant disorder-RF?

Answer 5

marital discord
poor parenting/inconsistent limit-setting
low family cohesion
parental mental disorder/substance abuse
biological
environmental
societal/socioeconomic

Question 6

Oppositional Defiant disorder - comorbidity?

Answer 6

ADHD

Question 7

Oppositional Defiant disorder-tx?

Answer 7

cautious dx: consider age appropriate expectations
parent management training
peer training (through a school system: antibully, etc)
pyschotherapeutics (referral)
meds tx related disorders sometimes helpful

Question 8

Intermittent explosive disorder?

Answer 8

recurrent episodes of inability to control aggressive impulses

Question 9

Intermittent explosive disorder-sx?

Answer 9

verbal or physical agrresison to people, property or animals in 3mo
OR
3 outbursts of damage, destruction, or injury over 12 mo

Question 10

Intermittent explosive disorder-etiology?

Answer 10

hx of traumatic exposure

heredity?

Question 11

Intermittent explosive disorder-tx?

Answer 11

pharmacologic tx + psychotherapy: managed by psychiatry
CBT is SOMETIMES helpful
REFER

Question 12

Conduct Disorder?

Answer 12

persistent and recurrent behavior style that violates rules/societal norms, and fundamental rights of others

Question 13

Conduct disorders - sx?

Answer 13

aggressive behavior: threatens or x bodily harm to people/animal
nonaggressive behavior: results in property damage or loss
theft or deceitfulness
breaches of rules and regulation

Question 14

Conduct disorders - associated weapons/hx?

Answer 14

guns and knives
BROKEN bottles
break ins
damaged property
fires
injuries

Question 15

Conduct disorder - specifiers?

Answer 15

lack of remorse or guilt
callous (lack of empathy)
unconcerned
shallow or deficient affect

Question 16

What can CD turn into?

Answer 16

antisocial personality disorder

Question 17

Conduct disorder - tx?

Answer 17

parent management
prob solving skills
multisystem therapies
pharmacology (hard to choose) - REFER

Question 18

Conduct disorder cormobidity?

Answer 18

ODD
ADHD
IED
depressive
bipolar

Question 19

Pyromania?

Answer 19

pahtological fire setting

Question 20

Pyromania -timeline?

Answer 20

adolescence or early adulthood

Question 21

Pyromania - sx?

Answer 21

deliberate and purposeful repeated fire-setting
tension or affective arousal preceding
fascination/interest/curiosity/attraction to fire
pleasure/gratification/relief whens netting/witnessing fires
NO monetary gain/ideology

Question 22

Pyromania - cycle?

Answer 22

tension–> set fire –> relief/pleasure –> goes away

Question 23

Pyromania - tx?

Answer 23

no meds are approved
impulse control drugs may help - opiod antagonists; topiramate, escitalopram, sertaline, lithium
children: fire safety education and CBT

Question 24

Kleptomania?

Answer 24

inability to resist repetitive urges to steal specific items: NOT REQUIRED FOR PERSONAL FXN
NOT an expression of anger, vengeance, hallucination, etc

Question 25

Kleptomania cycle?

Answer 25

tension –> steal –> relief

Question 26

Kleptomania- tx?

Answer 26

off label opiod antagonists

SSRI

Question 27

Kleptomania - etiology?

Answer 27

low inhibition (serotonin inhibition) and pathologically elvated urge (low in dopamine)