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PPC3 Exam 3 > Externalizing Behaviors: General, OCD, ODD > Flashcards

Externalizing Behaviors: General, OCD, ODD Flashcards

1
Q

Internalizing Behaviors (4) and Disorders

A

Behaviors:

  1. Social withdrawal
  2. Depressive symptoms
  3. Sleep problems
  4. Somatic problems

Disorders:
1. Central feature is disordered mood or emotion

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2
Q

Externalizing Behaviors (2) and Disorders

A

Behaviors:

  1. Aggressive
  2. Destructive

Disorders:
1. Central feature is unregulated behavior

*more difficult to treat than internalizing behaviors

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3
Q

DSM 5: OCD and Related Disorders (9)

A
  1. Obsessive-compulsive disorder
  2. Body dysmorphic disorder
  3. Hoarding disorder
  4. Excoriation (skin picking) disorder
  5. Substance /Medication–induced OCD
  6. OCD due to another medical condition
  7. Trichotillomania, now termed trichotillomania disorder (hair pulling), moved to OCD chapter
    a. No longer classified as an impulse control disorder.
  8. Obsessive compulsive and related disorder due to another medical condition
  9. Other specified obsessive compulsive and related disorder
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4
Q

OCD Prevalence (5)

A
  1. Approximately 2.5% of population
  2. May occur in children but more commonly seen in adolescents and adults
  3. Affects about 2.2 million American adults
  4. Men and women in roughly equal numbers
  5. Usually appears in childhood, adolescence, or early adulthood
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5
Q

OCD Obsessions (5)

A

Recurrent and persistent:

  1. Thoughts
  2. Impulses
  3. Images
  4. Experienced, at some time during the disturbance, as intrusive and inappropriate
  5. Cause marked anxiety or distress
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6
Q

OCD: General (3)

A
  1. Either obsessions or compulsions
  2. The person attempts to ignore or suppress such thoughts, impulses or images, or to neutralize them with some other thought or action
  3. The person recognizes that the obsessional thoughts, impulses or images are a product of his or her own mind (not imposed from without as in thought insertion)
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7
Q

OCD: Compulsions (2)

A
  1. Repetitive behaviors
  2. These acts reduce anxiety or reduce dreaded situational anxiety—Acts are not connected in a realistic way to reduction of anxiety and are clearly excessive
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8
Q

Assessing OCD Symptoms (3)

A
  1. Need to differentiate the obsessions, compulsions, and rituals of OCD from similar symptoms found in other disorders

Careful documentation of:

  1. Hours per day spent obsessing and performing compulsive behaviors
  2. Degree of effort applied to trying to escape the obsessions and to resisting the behaviors
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9
Q

Yale-Brown Obsessive Compulsive Scale (5 with 5 symptoms)

A
  1. Measures the severity of OCD symptoms not influenced by the number or type of obsessions or compulsions
  2. Intended to quantify symptom severity in patients diagnosed with OCD, and assess their response to treatment
  3. Not designed for use as a diagnostic measure
  4. Administration on a weekly basis
  5. Symptoms are assessed with regard to:
    a. How much time they occupy the patient’s time
    b. Interfere with normal functioning
    c. Cause subjective distress
    d. Are actively resisted by the patient
    e. Can actually be controlled by the patient
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10
Q

Yale-Brown OCD Scale Checklist looks at competence of (8)

A
  1. Withdrawn
  2. Somatic complaints
  3. Anxious/Depressed
  4. Social behavior problems
  5. Thought problems
  6. Rule-breaking
  7. Aggressive
    1. Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS) a clinician-rated scale of 10 items, each rated from 0 (no symptoms) to 4 (extreme symptoms), scores are summed to give a maximum score of 40.
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11
Q

OCD Psychiatric Management (7)

A
  1. Assess comorbid conditions
    * Anxiety is #1 comorbid condition
  2. Advocate for patients with disabling OCD
  3. Establish goals of treatment
  4. Advise about the genetic risk of OCD to future offspring.
  5. Enhance treatment adherence through education, knowledge of side effects, and exploration of issues such as cost and insurance coverage.
  6. Develop a therapeutic alliance.
  7. Assess the safety of the patient and others with the self-injury or suicide evaluation.
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12
Q

OCD Treatment Options (2)

A
  1. Clinician must consider the patient’s motivation and ability to comply with pharmacotherapy and psychotherapy
  2. 1st line therapy: CBT and SSRI’s are recommended as safe and effective
    a. SSRIs are type 1 drugs that can be used in primary care
    b. CBT can be taught and used in a primary care setting; can get certified in it
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13
Q

Decision to use CBT, an SSRI, or both will depend on (7)

A
  1. Nature and severity of the patient’s symptoms
  2. Presence of any co-occurring psychiatric and/or medical conditions and their treatments
  3. Availability of CBT
  4. Patient’s past treatment history
  5. Patient’s current medications
  6. Patient’s capacities
  7. Patient’s preferences
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14
Q

CBT (3)

A
  1. CBT can be delivered in individual, group, and family therapy sessions, with session lengths varying from < 1 hour to 2 hours.
  2. CBT sessions should be scheduled at least once weekly.
  3. When resources for CBT are not available, the psychiatrist can suggest and supervise the use of self-help treatment guides and recommend support groups such as those accessible through the Obsessive Compulsive Foundation.
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15
Q

Using Exposure and Response Prevention (2)

A
  1. The patient is exposed to situations that elicit the compulsive act and then refrains from performing the accustomed ritual
  2. The assumption is that the ritual is negatively reinforced because it reduces the anxiety that is aroused by some environmental stimulus or event. This is often very unpleasant for patients.
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16
Q

Disruptive behavior disorders: normal development (4)

A
  1. Some degree of oppositional and disruptive behaviors
  2. Child express anger and frustration by 2-6 months
  3. Children by 4-5 are twice as likely to be compliant with adult requests as 2-3 year old
  4. Conflict peaks in early adolescence with a natural decline after this (around 17/18 years old)
17
Q

OCD Treatment Options: CBT Alone (2)

A
  1. Consists of exposure and response prevention
  2. Recommended as initial treatment for a patient who is not too depressed, anxious, or severely ill to cooperate with this treatment modality, or who prefers not to take medications and is willing to do the work that CBT requires
18
Q

OCD Treatment Options: SSRI Alone (3)

A
  1. Patient who is not able to cooperate with CBT
  2. Has previously responded well to a given drug
  3. Prefers treatment with an SRI alone
19
Q

ADHD and Comorbidities in girls (4)

A
  1. Rates of Anxiety (37.7%) in ADHD girls versus controls
  2. Rates of conduct disorder was 12.8% versus . 8% in controls
  3. Rates of oppositional defiant disorder was diagnosed in 42% of girls with ADHD versus 5% in girls
  4. Depression in 10.3% versus 2.9% in control
20
Q

What are risk factors for greater pathology? (8)

A
  1. Isolated acts leading to negligible damage is not a risk factor

Symptoms of greater risk

  1. Many types of disruptive behavior
  2. Proactive or planned aggression; Thinking about or planning aggression
  3. Cruelty
  4. Use of a weapon
  5. Disruptive behavior outside of a reinforcing social context
  6. Male are four times higher for conduct disorder
  7. Children with conduct disorders are much more likely to become part of the penile system than children without
21
Q

Aggressive behavior (2)

A
  1. Aggressive behavior is a final step that begins with some form of provoking stimuli
  2. Provoking stimulus –> angry feelings –> angry thoughts –> angry behavior (verbal or physical)
22
Q

Disruptive, Impulse-Control, and Conduct disorder (DSM5) (8)

A
  1. Oppositional defiant disorder
  2. Intermittent explosive disorder
  3. Conduct disorder
  4. Anti social personality disorder
  5. Pyromania
  6. Kleptomania
  7. Unspecified disruptive, impulse-control
  8. Conduct disorders, unspecified
23
Q

Psych Disorders Associated with Aggression (3)

A
  1. ADHD
  2. Oppositional defiant Disorder
  3. Conduct Disorder
24
Q

Oppositional Defiant Disorder (6)

A
  1. Often considered less severe than Conduct Disorder
  2. A pattern of negativistic, hostile and defiant behaviors during which the child or adolescent exhibits four or more of eight behaviors in the DSM under this disorder and where the pattern of behaviors lasts at least six months.
  3. As with other diagnoses in this category the disturbance and behavior must result in clinically significant impairment in social, academic or occupational functioning in order for the criteria to be met.
  4. The troublesome behaviors must not occur exclusively during the course of a psychotic or mood disorder.
  5. Finally, for the diagnosis of Oppositional Defiant Disorder to be made, the criteria must not be met for Conduct Disorder.
    a. Ex: conduct disorder would be cruelty towards animals
  6. If the individual is 18 years of age or older, then the criteria must not be met for Antisocial Personality Disorder.
25
Q

ODD Prevalence (6)

A
  1. Prevalence estimated about 3.3%
  2. Male to female ratio (1.4:1 prior to adolescence
  3. Symptoms can start in preschool years and rarely later than early adolescence
  4. Risk for anxiety disorder and major depressive disorder if predominately angry or irritable mood
  5. If defiant, argumentative or vindictive → greater risk for conduct disorder
  6. Not all ODD goes on to conduct disorder
26
Q

Diagnostic Criteria for ODD (7 with info of angry/argumentative behavior)

A
  1. 6 months of angry/irritable mood, argumentative/ defiant behavior or vindictiveness in 4 of the 8 symptoms
  2. Angry/irritable mood
    A. Often loses temper
    B. Is often touchy or easily annoyed
    C. Is often angry and resentful
  3. Argumentative/Defiant Behavior
    A. Often argues with authority figures or for children and adolescent with adults
    B. Often actively defies or refuses to comply with requests from authority figures or rules
    C. Often deliberately annoys others
    D. Often blames others for his or her mistakes or misbehavior
  4. Vindictiveness
    A. Has spiteful or vindictive at least twice within the past 6 months
  5. For children younger than 5, the behavior should occur on most days for a period of at least six months
  6. For children over 5 years, once a week for six months
  7. Other factors should be considered—Is the frequency or intensity of the behaviors outside the range that is normative for the child’s developmental level, culture, and gender
27
Q

ODD Severity (3)

A
  1. Mild: Symptoms are confined to one settings (work, home, school or peers)
  2. Moderate: Some symptoms are present in at least two settings
  3. Severe: Some symptoms are present in three or more settings
    * Severity depends on settings
28
Q

Common features of Oppositional Defiant Disorder (ODD) (7)

A
  1. Excessive, often persistent anger
  2. Frequent temper tantrums or angry outburst
  3. Disregard for authority
  4. Annoy others on purpose
  5. Blame someone else for their behaviors
  6. More rigid and defiant behavior
  7. Revengeful
29
Q

Behavioral Features of ODD (7)

A
  1. Argues with adults
  2. Blames others for own mistakes
  3. Has few or no friends or has lost friends
  4. Is in constant trouble in school
  5. Spiteful or seeks revenge
  6. Touchy or easily annoyed
  7. Generally, these patterns of behavior will lead to problems at school and other social venues
30
Q

ODD Differential Dx (6)

A
  1. Conduct disorder
    a. Related to conduct problems
    b. More severe than ODD
    c. ODD does not include aggression toward people or animals; property destruction, pattern of theft and deceit
    * This would be criteria for conduct disorder
  2. ADHD
    a. Depressive or bipolar disorder
    b. Disruptive mood dysregulation disorder
    * Severity, frequency, and chronicity of temper outburst are more severe
  3. Intermittent explosive disorder
    * High rates of anger with serious aggression
  4. Intellectual disability
  5. Language disorder
  6. Social anxiety disorder
    * Defiance due to negative evaluation associated with social anxiety disorder
31
Q

ODD Screening (4)

A
  1. In the past 3 months has your child been spiteful or vindictive or blamed others for his or her mistakes
  2. How often is your child touchy or easily annoyed (more than once a week is a positive response)
  3. How often has your child lost his or her temper, argued with adults, or defied or refused adults’ request (more than once a week is positive)
  4. How often is your child angry and resentful or deliberately annoying to others (more than 3X per week is a positive response)

PPC3 Exam 3 (10 decks)

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