impulse control disorder (329 E3)

Question 1

3 types of impulse control disorders

Answer 1

1) oppositional defiant disorder
2) conduct disorder
3) intermittent explosive disorder

Question 2

with oppositional defiant disorder, behaviors

Answer 2

exceed the boundaries of what is socially acceptable -> impacting both emotions and behaviors

Question 3

ODD characteristics

Answer 3

-Negative, hostile, defiant, vindictive
-Pattern of irritable and angry mood.
-Swearing
-Mood lability (angry outbursts)
-low frustration tolerance
-interpersonal conflicts
-stubbornness
-starts around age 8
most children outgrow this disorder

Question 4

people w/ ODD at risk for

Answer 4

-developing a conduct disorder
-anxiety and mood disorders
-early onset of substance abuse

Question 5

risk factors for ODD

Answer 5

-Genetic component; family history of mental illness
-Numerous neurobiological causes identified
-Environment: family dysfunction; adverse childhood experiences
-Temperamental

Question 6

treatments for ODD

Answer 6

Psychosocial interventions: parent training, group therapy, anger management, individual and family therapy, cognitive problem-solving training

Psychobiological interventions: used to control anger and aggression such as divalproex sodium. The FDA has not approved any meds for the treatment of ODD

Question 7

conduct disorder

Answer 7

repetitive and persistent patterns of behavior in which the basic rights of other or age appropriate societal norms or rules are violated
behavior is much more severe than in those with ODD

Question 8

conduct disorder characteristics

Answer 8

-Onset: late childhood early adolescence
-Guarded prognosis
-Pyromania and kleptomania
-Unmanageable at home
-Argumentative, irritable, angry, defiant, negative, hostile
-lacks empathy
-only express remorse at being caught
-risk taking behavior
-cruelty to animals/ aggressive towards people & animals
-disruptive & destruction

Question 9

risk factors for conduct disorder

Answer 9

-Physical & sexual abuse
-Inconsistent parenting with harsh discipline
-Lack of supervision
-Early institutional living or out-of- home placement
-Association with delinquent peer group
-Parental substance abuse
-Genetic

Question 10

meds used for conduct disorder

Answer 10

no FDA approved drugs for treatment
Antidepressants, mood stabilizers, stimulants, antipsychotics, anticonvulsants, and adrenergic medications

Question 11

non pharm treatment for conduct disorder

Answer 11

Family Supportive Training
Psychosocial Interventions
Anger Management
Parent Management Training

Question 12

intermittent explosive disorder

Answer 12

inability to control aggressive impulses, verbal or physical and they can be targeted towards other people / animals / properties / self
triggered by environment and then rage builds then turns into an explosive anger

mean onset is 13-21 y/o

Question 13

IED leads to problems w/

Answer 13

Interpersonal relationships
Occupational difficulties
Criminal difficulties

Question 14

IED co morbidities

Answer 14

-Depressive
-Anxiety
-Substance use disorders
-Antisocial and borderline personality disorders

Question 15

IED risk factors

Answer 15

-Neurobiological abnormalities (loss of neurons in amygdala & hippocampus, abnormalities in serotonin)
-Conflict or violence in family of origin

Question 16

IED treatment approach

Answer 16

-Psychosocial: individual & group
-Pharmacologic

Question 17

what meds can be used for IED

Answer 17

off label
-SSRIs (d/t serotonin dysfunction)
-mood stabilizers: lithium
-anticonvulsants
-antipsychotics
-beta blockers (to calm)

Question 18

what do we never give a patient w/ IED

Answer 18

benzos

Question 19

Impulse control disorders
psychosocial interventions

Answer 19

1) Promote a climate of safety for the patient and for others.
2) Establish rapport with the patient.
3) Set limits and expectations.
4) Consistently follow through with consequences of rule-breaking.
5) Provide structure and boundaries.
6) Provide activities and opportunities for achievement of goals to promote a sense of purpose.

Question 20

impulse control disorder nursing interventions

Answer 20

assess for SI
Explore impact of child’s behaviors on family life & the other members’ behavior on the child.

Discuss how to make the home a safe environment, especially regarding weapons and drugs; attempt to talk separately to members if possible.

Discuss realistic behavioral goals and how to set them; explore potential problems.

Teach behavior modification techniques. Role-play with parents in different problem situations that might arise with their child.

Give support and encouragement as parents learn to apply new techniques.

Provide education about medications.

Refer patients, parents, or other caregivers to local self-help groups and supportive services.

Advocate with the educational system if special education services are needed.

Question 21

advanced practice intervention

Answer 21

CBT
DBT
PCIT
PMT
MST
Psychodynamic psychotherapy