impulse control disorder (329 E3) Flashcards
3 types of impulse control disorders
1) oppositional defiant disorder
2) conduct disorder
3) intermittent explosive disorder
with oppositional defiant disorder, behaviors
exceed the boundaries of what is socially acceptable -> impacting both emotions and behaviors
ODD characteristics
-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
people w/ ODD at risk for
-developing a conduct disorder
-anxiety and mood disorders
-early onset of substance abuse
risk factors for ODD
-Genetic component: family history of mental illness
-Numerous neurobiological causes identified
-Environment: family dysfunction; adverse childhood experiences
-Temperamental
treatments for ODD
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
conduct disorder
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
conduct disorder characteristics
-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
risk factors for conduct disorder
-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
meds used for conduct disorder
no FDA approved drugs for treatment
Antidepressants, mood stabilizers, stimulants, antipsychotics, anticonvulsants, and adrenergic medications
non pharm treatment for conduct disorder
Family Supportive Training
Psychosocial Interventions
Anger Management
Parent Management Training
intermittent explosive disorder
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
IED leads to problems w/
Interpersonal relationships
Occupational difficulties
Criminal difficulties
IED co morbidities
-Depressive
-Anxiety
-Substance use disorders
-Antisocial and borderline personality disorders
IED risk factors
-Neurobiological abnormalities (loss of neurons in amygdala & hippocampus, abnormalities in serotonin)
-Conflict or violence in family of origin
IED treatment approach
-Psychosocial: individual & group
-Pharmacologic
what meds can be used for IED
off label
-SSRIs (d/t serotonin dysfunction)
-mood stabilizers: lithium
-anticonvulsants
-antipsychotics
-beta blockers (to calm)
what do we never give a patient w/ IED
benzos
Impulse control disorders psychosocial interventions
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.
impulse control disorder nursing interventions
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.
advanced practice intervention
CBT
DBT
PCIT
PMT
MST
Psychodynamic psychotherapy
