impulse control disorders

Question 1

ODD (oppositional defiant disorder)

Answer 1

negative, hostile, defiant, vindictive
pattern of irritability and angry mood
lasts at least 6 months
swearing, mood lability, low frustration tolerance, interpersonal conflict, stubborness

Question 2

risk factors of ODD

Answer 2

genetics- hx family illness
neurobiology (amygdala and prefrontal cortex disorder)
environment- family dysfunction; adverse childhood experiences, neglect
temperamental

Question 3

treatment approaches of ODD

Answer 3

psychosocial interventions- parent training, group therapy, anger management, individual and family therapy, cognitive problem solving
psychobiological interventions- used to control anger and aggression- divalproex sodium, FDA has NOT approved any meds for the treatment of ODD
can use valproic acid off label to control anger

Question 4

conduct disorder

Answer 4

late childhood, early adolescent onset
persistent violation of basic rights of others (brings knife to fist right)
lacks empathy, does not feel guilty
only expresses remorse for being caught not the actions
risk taking behaviors
cruelty to animals
aggressive behavior toward people/animals
destruction of property

Question 5

risk factors of conduct disroder

Answer 5

physical and 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
biologic

Question 6

treatment for conduct disorder

Answer 6

six classes of meds used
antidepressants, mood stabilizers, stimulants, antipsychotics, anticonvulsants, and adrenergic medications
family support training
psychosocial interventions
anger management
parent management training

Question 7

intermittent explosive disorder

Answer 7

explosive anger
males
inability to control aggressive impulses
mean onset 13-21 yrs
over reaction to trigger (i cant find my keys and punches a hole in wall)
verbal and physical
4 stages 1- tension and arousal, 2- explosive behavior, 3- feels relief and release, 4- after event feels remorse

Question 8

comorbidities of intermittent explosive disorder

Answer 8

depression, anxiety, substance use
antisocial and borderline personality disorder

Question 9

risk factors of intermittent explosive disorder

Answer 9

neurobiological abnormalities
conflict or violence in family
have increased testosterone and inflammatory markers

Question 10

treatment approaches for intermittent explosive disorder

Answer 10

psychosocial- SSRI (used off label), mood stabilizer, beta blockers to keep calm and decrease HR and BP
NO BENZO’S

Question 11

impulse control disorders psychosocial interventions

Answer 11

promote a climate of safety for the patient and others
establish rapport with patient
set limits and expectations
consistently follow through with consequences for rule breaking
provide structure and boundaries
provide activities and opportunities for achievement of goals to promote a sense of purpose

Question 12

nursing interventions for impulse control

Answer 12

make home a safe environment
realistic behavior goals
role-play with parents with situations they may experience
give support and encouragement
provide education about medications
local self-help groups and supportive services
advocate with educational systems if special ED is needed

Question 13

advanced practice interventions for behavior disorders

Answer 13

CBT
psychodynamic psychotherapy
dialectical behavioral therapy
parent-child interaction therapy
parent management training
multisystem therapy