Impulse control disorders Flashcards
Where do ppl with iimpulse control disorders appear
hc and criminal justice
oppositional defiance dx
- bx and emo that exceed socially acceptable bx lasting over 6M
ODD characteristics
- negative, hostile, defiant, vindicative
- pattern of irritable and angry mood
- swearing
- mood lability (angry outbursts)
- low frus tol (can’t be told no)
- interpersonal conflicts (argument, disobedience, blame others)
- stubborn (resist directions, test limits, ignore rules, verbally agg)
Do kids with ODD think of themselves as angry or oppositional
NO
People with ODD are at higher risk for
anx, mood dx, conduct dx, SUD
Do most kids outgrow ODD?
Yes
rf for ODD
genetics, fam hx of MI, PFC and amygdala chx, enviro (fam dysfxn)
- temperamental
tx approaches for ODD
- psychosocial intx: parent training, group therapy, anger mngt
- psychobio intx: control anger and agg like w/ divalproex sodium
Are there meds specific to ODD?
No
Conduct dx
persistent and repetitive bx where basic rights of others or age-appropriate societal rules and norms are violated
Conduct dx vs ODD
Inc severity of neg bx vs ODD
- later onset
conduct dx characteristics
- pyromania and kleptomania
- prog unmanageable at home
- argue, irritable, angry, defiant, neg hostile
- lack empathy; does not feel guilty
- only express remorse at being caught
- risk taking bx
- cruelty to animals
- agg bx towards ppl and animals
- disruptive in comm and destroy property
rf for conduct dx
phys and sexual abuse, inconsistent parenting with harsh discipline
- lack supervision
- early inst or out of home placement
- assoc with delinquent peer group
- parental sub abuse or criminality
- genetic
tx for conduct dx
- pharm: antidep, mood stable, stims (Canadian), antipsychotics, anticonvulsants, adrenergic meds
- fam support training
- psychosoc
- anger and parent management
Intermittent explosive dx
- inability to control agg impulses
- verbal or phys
- target at self, others, objects
- feel anger and other emos stronger than others
- mean onset 13-21y, more in men
Intermittent explosive dx leads to probs with
- interpersonal relx
- occup difficulties
- criminal difficulties
Stages of intermittent explosive dx
- tension and arousal
- explosive anger and agg
- relief and release
- reality
What health probs can intermittent explosive dx lead to
inc stress and agit can lead to HTN and DM
comorbidities for IED
dep, anx, SUD, antisocial, BPD, ADHD
- conduct and ODD
rf for IED
neurobio, conflict or violence in fam origin, inc inflam markers, inc testosterone, Sr changes, fam hx SUD
- fewer neurons in amygdala and hippo
tx approaches for IED
- psychosoc or pharm
- mood stable, anticonvulse, SSRI, beta blocker (dec HR and BP)
Which med cannot be given for IED
BDZs bc they decrease inhibitions!
impulse control dx psychosoc intx
- promote climate of safety
- est rapport with patient
- set limits and expectations
- consistent follow thru w/ consequences of rule breaking
- provide struc and boundaries
- provide activities and opportunities for achievement of goals to promote a sense of purpose
- correct patterns, better coping, social goals
Programming for impulse control dx
- usually outpt
- sometimes crisis inpt
- many transfer to therapeutic foster care and group homes
- programs like multisystematic therapy
