Impulse Control, neurocognitive d/o, gender and sex offenders Flashcards
What are the impulse control and conduct d/o’s?
- Oppositional defiant d/o
- Intermittent Explosive d/o - Conduct d/o
- Disorders of Aggression
Diagnostic criteria for oppositional defiant d/o?
Pattern of angry/irritable mood, argumentative/defiant behavior or vendictivness > 6 mo
With 4 of:
- often looses temper
- touch and easily annoyed
- angry and resentful
- argues w authority figures
- defies or refuses to comply w authority/rules
- deliberately annoys others
- blames others for own mistakes
- spiteful/vindictive 2x in 6 mo
Severity levels for ODD?
Mild - one setting
Moderate - two settings
Severe - three or more settings
Settings: (school, home, peers)
Ddx for ODD?
- Conduct d/o (more sever that ODD)
- ADHD (often comorbid)
- Intermittent explosive d/o (violence toward people)
What is intermittent explosive d/o?
Failure to control aggressive impulses
Manifested by either:
- minor (2x week x 3 mo)
- severe (3x in 12 mo)
Minor vs severe intermittent explosive actions?
Minor
- verbal aggression
- physical aggression toward property, animals, or people
Severe
- damage/destruction and physical assault
Describe the aggression for intermittent explosive d/o
Aggression is:
- out of proportion
- not premeditated
- caused marked distress to the individual
What is conduct d/o?
Repetitive and persistent pattern of behavior in which the basic rights of others or social norms/rules are violated As manifested by at least 3x in 12 mo - aggression toward people/animals - destruction of property - deceitfulness/theft - serious violation of rules
Doesnt meet the criteria for antisocial personality d/o
With disorders of aggression ___
Aggression and violence are symptoms rather than disease and most frequently are not necessarily associated w an underlying medical condition
Tx for disorders of aggression?
Psychological - slow, non-threatening , calm
Pharm
- acute
- antipsychotics (TOC)
- benzos (for mild aggression)
- long term
- brain lesion - carbamazepine and valproic acid
- intermittent outburst - lithium, SSRI
- intellectual disabled - buspirone
Physical
- actual restraints
- threat of restraint (multiple big people in room)
What are neurocognitive d/o?
Transient or permanent brain dysfunction w alterations in awareness or attention
Classification of neurocognitive d/o?
Primary - brain d/o
Secondary - manifestation of gen d/o
Clinical findings of neurocognitive d/o?
Pobs w:
- orientation
- attention span
- memory
- judgment
- emotional liability
- initiative
- impulse control
- reason
- confabulation
- hallucinations
- delusions
Essentials of diagnosis for neurocognitive d/o?
- Transient or permanent brain dysfunction w alterations in awareness or attention
- cognitive impairment to varying degrees
- impaired recall/memory and trouble w attention, perceptual processing and psychotic ideation
- emotional d/o freq: depression, anxiety, irritability
- behavioral d/o: impulse control, sexual, attention deficits, exhibitionism
With neurocognitive d/o you must determine?
If its:
- primary brain d/o
- 2/2 some general d/o
What is dementia?
- chronicity and deterioration of selective mental functions
Dementia pts can be id’d by?
Their tendency to complain about memory problems rather than cover them up
If a dementia pt says they cant do something?
You should press them, they often can when encouraged to
What is depression induced dementia?
Reversible dementia - fix the depression and viola!
What type of dementia do geriatrics usually have?
Progressive dementia
What is delirium?
Transient global d/o of attention
Delirium pts often have?
- clouding of consciousness
- mental status fluctuates
- marked deficit of short term memory and recall
- anxiety
- irritability
- inability to retain info
What is sundowning?
When they are good during the day and bad at night
What is terminal delirium?
End of life delirium
Tx for delirium
Fix the medical prob if applicable
Fix the ETOH withdrawal if applicable
Formal psychological therapies are not helpful and usually make things worse
Why does psych therapy usually make delirium worse?
It taxes the pt/s limited cognitive resources
What type of medical problem can cause delirium?
Syndrome of acute brain dysfunction
- acute kidney injury
MCC of delirium in hospital?
ETOH withdrawal
What is amnesia?
Memory disturbance w/o delirium or dementia
- impairment of ability to learn new info
- inability to recall previously learned info
Causes of amnesia?
Thiamine deficiency
Chronic ETOH
Childhood gender dysphoria?
Marked incongruence between one’s experienced/expressed gender and assinged gender x 6 mo w 1 of these:
- desire to be another gender
- cross dressing
- cross gender play
- cross gender toy preference
- strong rejection of same gender toys
- strong dislike of sexual anatomy
- strong desire to sex change
Adult gender dysphoria?
Marked incongruence between one’s experienced/expressed gender and assigned gender x 6 months + 2 of these:
- incongruence in gender
- strong desire to be rid of sex anatomy
- desire for sex to match experience
- strong desire to be other gender
- strong desire to be treated as other gender
- conviction that they have typical feelings/reactions like other gender
Paraphilic d/o groups?
1st group courtship d/o
- voyeuristic
- algolagnic d/o (pain and suffering)
2nd group - anomalous (non standard) target preferences
- humans (pedophilloic)
- others
What is the MC type of paraphilic d/o?
Voyeuristic - observing unsuspecting individual
Sub groups of voyeuristic actions?
Exhibionist - flashing
Frotteuristic - touching/rubbing against non consenting
Subgroups of algolagnic d/o?
Sexual masochism - the gimp
Sexual sadism - suffering of other person
Definition of pedophilia?
The perp must be at least 16 and be 5 years older than victim
What is fetishictic?
Sexual arousal from nonliving objects of highly specific focus on nongenital body part
What is transvestic?
Arousal from cross dressing
What is psychosexual dysfunction?
Sexual dysfunctions including
- delayed ejaculation
- premature ejaculation
- ED
- female orgasmic d/o
- female sex interest/arousal d/o
- genito-pelvic pain/penetration d/o
- male hypoactivity sexual desire d/o
- substance/medication induced sexual dysfunction
