Impulse Control, neurocognitive d/o, gender and sex offenders Flashcards

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1
Q

What are the impulse control and conduct d/o’s?

A
  • Oppositional defiant d/o
    ​- Intermittent Explosive d/o
  • Conduct d/o
  • Disorders of Aggression
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2
Q

Diagnostic criteria for oppositional defiant d/o?

A

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
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3
Q

Severity levels for ODD?

A

Mild - one setting
Moderate - two settings
Severe - three or more settings

Settings: (school, home, peers)

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4
Q

Ddx for ODD?

A
  • Conduct d/o (more sever that ODD)
  • ADHD (often comorbid)
  • Intermittent explosive d/o (violence toward people)
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5
Q

What is intermittent explosive d/o?

A

Failure to control aggressive impulses
Manifested by either:
- minor (2x week x 3 mo)
- severe (3x in 12 mo)

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6
Q

Minor vs severe intermittent explosive actions?

A

Minor

  • verbal aggression
  • physical aggression toward property, animals, or people

Severe
- damage/destruction and physical assault

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7
Q

Describe the aggression for intermittent explosive d/o

A

Aggression is:

  • out of proportion
  • not premeditated
  • caused marked distress to the individual
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8
Q

What is conduct d/o?

A
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

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9
Q

With disorders of aggression ___

A

Aggression and violence are symptoms rather than disease and most frequently are not necessarily associated w an underlying medical condition

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10
Q

Tx for disorders of aggression?

A

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)
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11
Q

What are neurocognitive d/o?

A

Transient or permanent brain dysfunction w alterations in awareness or attention

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12
Q

Classification of neurocognitive d/o?

A

Primary - brain d/o

Secondary - manifestation of gen d/o

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13
Q

Clinical findings of neurocognitive d/o?

A

Pobs w:

  • orientation
  • attention span
  • memory
  • judgment
  • emotional liability
  • initiative
  • impulse control
  • reason
  • confabulation
  • hallucinations
  • delusions
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14
Q

Essentials of diagnosis for neurocognitive d/o?

A
  • 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
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15
Q

With neurocognitive d/o you must determine?

A

If its:

  • primary brain d/o
  • 2/2 some general d/o
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16
Q

What is dementia?

A
  • chronicity and deterioration of selective mental functions
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17
Q

Dementia pts can be id’d by?

A

Their tendency to complain about memory problems rather than cover them up

18
Q

If a dementia pt says they cant do something?

A

You should press them, they often can when encouraged to

19
Q

What is depression induced dementia?

A

Reversible dementia - fix the depression and viola!

20
Q

What type of dementia do geriatrics usually have?

A

Progressive dementia

21
Q

What is delirium?

A

Transient global d/o of attention

22
Q

Delirium pts often have?

A
  • clouding of consciousness
  • mental status fluctuates
  • marked deficit of short term memory and recall
  • anxiety
  • irritability
  • inability to retain info
23
Q

What is sundowning?

A

When they are good during the day and bad at night

24
Q

What is terminal delirium?

A

End of life delirium

25
Q

Tx for delirium

A

Fix the medical prob if applicable
Fix the ETOH withdrawal if applicable

Formal psychological therapies are not helpful and usually make things worse

26
Q

Why does psych therapy usually make delirium worse?

A

It taxes the pt/s limited cognitive resources

27
Q

What type of medical problem can cause delirium?

A

Syndrome of acute brain dysfunction

- acute kidney injury

28
Q

MCC of delirium in hospital?

A

ETOH withdrawal

29
Q

What is amnesia?

A

Memory disturbance w/o delirium or dementia

  • impairment of ability to learn new info
  • inability to recall previously learned info
30
Q

Causes of amnesia?

A

Thiamine deficiency

Chronic ETOH

31
Q

Childhood gender dysphoria?

A

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
32
Q

Adult gender dysphoria?

A

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
33
Q

Paraphilic d/o groups?

A

1st group courtship d/o

  • voyeuristic
  • algolagnic d/o (pain and suffering)

2nd group - anomalous (non standard) target preferences

  • humans (pedophilloic)
  • others
34
Q

What is the MC type of paraphilic d/o?

A

Voyeuristic - observing unsuspecting individual

35
Q

Sub groups of voyeuristic actions?

A

Exhibionist - flashing

Frotteuristic - touching/rubbing against non consenting

36
Q

Subgroups of algolagnic d/o?

A

Sexual masochism - the gimp

Sexual sadism - suffering of other person

37
Q

Definition of pedophilia?

A

The perp must be at least 16 and be 5 years older than victim

38
Q

What is fetishictic?

A

Sexual arousal from nonliving objects of highly specific focus on nongenital body part

39
Q

What is transvestic?

A

Arousal from cross dressing

40
Q

What is psychosexual dysfunction?

A

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