Trastornos de Conducta y el control de los impulsos Flashcards
18.1.
What is the common feature in the diagnosis of pyromania,
intermittent explosive disorder (IED), and kleptomania?
A. Guilt following the incident
B. Incidents result in legal trouble
C. Increasing tension prior to the incident
D. A personal benefit from the incident
E. A desire to cause harm by the incident
18.1. C. Increasing tension prior to the incident
The disruptive, impulse-control disorders of IED, kleptomania, and
pyromania are all similar in that there is a sense of rising tension
prior to the incident, followed by a decrease in tension afterward.
Guilt usually occurs in IED, may occur in kleptomania, and often
does not occur in pyromania. The incidents do not necessarily result
in legal trouble. The object stolen in kleptomania may have little to
no value to the person, just as in pyromania there is no personal
benefit, financial or otherwise, from the fire. The acts are not caused
by a desire to harm, but to relieve the tension that builds up
18.2.
What is the age requirement for a diagnosis of intermittent
explosive disorder?
A. The patient must be at least 3 years old
B. The patient must be at least 6 years old
C. The patient must be under 12 years old
D. The patient must be under 18 years old
E. The patient must be at least 18 years old
18.2. B. The patient must be at least 6 years old
Intermittent explosive disorder is one of the few disruptive, impulsecontrol
disorders with an age requirement. A diagnosis cannot be
made in an individual until they are at least 6 years old.
18.3.
Parents bring their 16-year-old son to the outpatient clinic
because of “his emotional outbursts over the last year. We’re
walking on eggshells around him. We never know what will set
him off.” He agrees with his parents and adds that he cannot
control himself. He states that some situations get him “so
mad that I start breaking things and punching holes in the
wall.” During the most recent episode, he was playing a video
game with friends until his team started to lose. He started
cursing loudly and threw the controller at the TV and broke
the screen. “The anger just rose up in me until I couldn’t
control it.” His parents note that he often cries and will “beat
himself up with guilt afterward,” but that in between episodes,
“he’s fine.” He denies feeling depressed or manic, and denies
auditory or visual hallucinations or suicidal ideation. He has
no chronic illnesses and is on no medications. Vitals are within
normal limits and there are no abnormal findings on physical
examination. What should be the next step in the management
of this patient?
A. Refer him for cognitive behavioral therapy
B. Begin a trial of carbamazepine
C. Perform a medical workup
D. Admit him to the hospital
E. Begin a trial of valproate
18.3. C. Perform a medical workup
The patient and his parents are reporting symptoms of intermittent
explosive disorder (IED). Since IED is a diagnosis of exclusion,
medical causes of his symptoms, such as substance use, brain
tumors, endocrine disorders, etc. should first be ruled out, so a full
medical workup should be performed. There is no current indication
for hospital admission. Recommending or starting treatment would
be premature before the other diagnoses are ruled out
18.4.
A 25-year-old man who was arrested and jailed 2 days ago on
a charge of petit larceny tells the judge that he could not resist
stealing a plastic vase from a department store, even though
he had no use for it. He is shown video from three other stores
which captured him stealing other relatively valueless objects
over the past 2 weeks. He states that he does not plan to steal,
“but I get this urge that I can’t resist and I have to do it.”
Afterward, he feels a sense of relief. He has never confronted
someone to take their possessions. He admits to stealing since
he was 18 years old. What is the most likely course of his
stealing behavior over the next 10 years?
A. It will wax and wane
B. It will become more frequent
C. It will stay constant
D. It will slowly decrease
E. It will remit completely
18.4. A. It will wax and wane
Kleptomania tends to be a chronic disorder, with the frequency of
stealing ranging from less than one to several episodes a month. The
course waxes and wanes over time
18.5.
Parents present with their 22-year-old son to the outpatient
clinic because of the son’s aggressive behavior. They state that
he seems to “get angry over nothing,” and will fly into a rage
consisting of screaming, slamming doors, and verbally abusing
them. He states that he cannot control himself and that he has
lost several jobs because of his outbursts. Afterward, he always
apologizes “and I promise not to do it again. I really mean it,
but then the rage just builds up sometimes and I have to let it
out.” He has tried meditation, deep breathing, and anger
management classes, but they have not been effective. His
parents state that he is a joy to be around outside of the
outbursts, but those times are overshadowed by the behaviors.
He lives at home, and they are worried that he will never keep
a job long enough to be able to move out. He has no chronic
illnesses and is on no medications. What treatment is most
likely to be effective?
A. Family therapy and an antipsychotic medication
B. Cognitive behavioral therapy and an anticonvulsant
medication
C. Family therapy and selective serotonin reuptake inhibitor
(SSRI)
D. Cognitive behavioral therapy and an antipsychotic
medication
E. Contingency management and an SSRI
F. Contingency management and an anticonvulsant
medication
18.5. C. Family therapy and an SSRI
The treatment most likely to be successful for intermittent explosive
disorder is a combination of psychotherapy and medication. For a
young adult living at home, family therapy is particularly useful,
though cognitive behavioral therapy and contingency management
may also be effective. SSRIs are helpful in reducing impulsivity and
aggression. Antipsychotics and anticonvulsants both have mixed
results.
