Week 11 - Impulse Control Disorders, Conduct Disorders, & Somatoform Disorders

What is the theme of Oppositional Defiant Disorder (ODD)?

Persistent age appropriate oppositional and defiant behavior towards adults and peers

When does ODD occur?

usually early in life (around 3 years) but typically dx'ed around 8 yrs old

ODD - who does it affect more - male or females?

Males

ODD - Cliniical Manifestations

- Bullying

- Argumentative

- Hostile

- Annoying

- Moody

- Irritable

*verbal agression and reactive!

ODD can develop into __________________?

Conduct disorder

How long does ODD need to be present to be dx'ed? + how many in category A?

6 months, 4 symptoms in category A, must be with someone outside the family

How is ODD assessed?

Conners Parent and Teacher Rating Scales

How is ODD managed?

- CBT

- Pharm therapy

- Alpha-2 Adrenergic agonists

- SNRIs or SSRIs

- Antipsychotics (ex. Risperidone) - txts the aggression

What is the prognosis for ODD? + what is the greatest risk factor for progression?

- Develops into Conduct Disorder (approx. 33%)

-family instability is the greatest risk factor for progression

Onset for conduct disorder

Mid-childhood to adolescence (onset after 16 is rare)

Conduct Disorder - Risk Factors

- Adverse parenting practices (lack of warmth, harsh discipline)

- Higher adverse childhood experience scores and family adversity

Conduct Disorder - Theme

Repetitive and persistent pattern of dissoacial, aggressive or defiant conduct

Conduct Disorder - Clinical Manifestations

- Aggression towards people and animals

- Destruction of property, theft and deceit

- Lack of remorse/guilt

- Problematic family and peer relationships

What are the qualifications for diagnosing conduct disorder?

At least 3 symptoms for 12 months

Treatment for Conduct Disorder

- Psychosocial Intervention

- Pharmacology

- Stimulants

- Alpha-2-Adrenergic agonists

- SSRIs

- Antipsychotics medications

Prognosis for Conduct Disorder

- Increased risk for Antisocial personality disorder

- Increased risk of substance use disorders

- Increased risk of suicidality

Clinical Manifestations of Somatic Symptom Disorder

- Increased healthcare utilization

- Disproportionate emotional and behavior reactions

- Chronic and cause significant distress or psychosocial impairment

- Excessive thoughts, worrying or time and energy are spent related to somatic symptoms

Timeline required to dx Somatic Symptom Disorder

- 6 or more months

- 1 or more symptoms that cause distress or interfere w/ day-to-day function

Screening tool for Somatic Symptom Disorder

- Patient Health Questionnaire (PHQ-15)

- Somatic Symptom Scale-8

Management for Somatic Symptom Disorder

Regularly scheduled visits to a healthcare provider REGARDLESS of active symptoms (Q4-8 weeks)

What is one major risk factor (what gender) for functional disorder?

Female Sex

Common triggers for Functional Disorder

Stressful Life Events

Functional Disorder includes _______________________?

- Functional neurologic symptom disorders

- Psychogenic non-epileptic seizures (PNES)

Functional Disorder - Clinical Findings

- Incongruent w/ the symptom or inconsistent and causes patients significant distress and impairment

Management for functional disorder

-First line - Educate pt

- Pts who do not respond to education

- Refer to PT

- CBT or Insight oriented therapy

What is PNES?

psychogenic non-epileptic seizures

PNES management

Psychotherapy

illness anixety disorder - Theme

Preoccupation with having or acquiring a serious illness and high level of anxiety about health

Illness anxiety disorder - time for dx?

6 months

Illness Anxiety Disorder -Management

- Regularly scheduled appts w/ PCP

- Psychology referral for CBT (first line) group therapy

- SSRIs

factitious disorder

Condition imposed on self

Signs and Symptoms of factitious disorder

- High rate of healthcare utilizations

- Evasive when providing hx

- Refuse to give access to prior records

factitious disorder imposed on another

a condition in which one person induces illness symptoms in someone else

Malingering Disorder

Intentionally pretending to be sick or injured to avoid work or responsibility

factitious disorder imposed on another - Management

Type of child abuse; needs to be reported

Is malingering a mental disorder?

No