t48 - conduct disorder

oppositional defiant disorder

-patterns of angry or irritability mood, argumentative or defiant behavior, and vindictiveness of at least 6 months

-pre school age

-males

-absence of behaviors that violate the law and the basic rights of others

oppositional defiant disorder patho

-abnormal reduced activation in the left amygdala, bilateral striatum, parietal cortex, and posterior cingulate

oppositional defiant disorder etiology

-punishment processing, reward process, cognitive control is impaired

-maternal use of alcohol, nicotine, cocaine

-lead exposure

-environmental toxins

-parental separation

-harsh physical discipline

-parental depression, antisocial personality and substance use

oppositional defiant disorder sx

-patterns of angry or irritability mood, argumentative or defiant behavior, and vindictiveness of at least 6 months

-irritable, resentful

-argue, angry, dislike authority figure

-vindictive, spiteful

-may also have ADHD

oppositional defiant disorder dx

DSM 5

-patterns of angry or irritability mood, argumentative or defiant behavior, and vindictiveness of at least 6 months and at least 4 sx present

-angry, irritable, losing temper, easily annoyed, angry, argumentative, argues with authority, defies, deliberately annoys others, blames others

-has been spiteful or vindictive at least 2x within 6 months

oppositional defiant disorder tx

Preschool age

-behavioral parent management training

6 to 12

-behavioral parent managementain training + CBT

youth

-CBT

13 to 17

-parenting interventions may become less effective

conduct disorder

-repetitive and persistent pattern of dissocial, or defiant conduct in which major age appropriate social expectations are violated

-males

Types

-childhood: <10

-adolescent: 10-18

conduct disorder etiology

-adverse parenting practice

-child maltreatment

-school environmental and peer interaction

-family and community factors

conduct disorder sx

-severe, persistent and pervasive dysfunction that is tolerable disruptive or dangerous at home, in school or in the community

-violates the basic rights of others and major social norms

-problems with learning, problems with regulation

-aggression, low self esteem, substance abuse

Types

1. aggression towards people or animals

2. destruction of property

3. pattern of deceitfulness or theft

4. serious violation of rules

conduct disorder dx

DSM 5

-behaviors that break major social normal + 3 sx during the past 12 months with at least 1 present in the last 6 months

1. aggression towards people or animals

2. destruction of property

3. pattern of deceitfulness or theft

4. serious violation of rules

conduct disorder tx

Nonpharm

-positive parenting program and fast track

-therapeutic foster homes

-multisystemic treatment, multidimensional treatment foster care

Pharm

-methylphenidate

intermittent explosive disorder

-recurrent outbursts due to failure in controlling aggressive impulses

intermittent explosive disorder etiology

-seizures, delirium

-childhood abuse

intermittent explosive disorder sx

-aggressive outbursts occur in discrete episodes and are grossly out of proportion to any precipitating event

-lack of rational motivation

-embarrassment, guilt, remorse after the act is perplexed

-exhaustion and sleepiness

intermittent explosive disorder dx

1. verbal aggression such as temper tantrums and arguments or physical aggression toward property, animals, or other people, that happens roughly twice a week, for at least 3 month

2.at least three outbursts that involve property destruction or physical assault resulting in injury to animals or people, over a 12 month per

intermittent explosive disorder tx

Nonpharm

-first line = CBT, DBT

Pharm

-fluoxetine

-resistant = phenytoin

kleptomania

-impulse to steal

-women

kleptomania sx

-failure to resist the impulse to steal useless objects that have little monetary value

-not purposeful behavior they feel remorse

-relief upon completion of theft

-feeling high or euphoric while stealing

kleptomania tx

Nonpharm

-first line = psychotherapy

Pharm

-SSRI and lithium

pyromania

-compulsion to set things on fire

-13 years old

-male

pyromania sx

-will have the impulse of setting things on fire

-suicidal behavior has been reported

-have significant amount of comorbidities

pyromania dx

-setting things on fire on purpose >1 occasion

-feels sense of arousal

-attracted to fire

-feeling pleasure when setting things on fire

-setting things of fire will be not be done for money or criminal

-not better explained by conduct disorder or antisocial personality

pyromania tx

-early intervention

-check for other comorbid disorders

trichotillomania

-pulling out there own hair

-dont feel pain

-like the feeling

- will have hair thinning

trichotillomania dx

-biopsy = increased catagen hairs alone with melanin pigmentation casts and granules in upper follicles and infundibulum

trichotillomania tx

Nonpharm

-first line = habit reversal therapy

Pharm

-SSRI

-clomipramine

skin picking

-repetitive picking, scratching, rubbing, digging, or squeezing of skin, resulting in visible tissue damage and impairment in social functioning

-women

-15 to 45 year old

-common feature of prader willi syndrome

skin picking sx

-excoriated, polymorphic lesions in various sizes and severity

-post inflammatory hypo or hyperpigmentation

-different stages of healing

-face, scalp, cuticles, extensor extremities, back, shoulder, perianal region, scrotal surface

skin picking dx

DSM 5

-Recurrent skin picking resulting in skin lesions.

-Repeated attempts to decrease or stop skin picking.

-clinically significant distress or impairment in social, occupational, or other important areas of functioning.

-not attributable to the physiologic effect of a substance

-not better explained by symptoms of another mental diso

skin picking tx

Nonpharm

-CBT

Pharm

-topical steroids

-SSRI

-antipsychotics