Disruptive, Impulse and Conduct Disorders

disruptive, conduct and impulse control disorders

Inability to resist an intense impulse, drive or temptation to perform a particular act that is obviously harmful to self and or others

tension, arousal

in disruptive, conduct and impulse control disorders before the events the individual usually experiences mounting ____ and _____

gratification and relief

in disruptive, conduct and impulse control disorders completing the act brings immediate ____ and ______

remorse, guilt, dread

in disruptive, conduct and impulse control disorders after the individual experiences _____,_____,______

oppositional defiant disorder

enduring patterns of negativistic, disobedient and hostile behavior toward authority figures

inability to take responsibility for mistakes, place blame on others

difficulty in classroom w/ peer relationships

negativist, disobedient, hostile

Those with oppositional defiant disorder have enduring patterns of _____, _____ and ______ behavior toward authority figures

on others

those with oppositional defiant disorder put the blame on who?

adults/peers that the child knows well

oppositional defiant disorder can occur at home, school or both but what specific people does it most often occur with?

parents/teachers

the diagnosis of oppositional defiant disorder is difficult for a clinician to detect on exam, it heavily relies on _____/______

boys before puberty

oppositional defiant disorder is most common in what population?

environmental/family issues

hx of abuse, neglect

harsh or inconsistent discipline

lack of supervision

ADHD diagnosis

Risk factors for oppositional defiant disorder ?

psychiatric conditions

oppositional defiant disorder is commonly seen with other _____ _____

ADHD

oppositional defiant disorder is seen in 50% of children w/ ______

demand sustained mental effort

require patient to refrain their hyperactivity

oppositional defiant disorder in patients with ADHD will arise when those patients are placed in what settings?

conduct disorder

many with oppositional defiant disorder will go on to meet the criteria for what other disorder?

ODD is usually less severe in nature and does not include aggression toward people or animals, destruction of property, theft etc

How to differentiate oppositional defiant disorder from CD?

adjustment disorder

when differentiating oppositional defiant disorder from other things behaviors that are temporary and related to a psychosocial stressor should be diagnosed with ______ ______

mood disorders, conduct disorders, substance use disorders, ADHD

oppositional defiant disorder is at increased risk for what other disorders?

setting small goals

working with patient and family

improve coping mechanisms

reduce severity of outbursts

individual therapy

cognitive problem-solving training

art therapy

social skills training

family intervention

meds if needed

Overall treatment of oppositional defiant disorder?

manage anger and express feelings in a healthier way

what is the goal of individual treatment for oppositional defiant disorder?

identify and change thought patterns that lead to behavior problems

what is the goal of cognitive problem-solving training for oppositional defiant disorder?

those who may not be able to explain their feelings in words

Who is art therapy helpful for in oppositional defiant disorder?

parent management training

this falls under family intervention in oppositional defiant disorder — parents are trained to change their own behaviors to alter the child’s behavior in the home

another mental health disorder

medications alone generally aren’t used for oppositional defiant disorder unless the patient has….?

another disorder

Patients with severe enough oppositional defiant disorder symptoms to warrant medications most likely meet criteria for _____ _____

second gen antipsychotic like risperidone, aripiprazole, quetiapine

for oppositional defiant disorder aggressive sx what meds can be used?

methylphenidate

For ODD + ADHD what med can be used?

SSRI like citalopram

For ODD + anxiety/ depression what med can be used?

intermittent explosive disorder

outbursts are rapid, little or no prodromal period, grossly out of proportion to situation and must have multiple outbursts

late adolescence or early adulthood

when does intermittent explosive disorder usually occur?

40

intermittent explosive disorder is rare to present after age ….

men

intermittent explosive disorder more likely in men or women?

first degree relatives, hx of physical or emotional trauma during first 2 decades of life

intermittent explosive disorder risk factors?

temporary outbursts patients are unable to be restrained, outbursts can present in various ways

Presentation of intermittent explosive disorder?

middle age

Most cases of intermittent explosive disorder decrease by what age?

intermittent explosive disorder shows aggression towards others

how to differentiate intermittent explosive disorder from ODD in regards to outburts

combo therapy w/ med (CBT, group therapy + med)

reduce triggers when possible

meds (SSRIs, anticonvulsants)

Tx of intermittent explosive dx?

SSRs, anticonvulsants

What meds can be used to treat intermittent explosive disorder?

fluoxetine

What is first line med tx for intermittent explosive disorder?

taper off and trial an alternative therapy but not another SSRI

if intermittent explosive disorder fails on fluoxetine what do you do?

phenytoin, carbamazepine, lamotrigine

What anticonvulsants can be used to tx intermittent explosive disorder?

benzos, paradoxical effect

what meds are not recommended in intermittent explosive disorder? why?

conduct disorder

this is one of the most common diagnoses in adolescent outpatient psychiatry clinics, characterized by aggression and violation of the rights of others —— long lasting, violates rights of others, goes against accepted norms of behavior, disrupts child’s or family’s everyday life

males

conduct disorder more common in what gender?

impulsivity

physical or sexual abuse/neglect

poor parental supervision

witnessing violence

history of being abused or bullied

harsh and punitive parental discipline

low IQ

poor school achievement

conduct disorder risk factors?

prior to 10

conduct disorder childhood onset is prior to what age?

10

adolescent onset type of conduct disorder is after what age?

ADHD

substance abuse

increase incidence of criminal behavior in adulthood

previous ODD
antisocial personality disorder in adulthood

common comorbidites for conduct disorder

antisocial personality disorder

40% of those with conduct disorder will develop what in adulthood?

multimodal treatment with therapy and psychopharmacologic interventions

Tx of conduct disorder?

teaches anger coping strategies

How does individual psychotherapy work in conduct disorder?

develop problem-solving soltuions

How does CBT help in conduct disorder?

enhance family communication and intervations

How does family therapy help with conduct disorder?

second gen antipsychotic like risperidone, aripiprazole, quetiapine

What do you use to tx aggressive sx in conduct disorder?

methylphenidate

tx ADHD in conduct disorder with what?

SSRI like citalopram

Tx anxiety/depression in conduct disorder with what?

kleptomania

objects stolen are not the goal, the act of stealing is the goal

stealing is not planned and does not involve others

late adolescence

kleptomania onset?

embarrassment, fear, and humiliation

what may prevent seeking treatment of kleptomania?

CBT, family & friend support & self help groups

meds if needed

kleptomania tx?

no

Are there are any FDA approved meds for kleptomania?

naltrexone and SSRIs

What off label meds can be used to tx underlying process of kleptomania?

pyromania

intentionally setting multiple fires, provide the patient with relief or satisfaction

no

Is pyromania done for gain?

history of cruelty to animals

risk factors of pyromania?

good if identified and treated in childhood

prognosis of pyromania?

combo including meds and behavioral approaches but no single tx proven effective

pyromania tx?

gambling disorder

overconfident/abrasive, energetic and free spending

usually lie to obtain money and hiding the extent of their gambling

no attempts to save, budget, engage in antisocial behavior to obtain money for gambling

lie

In gambling disorder patients will ____ to obtain money

if the casino is <50 miles away

gambling disorder what doubles the risk?

substance abuse, depressive disorders, ADHD, conduct disorder

comorbidities of gambling disorder?

young age, male gender

inappropriate parental discipline

nicotine or substance abuse

exposure to gambling as teens

family emphasis on materialistic needs

lack of family emphasis on saving, planning and budgeting

Risk factors for gambling disorder?

legal or financial difficulties that stem from underlying disorder

Those with gambling disorder often seek tx after what?

CBT, interventions such as enlisting family, treating comorbidities, providing support and resources

Tx for gambling disorder?

1-800-gambler, self exclusion, gamblers anonymous, national council on problem gambling

Resources for gambling?

SSRIs (mixed results), opioid antagonists like naltrexone

What meds can be used for gambling disorder?