Impulse Control Disorders (Final)

Question 1

Impulse Control Disorders

Answer 1

Oppositional defiant disorder

Conduct disorder

Intermittent explosive disorder

Question 2

Oppositional Defiant Disorder (ODD)

Answer 2

Behaviors exceed the boundaries of what is socially acceptable

-Negative - Hostile - DEFIANT - VINDICTIVE

-Pattern of IRRITABLE and ANGRY mood

-Swearing / loss of temper

-Mood lability (sweet calm –> angry outbursts) (angry outbursts out of the blue)

-Low frustration tolerance (can not tolerate being told no)

-Interpersonal conflicts (argumentativeness - disobedience - tendency to blame others) –> do not think of themselves as angry or oppositional –> do not think they are wrong

-Stubbornness; resistance to directions; unwillingness to negotiate with adults; test limits; ignore rules; verbally aggressive; hostile

Question 3

Children with ODD are at risk of developing what?

Answer 3

-A conduct disorder (more severe)

-Anxiety / mood disorders

-Substance abuse disorders

Question 4

ODD: Risk Factors

Answer 4

-Genetics component –> family history of mental illness

-Neurobiological causes –> abnormality in prefrontal cortex

-Environment –> family dysfunction can play a role

-Temperamental

Question 5

ODD: Treatment Approaches

Answer 5

Psychosocial interventions:
-Parent management training
-Group therapy
-Anger management

Psychobiological Interventions:
-Used to control anger and aggression such as divalproex sodium

NO FDA approved meds for treatment of ODD. Use some to control anger / aggression

Question 6

Conduct Disorder

Answer 6

Repetitive and persistent patterns of behavior in which basic rights of others / age appropriate societal rules are violated

MORE SERVED than ODD

Late childhood –> early adolescent onset

Lack empathy: does not feel guilty –> only express remorse at “being caught”

Increase in risk taking behaviors (substance abuse - sexual acts)

Persistent violation of basic rights of others (Bring Knife to Fist Fight)

Cruelty to animals

Aggressive behavior toward PEOPLE AND ANIMALS

Disruptive in community

Unmanageable at home

DESTRUCTION OF PROPERTY:
PYROMANIA and KLEPTOMANIA

Question 7

Conduct Disorder: Risk Factor

Answer 7

-Slower resting heart rate + increase testosterone

-Physical and Sexual Abuse

-Inconsistent parenting with harsh discipline

-Lack of supervision

-Early institutional living or out of home placement

-Association with delinquent peer group

-Parental substance abuse or criminality

GENETICS

Question 8

Conduct Disorder: Treatment

Answer 8

Pharmacological Treatments for Symptoms: NO FDA approved for disorder

Six classes of meds used are:
-Antidepressants
-Mood Stabilizers
-Stimulants (only canada)
-Antipsychotics (aggression)
-Anticonvulsants
-Adrenergic medications

-Family Supportive Training

-Psychosocial Interventions

-Anger Management

-Parent Management Training

Question 9

Intermittent Explosive Disorder

Answer 9

-Inability to control aggressive impulses (verbal - physical) (towards people - animal - themselves)

-Overreaction to a situation (can not find keys to they punch a hole in the wall)

-Mean age of onset is 13-21 years old

-Feel other emotions strongly as well (frequently explosive anger)

Question 10

Intermittent Explosive Disorder: Leads to problems with:

Answer 10

-Interpersonal relationships

-Occupational difficulties

-Criminal difficulties

-Physical health problems (heightened sense of stress + agitation)

Question 11

Intermittent Explosive Disorder: Stages

Answer 11

1. Tensions and arousal –> based on something in the environment (driving to slow in left lane) (can not find wallet)
2. Explosive behavior and aggression –> (tailgate –> cut people off) (punching wall)
3. Immediate sense of relief and release
4. As time goes on reality kicks in they feel remorse

Question 12

Intermittent Explosive Disorder: Comorbidity

Answer 12

-Depressive - anxiety - substance use disorder

-Antisocial and borderline personality disorder

Question 13

Intermittent Explosive Disorder: Risk Factors

Answer 13

-Neurobiological abnormalities

-Higher than normal rates of inflammatory markers and testosterone

-Conflict or violence in family of origin

-Childhood maltreatment

-Physical and sexual abuse

Question 14

Intermittent Explosive Disorder: Treatment Approaches

Answer 14

Combination of psychosocial and medication

Psychosocial:
-Anger management

Pharmacologic:
-(SSRI) = serotonergic dysfunction
-(lithium) = stabilize mood
-(antipsychotics) = calm
-(beta blockers) = calm

DO NOT GIVE BENZODIAZEPINES (these reduce inhibitions)

Question 15

What should we not give to patients with intermittent explosive disorder?

Answer 15

Benzodiazepines (these reduce inhibitors)

Question 16

Impulse Control Disorder: Basic Psychosocial Interventions

Answer 16

1. Promote a climate of safety for the patient and for others
2. Establish rapport with the patient
3. Set limits and define expectations
4. Consistently follow through with consequences of rule-breaking
5. Provide structure and boundaries
6. Provide activities and opportunities for achievement of goals to promote a sense of purpose

Question 17

Impulse Control Disorder: Nursing Interventions

Answer 17

-Continue assess for suicide risk and risk of violence toward others

-Explore impact of child’s behaviors on family life and the other members

-Discuss how to make the home a safe environment, especially reading weapons and drugs; attempt to talk serpartely to members if possible

-Discuss realistic behavioral goals and how to set them; explore potential problems

-Teach behavior modifications techniques. Role play with parents in different problem situations that might arise with their child

-Give support and encouragement as parents learn to apply new techniques

-Provide education about medications

-Refer patients, parents, or other caregivers to local self-help groups and supportive services

-Advocate with the educational system if special education services are needed

Question 18

Impulse Control Disorder: What should be routinely assessed?

Answer 18

Suicide ideation

They are very impulsive