MEDI7301 Study Guide - Final Guide: Adjustment Disorder, Bipolar Disorder, Dsm-5
Disruptive, Impulse-Control and Conduct Disorders
Introduction
Overview Disruptive, impulse-control and conduct disorder include conditions
predominated by issues with self-control of emotions and behaviour that usually violate
others (eg aggression, destroy property) and/or bring individual into significant conflict with
societal norms or authority figures
Classification (differentiated by relative emphasis on emotional vs behavioural
dysregulation)
Oppositional defiant disorder
Intermittent explosive disorder
Conduct disorder
Antisocial personality disorder
Pyromania
Kleptomania
Epidemiology
M > F predominance
First onset typically in childhood or adolescence
ODD usually precedes childhood-onset CD, however most children and
adolescents won't subsequently develop this
High levels of irritability is a primary presenting feature for children that
concurrently suffer from depression
ODD and CD are often comorbid with other conditions (eg major depression,
ADHD)
ODD and CD
Management
Family/
parenting
intervention
Reduce parent reinforcement of aggression
oRestrict 'punishments', saying 'stop doing …'
oParents only notice/ react when kids are 'misbehaving'
oParent should applaud good behaviour such as 'it's
good that you're calm'
Increase reinforcement of +ve behaviour
Non-violent punishment
Treat parental mental health disorders (eg depression, PTSD,
substance use)
Aggression
anger
management
CBT
Teach child how to recognise triggers, relax themselves,
'stop/think/choose'
Medication
Use anti-psychotics for core explosive aggression (eg
risperidone - SE include breast enlargement, metabolic syndrome)
Drug Start dose
(daily)
Target dose
(daily)
Route Notes
Risperidone
(5+yo, <50kg)
0.25mg 0.75mg (1-2
divided
dose)
PO AE - breast
enlargement,
metabolic syndrome
Risperidone
(5+yo, >50kg)
0.5mg 1.5mg (1-2
divided
dose)
PO AE as above
Use SSRI for comorbid anxiety/ depression (eg sertraline,
fluloxetine)
Possibility of using lithium or clonidine
Change broad
context
Usually low SES status, hence introduce intervention
Anti-poverty programs
Neighbourhood programs (eg reduce gang influence)
Reduce access to means (eg guns)
Increase family support
Limit screen time/ access to violent culture
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Anti-aggression culture (eg alcohol laws, 'one punch kills', anti-
bullying)
Prognostic factorsFavourable Environmental (strong work or family ties, oldest child, more
affective relationships, having a same-sex role model, a good relationship
with at least one adult, a support system, external support from others,
reinforcement of positive coping mechanisms)
Child (social competency, positive coping mechanisms; above-
average intelligence, school skills, school performance; better possibilities
for attachment; comorbid anxiety disorder as a protection against
delinquency)
Unfavourable Male
Early-age onset
High frequency and variety of behaviours
Physical aggression
Low intelligence
Pervasiveness (eg home, school, community)
Comorbid ADHD
Early sexual activity
Substance abuse
Oppositional defiant disorder
Epidemiology Onset during preschool/ primary school, rarely later than early adolescence
Distinguish symptomatic ODD vs normative child
Normal - preschool child may show temper tantrum on weekly basis
ODD - preschool child shows temper tantrums on most days for the last 6
preceding months along with at least 3 other sx of ODD + caused significant impairment
(eg led to destruction of property during outbursts) + onset before 8yrs
An enduring pattern of negative, hostile and defiant behaviour without serious
violations of societal norms or rights of others; it may only occur in one situation & tends to
be most evident in interactions with familiar adults or peers
ODD is a mix between conduct disorder & intermittent explosive disorder - an
even distribution of emphasis between emotions (anger and irritation) and behaviours
(argumentativeness and defiance)
Most children are at risk for eventually developing other problems such as anxiety
or depressive disorders
It usually progresses to CD
Risk factors History of abuse or neglect
Parent or caretaker with mood disorder or substance/ drug abuser
Parent who have/ have had ODD, ADHD or behavioural issues
Family instability (divorce, multiple moves, changing schools)
Financial issues in family
Exposure to violence
Inconsistent discipline
Lack of supervision
DSM-5 criteria A pattern of angry/ irritable mood, argumentative/ defiant behaviour or
vindictiveness on most days lasting at least 6 months as evidenced by at least 4 symptoms
from any of the following categories and exhibited during interaction with at least one
individual who isn't a sibling
Angry/ irritable
mood
Often loses temper
Often touchy or easily annoyed
Often angry and resentful
Argumentative/
defiant behaviour
Often argues with authority figures (adults) or
with adults (children and adolescents)
Often actively defies or refuses to comply with
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Disruptive, impulse-control and conduct disorder include conditions predominated by issues with self-control of emotions and behaviour that usually violate others (eg aggression, destroy property) and/or bring individual into significant conflict with societal norms or authority figures. Classification (differentiated by relative emphasis on emotional vs behavioural dysregulation) Odd usually precedes childhood-onset cd, however most children and adolescents won"t subsequently develop this. High levels of irritability is a primary presenting feature for children that concurrently suffer from depression. Odd and cd are often comorbid with other conditions (eg major depression, Reduce parent reinforcement of aggression o o o. Parents only notice/ react when kids are "misbehaving" Parent should applaud good behaviour such as "it"s good that you"re calm" Treat parental mental health disorders (eg depression, ptsd, substance use) Teach child how to recognise triggers, relax themselves, Use anti-psychotics for core explosive aggression (eg risperidone - se include breast enlargement, metabolic syndrome) Use ssri for comorbid anxiety/ depression (eg sertraline, fluloxetine)
