Disruptive Behavior Disorders And Psychosis

Question 1

What are symptoms of conduct disorder? (6)

Answer 1

Lack of cause and effect thinking Lack of conscience Superficially engaging or charming Destructive to others and material things Cruelty to animals May pose a danger to others

Question 2

What disorder does this describe? Poor peer relationships, self destructive (accident prone), May be seductive and have problems with sexual aggression, not affectionate on parents’ terms (not cuddly), preoccupation with fire.

Answer 2

Conduct disorder

Question 3

Definition of conduct disorder?

Answer 3

Repetitive pattern of behavior in which the basic rights of others or societal norms are violated. Three or more criteria in the last 12 months.

At least one criterion present in the last 6 months.

Aggression to people or animals

Destruction of property

Deceitfulness or theft

Serious violations of rules.

Question 4

What are some predisposing factors for CD?

Answer 4

Studies give a range of 1-10% Parental rejection or neglect Inconsistent child rearing with harsh discipline Physical or sexual abuse Frequent change of caretakers Early institutional living.

Question 5

What is the DSM 5 criteria for ODD?

Answer 5

A pattern of angry/irrtiable mod, argumentative/defiant behavior or vindictiveness, lasting at least 6 months as evidenced by ast least four symptoms from any of the following categories, and exhibited during interaction with at least one individual who is not a sibling.

Angry irritable mood - often loses temper, is often touchy or easily annoyed, often angry and resentful

Argumentative/defiant behavior - often argues with authority figures, or for children and adolescents, with adults, often actively defies or refuses to comply with requests of authority figures or with rules, often deliberately annoys others, often blames others for his or her mistakes or misbehavior

Vindictiveness - has been spiteful or vindictive at least twice within the past 6 months.

Question 6

What is oppositional defiant disorder?

Answer 6

This is where you have defiance directed towards an authority figure. Not always apparent in the school or in the community. More apparent in interactions with familiar adults and peers.

Question 7

Preschool children that have oppositional defiant disorder tend to be?

Answer 7

Tend to be highly reactive and not easily soothed

Question 8

People with oppositional defiant disorder see themselves as responding reasonably to?

Answer 8

Unreasonable demands

Question 9

What is the sex ratio of oppositional defiant disorder to CD? ODD:CD

Answer 9

Generally sex differences in disruptive behavior disorders do not emerge prior to age 6 At later ages, however, males referred for disruptive behavior disorders significantly outnumber females anywhere from 4:1 to 6:1 These children account for somewhere between one-third and two-thirds of all child mental health referrals.

Question 10

Is there comorbidity between ODD and CD?

Answer 10

Children with ODD and CD frequently display other types of problems 34.7-48% - ADHD 12-17.6 % - Depressive disorders 19% - Anxiety disorders

Question 11

What is the prognosis of conduct disorder?

Answer 11

In general - children who develop conduct disorder behavior later in childhood have a somewhat better prognosis. Severity and variety of early antisocial behavior is a powerful predictor of serious antisocial behavior in adulthood Also worse prognosis may be worse for those who have comorbid disorders

Question 12

The severity and variety of early antisocial behavior is a powerful predictor of?

Answer 12

Antisocial behavior in adulthood.

Question 13

What is the cost of conductive disorder over 7 years? What are the costs causes

Answer 13

70k Cost of general health Inpatient and outpatient mental health Justice system School (special ed)

Question 14

What are the causes of CD or ODD?

Answer 14

Evidence of genetic basis - family studies show that approximately 20% of first degree relatives of people with ASP also have ASP High concordance in monozygotic twins (vs dizygotic twins)

Question 15

There appears to be highly heritable general vulnerability to externalizing disorders such as (4)

Answer 15

Conduct disorder

Antisocial personality disorder

Alcohol dependence

Drug dependence

Question 16

Adoption studies have shown what about ASP?

Answer 16

Adoptees with biologic background of ASP more likely to develop disorder than those without.

Question 17

Chronic under arousal leads patients with ASP to seek?

Answer 17

Seek out dangerous or risky situations to raise level of arousal

Question 18

Patients with ASP have a more _______ EEG activity, _____ resting pulse, _____ resting skin conduction

Answer 18

Slow-wave EEG activity

low resting pulse

low resting skin conduction

Question 19

____ % of boys with CD develop _________

Answer 19

50% of boys with conduct disorder develop antisocial personality disorder

Question 20

When boys with CD or CD and ADHD were shown peasent scenes, neutral scenes, and unpleaseant images how did they react?

Answer 20

Boys with CD or CD + ADHD evaluated negative pictures as being less aversive than those with just ADHD and controls.

They also had decreaed EDR to all slides

Question 21

What medications are effective in decreasing aggression in CD?

Answer 21

Risperidone effective in decreasing aggression in CD

Lithium in short-term treatment of aggression

Question 22

What are the cause and effect problems that parents should follow?

Answer 22

Extremely important for parents to be highly consistent with rules

Rules need to be logical and enforceable

“You have to be in bed by 9pm” instead of “you have to be asleep by 9pm” - Never try to control a child’s biology

Question 23

What should you do about good and bad behavior?

Answer 23

Whenever possible, there should be consequences for breaking rules.

Children should be rewarded for appropriate behavior

Don’t assume positive behavior and thereby, let it go unrewarded.

Question 24

What is ADHD? Impulsivity/hyperactivity qualifications

Answer 24

ADHD is impulsivity/hyperactivity, they need 6 or more of the following - manifested often

• Impulsivity
  
  • Blurts out answer before question is finished
  • difficulty awaiting turn
  • interrupts or intrudes on others
• Hyperactivity
  
  • fidgets
  • unable to stay seated
  • inappropriate running/climbing (restlessness)
  • difficulty in engaging in lesiure activities quietly
  • “on the go”
  • Talks excessively

Question 25

Inattention criteria for ADHD?

Answer 25

Six or more of the following - manifested often

• inattention to details/makes careless mistakes
• difficulty sustaining attention
• seems not to listen
• fails to finish tasks
• difficulty organizing
• avoids tasks requring sustained attention
• loses things
• easily distracted
• forgetful

Question 26

What is the most comon behavioral disorder of childhood?

Answer 26

ADHD

Question 27

Does ADHD affect girls or boys more?

Answer 27

Boys - most common in 1st born boys

75% persist into adolesence

65% persist into adulthood

Question 28

What predicts worse prognosis in ADHD?

Answer 28

Earlier onset

Question 29

What are common comorbidities in ADHD? whats the most common?

Answer 29

Depressive disorder, cyclothymia, bipolar disorder, anxiety disorder, OCD, learning disorders, ODD, conduct disorder, antisocial disorder, psycoactive substance abuse, tourette’s syndrome

ODD is most common, then conduct disorder, then cyclothymia

Question 30

Do ADHD youth have a substance abuse issue growing up?

Answer 30

Yes

Question 31

MTA study showed?

Answer 31

Multimodal treatment study of children with ADHD

Med management = med management + Behavioral management > behavioral tx and community based treatment

TID ritalin is preferred dosing regimen, subjects with any form of comorbidity, including disruptive behavior disorder or anxiety, did better with combined treatment

Question 32

For Schizophrenia - at least ____ of five symptoms must be present for at least 1 month. One of the two symptoms MUST be _____,________, or disorganized speech

Answer 32

At least 2 of 5, and one of the symptoms must be delusions, or hallucinations.

5 include - delusions, hallucinations disorganized speech, grossly disorganized or catatonic behavior, negative symptoms (diminished emotional expression or avolition)

Question 33

To distinguish schizophrenia from schizphreniform disorder, how long must it go on?

Answer 33

Six-month duration distinguishes.

Question 34

Duration of schizophrenia, schizophreniform disorder, brief psychotic disorder

Answer 34

schizophrenia -more than 6 months

schizophreniform disorder - one to six months

brief psychotic disorder - one day to six months

Question 35

How is schizophrenics level of functioning compared to prior to the onset?

Answer 35

Markedly below the level of achieved prior to onset.

Question 36

Hallucinations are?

Answer 36

Sensory perceptions in absence of external stimuli

Question 37

Delusions are?

Answer 37

Firmly held false beliefs

Question 38

Thought disorder is?

Answer 38

Disruption in form of organization of thinking - incoherence, difficulty communicating, loose associations, thought blocking, echolalia, clanging.

Question 39

Cognitive symptoms of schizophrenia?

Answer 39

Cognitive symptoms are subtle and are often detected only when neuropsychological tests are performed. They include the following:

Poor “executive functioning” ( the ability to absorb and interpret information and make decisions based on that information)

Inabiltiy to sustain attention

Problems with “working memory”

Question 40

What is the prodromal phase or residual phase in schizophrenia?

Answer 40

Social isolation, withdrawal, impariment of functioning, peculiar behavior, impaired personal hygiene, blunted or inappropriate affect, abnormal speech, odd beliefs, unusual perceptual experiences, apathy.

Question 41

Someone with a preoccupatio nwith one or more delusoin or frequent auditory hallucinations but no disorganized speech, no disorganized or catatonic behvaior, and no flat or inappropriate affect is?

Answer 41

Paranoid type of schizophrenia.

Question 42

The residual type of schizophrenia is?

Answer 42

Absence of prominent delusions, hallucinations, disorganized speech or behavior

Continued evidence of disturbance or negative symptoms.