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Chapter 21: Impulse Control Disorders

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Trini Sadangsal

on 21 March 2014

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Transcript of Chapter 21: Impulse Control Disorders

Objective 4 Self Assessment
People with impulse-control disorders have behaviors that are considered objectionable by most.
Safety should be addressed
Provide equal care
Empathetic view of people necessary
Objective 6
Objective 2
Discuss etiology and comorbidities of the impulse control disorders.
Objective 3
Describe biological, psychological, and environmental factors related to the development of impulse control disorders
Oppositional Defiant Disorder
Angry/irritable mood
Defiant behavior
Vindictive behavior
Intermittent Explosive Disorder
Stage 1: tension & arousal
Stage 2: sense of relief & release
Stage 3: feelings of remorse, regret, & embarrassment
Conduct Disorder
Childhood-onset conduct disorder
Adolescent-onset conduct disorder
Objective 1
Chapter 21: Impulse Control Disorders
A classic example of a child with an impulse control disorder ( Conduct disorder)
Three major disorders associated with impulse control disorders
1. Oppositional defiant disorder
2. Intermittent explosive disorder
3. Conduct disorder
Oppositional defiant disorder is related to ADHD, anxiety, depression, suicide, bipolar disorder, and substance abuse.
Intermittent explosive disorders tend to be associated with mood disorders, anxiety disorders, eating disorders, substance-use disorders, and other impulse-control disorders.
Conduct disorders are often comorbid with ADHD, substance use disorders, and learning disabilities
Biological Factors
such as Genetic and Neurobiological

Environmental Factors
- During childhood the main context is the family.

Psychological Factors
- People with conduct disorders may be compensating and covering for low self-esteem.
Oppositional defiant disorder
may be related to genetics and occurs at a young age. Many individuals diagnosed with it have a family history of other mental illnesses.
ntermittent explosive disorder
genetics run in families
Conduct disorders
are more common in children & adolescents whose parents were similarly afflicted. These pt's also have a reduced gray matter bilaterally in the anterior insulate cortex which is believed to be involved with empathy and emotion.
Psychological Factors
Environmental Factors
- Parents model behavior and provide the child with the view of the world. These disorders may reflect behavior that is learned from generation to generation.
- Other stressors can include major disruptions such as placement in foster care, severe marital discord, or separation of parents
External factors-
*Myth- bad parenting
does not
necessarily cause bad behavior.

Parent Management Training
- Children with conduct disorders tend to utilize more immature styles of coping and problem solving.
- They may be compensating & covering for low self-esteem.
-They may respond impulsively to situations that remind them either consciously or unconsciously of trauma experienced in childhood.
Parent-Child Interaction Therapy
Cognitive-Behavioral Therapy
It’s a talk therapy that focuses on patient feelings, thoughts, and behaviors. It is based on the idea that if we change our thoughts to be more realistic and positive, we can change the way we experience life
Psychodynamic Psychotherapy
It focuses on underlying feelings and motivations and explores conscious and unconscious thought processes.
Help patients to develop better ways to think about & control behavior
Pharmacotherapy is generally not indicated for

Oppositional defiant disorder.
Intermittent Explosive Disorder
SSRI- Prozac,
Mood stabilizers- Lithium
Some anticonvulsant agents
Antipsychotic- Clozaril, Haldol (exer a calming effect on outburst
Conduct Disorder
2nd generation anitpsychotics- Risperdal,Zyprexa
3rd generation antipsychotics- Abilify
Chapter Review #1
Joshua, a 17-year-old outpatient, has been diagnosed with intermittent explosive disorder. As you care for Joshua, you anticipate that the psychiatric care provider may prescribe which of the following ?

a. A benzodiazepine
b. An anticonvulsant
c.A psychostimulant
d. An anticholinesterase inhibitor.

Chapter Review # 2
You are caring for Gabby, a 12 yea-old pt. diagnosed with oppositional defiant disorder. Gabby's mother asks you what type of medication is usually prescribed for this diagnosis. Your answer is usually based on the knowledge that:

a. Tx of the disorder does not usually involve any specific medication but focuses on adaptive coping mechanisms.
b. Interventions for this disorder usually include Tx with mood stabilizers or "off label" uses of the other classifications of medications.
c. A care plan may include medication, but the pt will outgrow the behavioral problems without any specific Tx.
d. Psychiatric medications have not been proven to work in the child and adolescent population.

Chapter Review #3
Blake is a 15-year-old pt admitted for emergency observation after stealing a car and being pulled over by the police for reckless driving. He also has a history of pyromania. Which of the following is the priority assessment?

a.Illegal behaviors in the past six months
b.Assessment of childhood development and family interactions
c.Suicide risk
d. feelings of remorse
Chapter Review #4
When working on an in patient adolescent mental health unit, staff may be able to maintain safety and a calm environment when they interact with patients using:

a. high expressed emotion--"You must stop tat immediately!"--using a stern tone
b.Strict rule adherence--"There are no snacks after 10 pm. No exceptions!"--using a authoritarian tone.
c.Suppressed emotion--"Hey, lets just talk about something else that doesn't upset you!"--using a light friendly tone.
d. Low expressed emotion--"Please go to your room for quiet time now."--using a neutral, calm tone.
Objective 5
Risk for Suicide
Outcomes: Expresses feelings, verbalizes suicidal ideas, refrains from suicide attempts, plans for future

Risk for other-directed violence
Outcomes: Identifies harmful impulsive behaviors, controls impulses, refrains from aggressive acts, identifies social support
Defensive coping related to impulse-control problems
Outcomes: Identifies ineffective and effective coping, identifies and uses support systems, uses new coping strategies
Promote a climate of safety for the patient and establish rapport with the patient.
Set limits and expectations. Consistently follow through with consequences of rule breaking.
Provide structure and boundaries.
Provide activities and opportunities for achievement of goals to promote a sense of purpose.
Antipsychotics (first and second generation)
Full transcript