Identifying, Assessing, and Treating Conduct Disorder at School (Developmental Psychopathology at School) GGZ36WQhttps://t.co/caLoJlQMFz pic.twitter.com/EzjOvnSqr9
— Garth93RdX (@Garth93X) December 28, 2022
In the last post, we saw how:
- The cause of Intermittent explosive disorder can be linked to psychological, social and biological factors.
- Children and adolescents need to be carefully monitored for the amount of screen time they are exposed to.
- For those who have the intermittent explosive disorder to get better they should be advised to avoid mind-altering drugs.
Welcome to Medic Vibes, where we discuss mental health disorders and make sense of them. Dr Ebingo Kigigha is a medical doctor (aspiring psychiatrist) and creative person (illustration and music). This has been our routine for four consecutive months. This month will be dedicated to Conduct disorder. In the first month, we discussed Depression, and in the subsequent month, anxiety. We just finished with Eating disorders.
In this post, we are looking at Twitter posts. To learn more just keep scrolling down. You can also skip to the key point of the post if you which or go to the conclusion to get the summary.
To assess a patient for intermittent explosive disorder it has to start with the history of the patient. History usually has stories of frequent aggressive behavior. If the behaviour was seen in just one episode then it is not enough to deduce that the patient has the intermittent explosive disorder.
The patient most times have a dependence on alcohol, anger management problems and mood swings. They go in and out of work and are often time jobless. They have difficulty maintaining decent relationships and have problems with law enforcement. They usually are return patients after not getting help in the past. They usually feel guilty and anxious after each episode. When a neurological examination is done there is right-left ambivalence but they have normal brain wave activities.
When someone has this disorder, there are some abnormal reflex findings, their EEG is usually normal but they have letter reversal difficulties. Other tests such as liver function tests, thyroid function tests, blood glucose, drug tests and STD tests are done to exclude secondary causes of aggressive behaviour.
Some abnormalities are seen on imaging like the prefrontal cortex has changes that are linked to the inability to control impulses.
Before a diagnosis of Intermittent explosive disorder is made, other causes need to be excluded from the realm of possibility such as other conditions that would normally cause episodes of aggression.
In schizophrenia, the patient is aggressive when they have delusions and hallucinations, especially in paranoid and catatonic types of schizophrenia and they do not show signs of any connection to reality.
If the cause of the aggressive behaviour is mania, the patient will reveal this in their mental status examination and their presentation.
Another differential to keep in mind is Amok, where the patient has amnesia after the episodes and is commonly seen in people who are from Southeastern Asia but some cases have been seen in North America.
The main difference is that Amok is only an episode of aggressive behaviour and the patient is dissociated.
Intermittent Explosive disorder can begin anytime in a person's life but most commonly it has been noted to occur in late adolescence and early adult life. There is no gradual pattern in this disorder and it can continue for years. In most patients, however, it is noted to reduce its intensity in middle age but when they have a brain abnormality it increases the number of episodes and the intensity.
The disorders to keep in mind are psychotic disorders or medical problems that can change the patient’s personality, substance abuse such as alcohol or barbiturates or hallucinogens which cause hallucination and psychostimulants such as amphetamines. Conditions such as epilepsy, masses in the brain, degenerative brain conditions and endocrine disorders.
In conduct disorder, there is usually a repetitive pattern that is very resistant Intermittent explosive disorder comes in episodes.
In antisocial and personality disorders the patient behaves in the same manner even when the person is not having an outburst episode. So meaning they are typically aggressive on a normal day.
Conduct disorders features(Reaction)
Image by storyset on Freepik
The features seen in children depend on the age of the child in question and also the severity of the condition. The features seen are either aggressive, destructive, deceitful or violations.
If the behaviour has an element of threat and can harm a person or animal it is considered aggressive behaviour. These are behaviour such as fighting, oppressing others or being unkind to animals. The aggressive behaviour may also be sexual assault or rape.
They may exhibit destructive behaviour which includes destroying property with fire (arson) or causing harm to someone’s property (vandalism).
The deceitful behaviour these patients may engage in are acts such as stealing or breaking into people’s houses and can steal a car.
These children tend to break the rules of the home, school or the broader society in a way that children their age typically do not. This behaviour includes running away from school, and home and playing mean pranks on other kids. They may also partake in sexual behaviour early in life.
In addition, many children with conduct disorder are irritable, have low self-esteem, and tend to throw frequent temper tantrums. Some may abuse drugs and alcohol. Children with conduct disorder often are unable to appreciate how their behaviour can hurt others and generally have little guilt or remorse about hurting others.
These children are easily irritated by little things and are sensitive to negative emotions. They are very expressive of their anger and do so frequently. They tend to abuse drugs and alcohol. When a child has conduct disorder, they can not understand the emotions of others and do not have any empathy for their actions.
Nobody knows why the children affected by this condition behave this way but theories are pointing to biological factors, psychological factors, and social factors.
From a biological standpoint, the children or adolescents who have this condition usually have family members with other mental health conditions such as anxiety disorder, substance abuse disorders or personality disorders. This would mean that there is some genetic influence in this condition but it is not clearly defined. Some studies have shown that brain injuries in some areas of the brain have been known to cause behavioural problems.
People who have impulse problems, or difficulty handling their emotions usually result from brain damage in certain areas leading to conduct disorders.
Conduct disorders happen when the nerve wiring in the brain is not working properly. There are significant connections between those who have conduct disorders with disorders such as ADHD learning disorders and other mental health conditions,
The psychological features that are seen in these patients are the lack of empathy shown by guiltless actions and there is also a lack of cognition seen in these patients.
Socially they usually come from families with a lot of dysfunction and abuse. Their history has a lot of bad experiences. Their parents tend to be substance abusers and do not have good socioeconomic standing.
Questions
- What did you learn about Conditional disorders?
Conclusion
- The diagnosis of Intermittent explosive disorder is one of exclusion.
- Identification of the features of intermittent explosive disorder is very dependent on the history.
References
- Kaplan-Sadocks-Comprehensive-Textbook-Psychiatry
- Page demarcations made with Inkscape.org
- Pub Med
- Biomed Central