Case Study: Conduct Disorder Işıl Sansoy

Information About the Patient Born in 1992 Male Normal birth No reported psychiatric diagnosis of parents Has 4 siblings He is the fourth child among 5 children Reported as a child with difficult temperament

Information About the Patient Drop out at sixth grade A stabbing incident at school Second time in the hospital For the last 1.5 year smokes one packet of cigarettes per day For the last 3 months smoking marijuana

Assessment Wechsler Adult Intelligent Scale IQ score: 79 (borderline intellectual functioning) Rorschah Inkblot Test When exposed to intense affective stimulus, he has difficulties with testing the reality. Becomes anxious when the situation requires solving a problem. Shows impulsive characteristics.

Diagnostic Criteria: DSM-IV TR Aggression Toward People and Animals Bullies, threatens or intimidates Initiates physical fights Has used a weapon Is physically cruel to people Is physically cruel to animals Has stolen while confronting a victim Has forced someone into sexual activity

Diagnostic Criteria DSM-IV TR Destruction of Property Has deliberately destroyed others’ property Engaged in fire setting with the intention of causing serious damage Deceitfulness of Theft Often lies to obtain goods or favors or to avoid obligations. Has broken into a house,building or car

Diagnostic Criteria DSM-IV TR Serious Violations of Rules Is often truant from school, beginning before age 13 Stays out at night despite parental prohibitions, beginning before age 13 Has run away from home overnight at least twice (or once without returning for a lengthy period).

Early starter pathway/childhood onset The most negative long term prognosis Problematic behaviors emerge in preschool period Overt behaviors appear before covert behaviors Family relations are very important in this type.

Risk Factors Temperament (difficult temperament) Genetics (Early childhood onset) Gender (CD is diagnosed 4 times more in boys) Family relations (Neglecting parents, marital conflicts, stress?) Overcrowded family (7 family members) Economic problems- (his father’s sight loss) Environmental factors /neighborhood Exposure to violence through media

Protective Factors Living with the family Social support of the family members (siblings)

Pharmacological Treatment Risperidal (Risperidone): Neuroleptic, inhibiting dopamine activity in the brain, reduces aggressive behavior. Side effects: weight gain, sedation, sexual dysfunction, muscle stiffness Patient does not prefer to use this drug, and even he/she does prefer, she cannot use it a life time. It is just a supportive treatment.

Cognitive Problem-Solving Skills Training Focused on the patients thought processes in interpersonal situations. Step by step approaches, child is taught to solve problems. Prosocial behaviors are fostered through modeling or direct reinforcement. Games, academic activities and stories are used to teach cognitive problem solving skills. And these skills are applied to real life situations.

Treatment Family Based interventions Multicomponent interventions Community based programs

Parent Training Teaching parents to alter interactions with the child to increase prosocial behavior. New ways of identifying, defining and observing behavior problems are taught. Social learning principles, (reinforcements, points for prosocial behavior,loss of privilage)

Functional Family Therapy Focuses on the cognitive, affective and interpersonal processes of the family system. Aim is to motivate the family for positive change, improve communication skills, modify cognitive sets, expectations, attitudes and affective reactions and establish new interpretations and meanings of behavior. Solving marital/parental conflicts

Functional Family Therapy Therapist uses modeling, prompting, shaping and rehearsing effective communication skills, and provides feedback and reinforcement for positive changes.

Multisystemic Treatments Parent training and Problem solving skills training are most effective together. Family is the core focus of intervention. Patient interacts in many different systems.School is also considered in the treatment program.

Prognosis In this case, the future of the patient does not seem very hopeful. If the family is engaged in the treatment procedure and receive training, positive outcome is expected. If the treatment stays limited with the drugs, the problems will come back sooner or later, and there is the risk of developing antisocial personality disorder.