Impulse Control Disorders Chapter 21 Impulse Control Disorders Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Oppositional Defiant Disorder Angry and irritable mood Defiant and vindictive behavior Experience Social difficulties Conflicts with authority figures Academic problems Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Intermittent Explosive Disorder Inability to control aggressive impulses Adults 18 years or older Leads to problems with Interpersonal relationships Occupational difficulties Criminal difficulties Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Conduct Disorder Behavior is usually abnormally aggressive Rights of others are violated and societal norms or rules are disregarded Complications Academic failure, school suspensions and dropouts, juvenile delinquency, drug and alcohol abuse, and juvenile court involvement Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Conduct Disorder (Cont.) Childhood-onset conduct disorder Adolescent-onset conduct disorder Two problems Pyromania Kleptomania Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Conduct Disorder (Cont.) Epidemiology Comorbidity Etiology Biologic factors Psychological factors Environmental factors Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Application of the Nursing Process Assessment Suicide risk Assessment tools Self assessment Diagnosis (Table 21-2) Outcomes identification (Table 21-3) Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Nursing Process (Cont.) Implementation Psychosocial interventions Pharmacological interventions Health teaching and health promotion Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Nursing Process (Cont.) Advanced practice interventions Cognitive-behavioral therapy (CBT) Psychodynamic psychotherapy Dialectical behavioral therapy (DBT) Parent-child interaction therapy (PCIT) Parent management training (PMT) Multisystemic therapy (MST) Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Nursing Process (Cont.) Teamwork and safety Seclusion and restraint Evaluation Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Audience Response Questions An adolescent with oppositional defiant disorder says, “My therapist doesn’t understand me. I want to see someone else.” Should this client have the option to change therapists? Yes No Not sure ANS: Responses will vary.   Discuss potential dilemmas associated with this problem. An effective therapist is needed and yet should the child be permitted to control the environment? Also, consider the patient’s rights. REF: 401-405, 409 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Audience Response Questions An adolescent with a conduct disorder is taken to the principal’s office after assaulting and injuring another student. Which comment is this adolescent most likely to make? “I lost my temper, but it will not happen again.” “I’m sorry and embarrassed that this happened.” “I failed my math test, and guess I was just having a bad day.” “So what if that kid was hurt? I should have beaten him more.” ANS: D   Conduct disorder is a persistent pattern of behavior in which the rights of others are violated and societal norms or rules are disregarded. The behavior is usually abnormally aggressive and can frequently lead to destruction of property or physical injury. These individuals initiate physical fights, bully others, and may steal or use a weapon to intimidate or hurt others. REF: 402 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.