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

2. 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.

3. 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.

4. 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.

5. 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.

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

7. 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.

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

9. 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.

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

11. 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: , 409
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

12. 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.