DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University, Exams of Nursing

Download DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University and more Exams Nursing in PDF only on Docsity! DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University • Milestones are recognizable skills or abilities that have an expected range and order of appearance, such as a child taking his first step around the time of his first birthday. Identifying any significant variations from expected patterns, such as a child taking that first step near his second birthday, is a key task for any practitioner. Knowing when a significant variation in development has occurred improves diagnostic accuracy because DSM-5 specifically requires consideration of developmental stages • Five different milestone skill areas should be evaluated: gross/fine motor, visual motor problem solving, speech and language, social/emotional, and adaptive skills • Gross motor skills are the most obvious to recognize because they involve crawling, walking, running, and throwing • Visual motor problem solving describes a child’s physical interactions with the world. Fine motor skills (using one’s hands and fingers) rely on visual input and generally progress at a slower pace than gross motor skills. If the development of these milestones is delayed, it may be because of impairments in cognitive, sensory, or motor abilities. • To be able to communicate, a person first must be able to receive input (process what is seen and heard), understand the meaning of that input, then generate an expression of his thoughts (translate thoughts into words, then express fluently). Delays in expressive language milestones may be more apparent than receptive language delays, which may be more subtle but when present may worsen an expressive language DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University impairment • Social/emotional skills are the core elements of psychiatric functioning. Social skill development is interactive and thus reliant on the presence of a responsive caregiver. A child’s temperamental traits influence how he responds to routine activities, which influences how his caregivers respond. Developing shared joint attention with another person by approximately age 1 year is a key social milestone. Normal social and emotional development is most closely linked with speech and language skills. • When you evaluate for the presence of an intellectual disability, adaptive milestones need to be investigated. Standardized intelligence testing is no longer considered the sole basis for diagnosing intellectual disability. Adaptive skills include infants learning to feed themselves or dress themselves. For older kids, it involves self-protection and self-direction. • A child may acquire all his skills in the usual sequence but at a slower rate (a delay), may acquire his skills at differential rates in different areas (a dissociation), or may achieve milestones out of the usual order of acquisition (a deviation). Growth and development will follow recognizable patterns, but it is not an exact script. It is our task to consider what would constitute normal- range development. • Table 12-2 in the book shows normal-range developmental milestones and developmental red flags that should trigger specialized assessments • ******************************************************************* DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University diagnosis of either autism or AS. Ret t syndrome was a type of PDD that was characterized by a period of normal development and then a very specific set of signs and symptoms (e.g., hand wringing) with developmental regression. Disintegrative disorder was a subtype of PDD characterized by normal development past 36 months of age at which point the clinical presentation of autism would emerge • DSM-5 has revised the diagnostic criteria for ASD replacing a triad of impairments with two behavioral domains—social communication and repetitive stereotyped behaviors. • Although delays in language acquisition are common in ASD, they are nonspecific and so have been removed from the diagnostic criteria. Each domain includes different groups of symptoms or sub-domains and can be represented dimensionally depending on the need for intervention and support. • DSM-5 includes stereotyped and repetitive speech within the restricted/repetitive behaviors domain and for the first-time sensory reactivity to aspects of the individual’s environment has also been included • For an individual to meet criteria for a DSM-5 diagnosis of ASD, evidence of symptoms in all three of the social-communication sub-domains and any two (or more) of the four restricted and repetitive behavior sub- domains is required. For individuals who meet criteria for impaired Social Communication in the absence of restricted and repetitive behaviors, a DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University new diagnostic category of Social Communication Disorder has been included in DSM-5. Impaired Social Communication- non-verbal communication, developing and maintaining relationships, and social- emotional reciprocity. Repetitive/Restrictive patterns of behavior- restricted and fixated interests, excessive adherence to routine, stereotyped repetitive speech/motor/use of object, hyper or hypo- reactivity to sensory input. • In the USA, a rapid increase in the number of children receiving a diagnosis occurred once legislation for special schooling was introduced for autistic children • Parents often become concerned about the development of their children at 12–18 months of age but children most commonly do not receive a diagnosis until 4 or 5 years of age. the American Academy of Pediatrics (AAP) and the UK National Screening Committee do not recommend universal screening. The AAP does suggest that surveillance for ASD should take place at well baby visits at 6, 12, 18, and 24 months • No screening instrument currently available has sufficient sensitivity and specificity to be used as a diagnostic instrument • Among all mental disorders, health care spending in the United States is the highest for individuals with ASD, who had higher physician and outpatient visits as well as greater prescribed medication use when compared to the non ASD pediatric population DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University • Zaroff and Uhm (2012) have reported higher rates of ASD among white Americans compared to Hispanic individuals. Likewise, according to Bernier et al. (2010), white Americans receive a diagnosis approximately a year and a half before African American children and two and a half years before Latino children • The ToM (Theory of Mind) deficit may help our understanding of some of the behavioral features of ASD including a lack of ability to generalize learned responses across settings and the presence of repetitive and stereotyped behaviors. The “ToM” deficit focuses on aspects of the social communication impairments and the inability to impute mental states either to oneself or to others. • The WCC (Weak Central Coherence) Theory was formulated by Frith arguing that individuals with autism demonstrated a local processing bias (and thus a WCC). The weak central coherence theory attempts to explain how some people diagnosed with autism can show remarkable ability in subjects like mathematics and engineering, yet have trouble with language skills and tend to live in an isolated social world. These perceptual abilities might also account for the extreme distress experienced by some children with ASD at small changes in the environment. • Overall, for many individuals, there is a gradual reduction in autistic DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University risk factors for autism, with paternal age perhaps playing a more significant role. Fathers over the age of 50 have the greatest risk of having an offspring with autism compared to fathers below 30 years of age • The most consistent and well-replicated finding has been that 25– 50% of children and adolescents with autism have elevated serotonin levels in blood and platelets • OT and arginine vasopressin (AVP) are important regulators of complex social behaviors. There have been some reports of differences in levels of peripheral OT and AVP in children with autism compared to age-matched controls. • GABA abnormalities in blood and platelets have been reported in individuals with autism. Postmortem studies have identified widespread decreased number of GABA receptor binding sites • Observations of immune system abnormalities in ASD have been noted including fetal protein reactive IgG antibodies in plasma from mothers of children with autism, maternal infection, and dysregulated cytokine signaling • Many different neuropathological changes have been described in postmortem samples including macroencephaly, acceleration and deceleration in brain growth, increased neural packing, decreased cell size in the limbic system and decreased Purkinje cell number in the cerebellum. Abnormalities in organization of the cortical mini-column, representing the fundamental subunit of vertical cortical organization DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University may underlie the pathology of ASD and result in altered thalamocortical organization, cortical disinhibition, and dysfunction of the arousal- modulating system of the brain • One of the most widely replicated findings in ASD is the increased head size and brain volume (mainly due to increased volumes in frontal lobes and anterior temporal regions) most notably in the preschool period • In general, studies show that there are abnormalities in measures of white matter, particularly in those pathways integrating higher order cognitive processes or complex social-emotional processing • Although there are no pathognomonic signs or symptoms of ASD, a number of the national clinical guidelines provide detailed information about the types of signs and symptoms that are commonly observed in preschool, school-aged children and adolescents with a possible ASD. Several authors and guidelines highlight the so-called “Red Flags” for an DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University immediate “fast track” referral of certain “high risk” groups for an ASD specific assessment • For children with a diagnosis of ASD, review and reassessment, especially at times of transition (such as starting in education, changing school, onset of adolescence or emerging into early adulthood) are likely to be beneficial either in anticipation of possible change in circumstances or if there is evidence of deterioration, onset of a mental health problem, or a new disorder such as epilepsy. Furthermore, some children and youth may not have been identified or assessed during the early years, but additional developmental, social, and academic pressures or the increased expectations of the school years may lead to symptoms and behaviors that require a multidisciplinary ASD diagnostic assessment at a later stage • The core components of an ASD diagnostic assessment include: o an ASD specific developmental history using the framework of published internationally agreed diagnostic criteria o medical history including a prenatal and perinatal history, identification of any relevant past and/or current health conditions and risk factors such as a history of possible epilepsy, and family history to identify genetic disorders, recognized medical and mental health conditions o physical examination including an assessment for congenital anomalies, any evidence of skin conditions, evaluation of growth, and measurement of head circumference. DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University the comprehensive treatment plan • Interventions such as sensory integration therapy (SIT) and auditory integration training (AIT) have been proposed to alleviate hyper- or hyposensitivity to certain stimuli and to frequencies and sounds • Visual therapies, music therapy and use of restricted diets and dietary supplementation such as omega-3 fatty acids, have also been used by families to treat both core ASD symptoms and associated problems such as ADHD-like behaviors, gastrointestinal problems, and sensory disturbance. The gluten free, casein free diet (GFCFD) is the most frequently implemented restrictive dietary intervention for individuals with ASD. • There is some evidence that vocational programs may increase employment success for some individuals with ASD • Systematic reviews have also demonstrated some evidence that the use of antipsychotic medications (such as risperidone) can reduce repetitive behaviors in children and adolescents. Considering the evidence for statistically significant adverse effects associated with antipsychotics (see NICE CG 170, 2013 for an updated review) the NICE clinical guideline development group did not recommend antipsychotic medications for the treatment of core symptoms of ASD. There is now sufficient evidence to recommend that certain interventions should not be used to treat core features of ASD. These include long-term chelation therapy, DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University hyperbaric oxygen, and secretin • It is now widely recognized that children and young people with ASD have higher rates of co- occurring mental health disorders than individuals in the general population and children with other disabilities. These include ADHD, Oppositional Defiant Disorder, anxiety, mood disturbance, and obsessive-compulsive disorder • There is evidence that a group or individual-based intervention adjusted to the needs of children with ASD can be effective • For the treatment of co-occurring ADHD, a combination of family and school-based behavioral interventions could be instigated and later, if required, supported by a trial of medication. However, the use of stimulants and other recommended second line medications for the treatment of ADHD-like symptoms show that the response rate is lower than for children and adolescents without ASD and with a higher rate of adverse side effects • Antipsychotic medication has been used to ameliorate associated symptoms such as aggression and irritability. The evidence appears to be consistent in demonstrating a positive impact on these symptoms. The starting dose should be low, aiming for the minimum effective dose and carefully monitoring for adverse effects with a plan for regular review and eventual discontinuation ************************************************************************* ************ DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University CERTIFICATION REVIEW MANUAL CHAPTER 8 DELIRIUM AND NEUROCOGNITIVE DISORDERS • The primary symptom associated with cognitive deficits involves either short term or remote memory • Rule out delirium before diagnosing dementia • Neurocognitive evaluation- evaluates the relationship between the functional integrity of the brain and human behavior. The process distinguishes behavioral changes resulting from central nervous system disease or injury. The evaluation consists of psychometrically validated tests and clinical interview (neuropsychological testing). The PMHNP combines this formalized testing procedure with a comprehensive history and physical exam to rule out delirium and diagnose dementia o Comprehensive history: general medical conditions that can cause delirium include sepsis, toxicity, nutritional deficiency, electrolyte disturbance, over/under stimulation. Substance induced disorders, primary sleep disorder, primary mood or psychotic disorder DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University Alzheimer’s; the second most common type, caused by cardiovascular and cerebrovascular disease, manifests with progressive cognitive decline in a stepwise fashion, evidenced by rapid episodic deterioration with interspersed plateau phases marking new baselines. Previously lost function is not regained. o Dementia in HIV is a poor prognosis and likely results in death in 6 months. In late stages, psychotic symptoms can manifest. Subcortical dementia with parenchymal abnormalities visualized on MRI. Many anti-retroviral medications and protease inhibitors are metabolized via the CYP450 pathway and can interact with many DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University antipsychotics. Therefore, antipsychotics should be used only if benefits outweigh risks. Impaired remote memory is the most prominent symptom. Dementia specific history includes a gradual onset of cognitive decline, impaired executive function (impaired problem solving, difficulty in learning new information), losing valuables, wandering/getting lost easily, and a decline in activities of daily living • Delirium neurological findings: psychomotor agitation/restlessness, purposeless, random actions, uncoordinated, tremor, myoclonus, nystagmus, asterixis • Cholinesterase inhibitors are believed to slow the loss of function and reduce agitated behaviors; they don’t prevent the progression of the disease o Donepezil 5-23mg/day • N-Methyl D-aspartate glutamate receptor antagonists: believed to enhance cognition, preventing overexciting glutamate receptors. Stalling the neurodegenerative process and promote synaptic plasticity o Memantine 10-20mg/d Dementia Delirium Symptoms usually start gradually, constant, and Symptoms appear over a few hours- days and DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University steadily become worse may fluctuate on and of f during the day Memory loss Memory loss Difficulty speaking and communicating Difficulty speaking and communicating Difficulty with complex tasks Rambling or nonsense speech Difficulty planning and organizing Difficulty reading and writing Disorientation Disorientation Loss of coordination Wandering attention Personality changes Becoming easily distracted Inability to reason Becoming withdrawn Fear Inability to focus Anxiety Inability to reason Inappropriate behavior Reduced awareness of the environment Paranoia Agitation Agitation Hallucinations Hallucinations Disturbed sleep Anger or depression • Medical foods- believe to provide essential nutrients by introducing high concentrations of ketones to cross the blood brain barrier o Axona 40g packet contains 20grams of medium chain triglycerides to be mixed into 4-8 oz. water, drink immediately. Adverse reactions include bloating, nausea, and diarrhea during acclimation. ▪ Metabolized into ketone bodies for energy with impaired glucose DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University adjusted age rather than the chronological age • Adjusted age is used until the age of 24 months • Behavioral red flags: o 2months: doesn’t respond to loud sounds, doesn’t track faces or lights around the room, doesn’t reciprocate smiling, doesn’t bring hands to mouth, unable to hold head while on tummy o 4-6months: eyes don’t move symmetrically in all directions, doesn’t push down legs when placed on a hard surface, shows no affection for caregivers, difficulty bringing things to mouth, no ability to roll over in either direction, no laughter or squealing sounds o 6-8months: no attempt to get things in reach, no interest in exploring, no babbles o 9months-1year: unable to bear weight on legs, unable to sit with help, doesn’t babble, doesn’t respond to name, doesn’t recognize familiar people, doesn’t look where pointing, doesn’t transfer toys from one hand to another, doesn’t crawl, can’t stand when supported, losing skills previously acquired o 18mos-3years: unable to walk, doesn’t point to show things, doesn’t know what familiar things are for, doesn’t copy others, has no interest in caregiver leaving or entering room, trouble with stairs, drools, unclear speech, no pretend play, poor eye contact DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University o 4-5 years: can’t jump in place, trouble scribbling, no interest in interactive games, ignores other children, resists dressing, sleeping, using the toilet, unable to follow a three-step command, restricted range of emotions, withdrawn, poor attention span, can’t brush teeth, wash hands, or get dressed without help o 6-12 years: fearful or timid behavior, extreme aggression, easily distracted, unable to concentrate for more than 5 minutes, little interest in other kids, restricted emotions, trouble dressing or undressing, poor impulse control, doesn’t respond to positive attention, ignored by other children, can’t adapt behavior to different social settings DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University o 13-21 years: lacking secondary sex characteristics, poor motor coordination, lack of peer relationships, doesn’t consider consequences, can’t empathize, doesn’t question, or reject parental standards, emotional or behavioral problems, lack of concentration, drug use • Intellectual disability can be like many conditions but are distinguished by: o Autism: defined by the presence of persistent deficits in social interactions with restricted and repetitive patterns of behavior. The social impairment in intellectual disability is on par with deficits in other intellectual abilities rather than the primary feature as in autism o Communication disorders: impairment is confined to speech and language without deficits in intellectual and adaptive functions o Specific learning disorders: impairment is confined to a specific area of academic achievement without deficits in intellectual and adaptive behaviors o Major neurocognitive disorder: a decline in relation to previously mastered skills in one or more areas of cognition. If the decline is during the developmental period, then intellectual disability is comorbid • Rett syndrome: a congenital neurodevelopmental disorder primarily occurring in females, characterized by specific deficits following a period of normal function, growth, and development DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University primary goal of hemodynamic stability and weight restoration in the short-term, and cognitive restructuring in the long term. Fluoxetine is FDA approved for bulimia. ▪ Psychopharmacology is targeted at symptoms associated with comorbid mood disorders, anxiety, or psychotic disorder ▪ Cognitive behavioral therapy • ADHD: characterized by consistent symptoms of inattention in at least two domains and may or may not have hyperactivity and impulsivity that is inconsistent with the developmental age, and negatively impacts function, causing distress o Shares symptoms with other disorders however can be distinguished ▪ ODD: characterized by resistance to work and school tasks DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University because of resistance to authority, accompanied by hostility and defiance. ▪ IED: characterized by high levels of impulsive behavior with episodes of serious aggression towards others ▪ DMDD: characterized by persistently pervasive irritability and low frustration tolerance ▪ Medication Induced Hyperactivity and Inattention: bronchodilators, antipsychotics, steroids, caffeine o Diagnostics include Conner’s Parent-Teacher Rating Scale, Barkley Home Situations Questionnaire, and Wender Utah Rating Scale o Rule out mood disorder, anxiety disorder or PTSD first o Treatment includes primarily stimulants, followed by SNRIs and alpha agonists ▪ Methylphenidate (Ritalin, Metadate, Concerta): Mixed inattention/hyperactivity • Dextromethamphetamine • Amphetamine (Adderall) • Dexmethylphenidate (Focalin) • Lisdexamfetamine (Vyvanse) ▪ SNRIs/Dopamine Reuptake Inhibitor: Attention • Atomoxetine (Strattera) • Bupropion (Wellbutrin) DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University ▪ Alpha-blockers: Hyperactivity and Impulsivity • Clonidine • Guanfacine • Conduct Disorder: characterized by repetitive and persistent pattern of disregard for social norms, and the basic rights of others. In adults this is called antisocial personality disorder. o Requires three or more signs in the past year with one sign in the previous six months, and one criterion met before age ten, and associated with significant impairment in social or academic function ▪ Aggression towards people and animals ▪ Destruction of property ▪ Deceitfulness or theft ▪ Serious violation of the rules o Treatment consists mainly of behavioral modification, cognitive restructuring, pharmacology to treat comorbid mood disorder o May be diagnosed in patients over the age of 18 if not meeting full criteria for antisocial personality disorder DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University disorders but rather character flaws c. Now we know that ODD/CDs have: i. Biological component involving genetic and brain differences ii. Different subtypes of antisocial behavior are better understood iii. Considerable advances in developing effective treatments for children and adolescents 2. Classification a. ODD requires 4 of the following 8 symptoms to be present for a least 6 months i. Angry & Irritable Mood (children with angry and irritable mood symptoms of ODD are most likely to develop mood disorders later in life) 1. (1) Unusual and frequent temper tantrums 2. (2) Often touchy or easily annoyed 3. (3) Often Angry or resentful ii. Argumentative and Defiant Behavior 1. (4) Often argues with adults 2. (5) Often actively refuses to comply with adults requires or defies rules 3. (6) Often deliberately does things to annoy other people DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University 4. (7) Often blames others iii. Vindictiveness 1. (8) Often spiteful or resentful b. CD requires 3 of the following 15 criteria to have been manifest in the past 12 months i. Aggression to People and Animals 1. (1) Frequently bullies others 2. (2) Frequently initiates physical fights 3. (3) Has used a weapon that can cause serious physical harm to others DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University 4. (4) Exhibits physical cruelty to other people 5. (5) Exhibits physical cruelty to animals 6. (6) Commits a crime involving confrontation with the victim 7. (7) Forces another person into sexual activity ii. Destruction to Property 1. (8) Deliberately sets fires with a risk of causing serious damage 2. (9) Deliberately destroys the property of others iii. Deceitfulness or Theft 1. (10) Has broken into someone else’s house, building or car 2. (11) Often lies to obtain goods or favors or to avoid obligations 3. (12) Has stolen objects of value without confronting the victim iv. Serious Violations of Rules 1. (13) Often stays out at night despite parental prohibitions, beginning before age 13 2. (14) Has run away from home at least twice 3. (15) Is Frequently truant from school beginning before age 13 c. Differences in ODD and CD DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University 3. Epidemiology a. Overall Prevalence i. ODD more common in younger children ii. CD more common in adolescents iii. ODD/CD make up about half of all child and adolescent psychopathology and is the commonest condition b. Variations in Prevalence i. Gender 1. Gender and parenting is the strongest predictor of antisocial behavior 2. Boys outnumber Girls by about 2:1 in ODD in younger children 3. CD in adolescents boys outnumber girls between 3:1 to 7:1 ii. Socioeconomic Status (SES) & Geographical Area 1. 5 x more common in lower SES 2. Rates 2-3 x higher in Inner City areas iii. Worldwide Prevalence & Minority Ethnic Groups 1. High rates in Bangladesh, Yemen and Brazil 2. Medium rates in Britain 3. Low rates in Italy 4. Very low rates in Goa, India 5. In developed countries DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University - High rates in African Caribbean/African American - Lower rates among Hispanic Americans - Lower rates among British Indians iv. High Risk Populations 1. Maltreated children 2. Children in foster care DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University 3. Children with intellectual disabilities 4. Young offenders v. Time Periods 1. Increase over the years c. Subtypes according to Phenomenology and Longitudinal Course i. Subdivisions of antisocial behavior 1. Overt vs Covert Antisocial Behavior - Overt = tantrums and aggression - Covert = lying and stealing 2. Proactive vs Reactive Aggression - Proactive = premeditated, predatory attacks - Reactive = Irritable, lashing out when provoked 3. Physical vs Relational Aggression - Physical = hitting, biting - Relational = bullying, scapegoating, verbal insults 4. Antisocial Behavior at School vs Home DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University v. By their mid-20’s they have cost an average 10 times as much as controls – as much as 2 million vi. Therefore, Good Quality Early Intervention is Very Cost Effective 4. Etiology a. Individual Level Influences i. Overall Genetic Effects 1. Strong genetic contribution 2. Twin studies show genetic influences but also shared environmental component 3. Genetic contribution is higher for antisocial behavior in the presence of inattention and hyperactivity or higher levels of physical aggression and if it pervasive across situations ii. Specific Genes 1. No consistent linkage regions have been identified 2. Genome wide approachesto date have been disappointment for ODD/CD iii. Pregnancy and Perinatal Complications DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University 1. Maternal Alcoholism and Smoking have been associated with increased antisocial behavior in children iv. Temperament 1. Associations between early temperament and later conduct problems – like negative emotionality, poor emotional self- regulation, inattention and restlessness 2. A difficult temperament becomes more likely to lead to disruptive behavior problems when it interacts with a harsh inconsistent parenting style v. Brain Function 1. Lower Amygdala Volume in ODD/CD in both child and adolescent onset 2. Reduced Right Insula Volume in Adolescent Onset Group 3. Associated with abnormalities of the “hot” paralimbic system that regulates motivation and affect vi. Language, IQ and Educational Attainment Deficits 1. Low IQ and low school achievement are important DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University predictors of ODD/CD and delinquency 2. Poor verbal ability 3. Performance scores are lower 4. Low language ability/verbal IQ 5. Lower abilities to recall oral instructions and to use language to think through consequences of actions DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University 1. ODD/CD associated with harsh inconsistent discipline, low warmth, low involvement, and high criticism 2. Patents of antisocial children - More inconsistent on rules - Less likely to monitor child’s whereabouts - Unresponsive to children’s prosocial behavior 3. Mechanisms - Positive overtures and behaviors by children are ignored - Negative behavior attracts parental attention - Negative Reinforcement Trap 1. Parent responds to mild oppositional behavior to which the child responds by escalating his behavior and mutual escalation continues until the parent backs off 2. Thus, teaching child if he gets more aggressive the parents will back off and he DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University will get his way 4. Possible Alternative Explanations - Associations reflect familial genetic liability toward children’s psychopathology and parents’ coercive discipline 1. Common genetic liability 2. Strong association between parent to child hostility and child antisocial behavior DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University - They represent children’s behaviors on parents 1. Evidence that children’s difficult behaviors do evoke parental negativity - That coercive parenting may be a correlate of other features of the parent/child relationship ii. Attachment Insecurity 1. Insecure attachment patterns are strongly associated with antisocial behavior iii. Exposure to Interparental Conflict and Violence 1. Children exposed to domestic violence between adults are subsequently more likely to themselves become aggressive 2. More studies needed to see extent to which interparental conflict adds to child antisocial behavior iv. Maltreatment 1. Physical punishment is widely used and parents resort to it out of desperation DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University b. These schools have high rates of distrust between students and teachers c. Low pupil commitment to the school d. Unclear and inconsistent rules e. Schools with clear, fair and consistently enforced rules tend to have low rates of student misbehavior 6. Poverty a. Antisocial children come in disproportionate numbers from poor families b. Reduced poverty can reduce antisocial behaviors as seen in the “natural experiment” c. Poor circumstances can also affect parenting quality, which in turn affects child antisocial behaviors 7. Neighborhood Influences a. Young people with ODD/CD disproportionately live in inner city areas characterized by physical deterioration, neighborhood disorganization, and high residential mobility. b. Relation between community and individual violence is mediated by parenting practices, gang membership, and peer violence c. Synthesis – Factors that influence the development of ODD/CD DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University i. Number of risks are intercorrelated DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University ii. When there are more highly heritable characteristics such as inattention/hyperactivity, lower IQ and callous- unemotional traits, the prognosis is generally worse iii. Being subject to several risk factors seems to have a cumulative effect so that outcomes are worse iv. Children with ADHD more likely to develop CD if they are subjected to critical Expressed Emotion v. As children grow up their circumstances change and they will not be passive recipients of their environment 8. Assessment, Diagnosis and Formulation a. Assessment i. Before the Interview 1. Getting parent and teachers to fill out questionnaires can be helpful to get perspective of school and detect possible comorbidity - Strength and difficulties Questionnaire (SDQ) – is free and short DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University - Inquire about gang involvement and interparental violence - Drugs, alcohol use - Involvement with parents - In young people what is the attachment to the parent - Ask what they enjoy doing and hopes for future - Any positive adults in their life? - Are there potential protective factors - Physical exam to check for dysmorphic features including fetal alcohol syndrome iii. Investigation 1. Evaluate presence of learning disabilities 2. May have specific reading retardation or dyslexia 3. General learning disability is often missed in children with CD unless IQ testing is carried out 4. Rate of CD rises as IQ gets below 70 DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University b. Differential Diagnosis and Formulation i. Differential Diagnosis – comorbid conditions are often missed 1. ADHD - Impulsively, inattention and motor overactivity can be misconstrued as antisocial - Careful history of ability to attend and be still both at home and school will usually reveal ADHD if present DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University - In contrast antisocial behavior is NOT a feature of pure ADHD 2. Mood Disorders - Depression can be present with irritability but, unlike ODD/CD, mood is clearly low and often vegetative features - If irritability is marked, then DMDD should be considered – although disobedience is not a core feature - Intermittent Explosive Disorder shares features, but aggression is not premeditated or committed to achieve a tangible object - DO NOT diagnose early bipolar without clear evidence of manic symptoms 3. Adjustment Reaction - Can be diagnosed after exposre to a stressor like divorce, trauma, abuse etc. But onset is one (1) DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University - Always ask about drug and alcohol use but often will fall short of dependent syndrome ii. Multiaxial System - ICD-10 has scheme for multiaxial assessment for children and adolescents 1. Axis 1 = clinical syndromes 2. Axis 2 = specific learning disabilities 3. Axis 3 = general learning disabilities 4. Axis 4 = medical conditions 5. Axis 5 = psychosocial and environnemental problems 6. Axis 6 = global level of functioning iii. Formulation 1. The formulation should synthesize all that has been learned from the assessment about the child’s predisposing, precipitating, perpetuating and protective factors in an individualized narrative way DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University 2. First assessment session crucial for engaging the family and identifying strengths that can bring about therapeutic change 9. Intervention – covers treatment of children ages 2-12 a. Principles i. Personalizing the Treatment Plan 1. Personalized to fit the needs of the child and family 2. Intervention needs to be tailored to the needs and strengths of the family ii. Engaging the Family 1. Drop out rates are high often 60 percent 2. Practical measures like assisting with transportations, providing childcare, and holding sessions in the evening are likely to facilitate retention 3. Form a good alliance with the family 4. The quality of the alliance with the therapist and the family affects treatment success iii. Choosing which treatment modality to use 1. Improvements in home arise from successful parent training program but will not lead to antisocial behavior DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University at school 2. Therefore, cases with difficulty at home = first line treatment is parent training 3. If classroom behavior is a problem and a school visit shows that the teacher is not using effective methods, then advice to the teacher and staff can be effective 4. Pervasive problems like fights with peers DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University the mainstay of treatment especially for children younger than 8 2. Target skills like promoting play and positive parent-child relationship 3. Using praise and rewards to increase desirable social behavior 4. Giving clear directions and rules 5. Using Consistent and calm consequences for unwanted behavior DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University 6. Reorganizing the child’s day to prevent problems 7. Two Examples of Parent Training are - Helping the Noncompliant Child - Parent Child Interaction Therapy 8. Group treatments help parents like Incredible Years Program and Positive Parenting Program 9. Parent training most studied treatment for conduct disorders 10. Combined programs for targeting antisocial behavior and reading programs for 5- and 6- year-olds iii. Family Systemic Therapies 1. Typically involve all family members attending 2. Try to improve patterns of communication that have gone wrong c. Child Therapies i. CBT and social skills therapies aim to: 1. Reduce aggression 2. Increase prosocial interactions such as entering a group DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University 3. Correct the cognitive deficiencies, distortions, and inaccurate self- evaluation 4. Ameliorate emotional regulation and self- control problems so as to reduce emotional lability, impulsivity and explosiveness d. Intervention in School i. Target 4 areas 1. Promote positive behaviors such as compliance 2. Interventions prevent problem behaviors 3. Teach social and emotional sills such as conflict resolution and problem solving 4. They prevent the escalation of angry acting out behavior e. Medication i. Prescriptions of antipsychotics like Risperdal are increasing in the US ii. In UK meds not generally be supported as good practice because of lack of clinical trials of effectiveness and risk of unwanted side effects iii. Best studied pharmacological intervention is Psychostimulants for youths with ODD/CD with comorbid DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University b. Great deal has been discovered including what leads to the condition and what treatments are likely to work to make it better Much further research needs to be done ************************************************************************* **** ***** Kaplan and Sadock Chapter 19 Disruptive, Impulse-Control, and Conduct Disorder Five conditions comprise this category: 1) Oppositional Defiant Disorder 2) Conduct Disorder (childhood disorders) 3) Intermittent Explosive Disorder 4) Kleptomania 5) Pyromania. Characterized: Inability to resist an intense impulse, drive, or temptation to perform a particular act that is harmful to self or others or both. Mounting tension builds and arousal, with conscious anticipatory pleasure. Completion = gratification, relief. Then later: remorse, guilt, self-reproach and dread. Shameful secretiveness expands and pervades the individual’s entire life, delaying treatment. DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University Etiology: Psychodynamic, psychosocial, and biological factors all play an important role in impulse- control disorders; however, the primary causal factor remains unknown. Some impulse-control disorders may have common underlying neurobiological mechanisms. Fatigue, incessant stimulation, and psychic trauma can lower a person's resistance to control impulses. DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University Psychodynamic factors: Otto Fenichel linked impulsive behavior to attempts to master anxiety, guilt, depression, and other pain by means of action. He thought that such actions defend against internal danger and that they produce a distorted aggressive or sexual gratification. To observers, impulsive behaviors may appear irrational and motivated by greed, but they may actually be endeavors to find relief from pain. Heinz Kohut considered many forms of impulse-control problems, including gambling, kleptomania, and some paraphilic behaviors, to be related to an incomplete sense of self. He observed that when patients do not receive the validating and affirming responses that they seek from persons in significant relationships with them, the self might fragment. As a way of dealing with this fragmentation and regaining a sense of wholeness or cohesion in the self, persons may engage in impulsive behaviors that to others appear self-destructive. Kohut's formulation has some similarities to Donald Winnicott's view that impulsive or deviant behavior in children is a way for them to try to recapture a primitive maternal relationship. Winnicott saw such behavior as hopeful in that the child searches for affirmation and love from the mother rather than abandoning any attempt to win her affection. Patients attempt to master anxiety, guilt, depression, and other painful affects by means of actions, but such actions aimed at obtaining relief seldom succeed even temporarily Biological: Experiments have shown that impulsive and violent activity is associated with specific brain regions, such as the limbic system, and that the inhibition of such behaviors is associated with other brain regions. A relation DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University Signs of generalized impulsivity or aggressiveness are absent between episodes. The diagnosis of intermittent explosive disorder should not be made if the loss of control can be accounted for by schizophrenia, antisocial or borderline personality disorder, ADHD, conduct disorder, or substance intoxication. The DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University term epileptoid personality has been used to convey the seizure-like quality of the characteristic outbursts, which are not typical of the patient's usual behavior, and to convey the suspicion of an organic disease process, for example, damage to the central nervous system. Several associated features suggest the possibility of an epileptoid state: the presence of auras; postictal- like changes in the sensorium, including partial or spotty amnesia; and hypersensitivity to photic, aural, or auditory stimuli. Epidemiology: Intermittent explosive disorder is underreported. The disorder appears to be more common in men than in women. The men are likely to be found in correctional institutions and the women in psychiatric facilities. In one study, about 2 percent of all persons admitted to a university hospital psychiatric service had disorders that were diagnosed as intermittent explosive disorder; 80 percent were men. Evidence indicates that intermittent explosive disorder is more common in first- degree biological relatives of persons with the disorder than in the general population. Many factors other than a simple genetic explanation may be responsible. Comorbidity: High rates of fire setting in patients with intermittent explosive disorder have been reported. Other disorders of impulse control and substance use and mood, anxiety, and eating disorders have also been associated with DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University intermittent explosive disorder. Psychodynamic Factors: Psychoanalysts have suggested that explosive outbursts occur as a defense against narcissistic injurious events. Rage outbursts serve as interpersonal distance and protect against any further narcissistic injury. DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University Genetics First-degree relatives of patients with intermittent explosive disorder have higher rates of impulsecontrol disorders, depressive disorders, and substance use disorders. Biological relatives of patients with the disorder were more likely to have histories of temper or explosive outbursts than the general population. Diagnosis: Neurological examination sometimes reveals soft neurological signs, such as left– right ambivalence and perceptual reversal. Electroencephalography (EEG) findings are frequently normal or show nonspecific changes. History-taking that reveals several episodes of loss of control associated with aggressive outbursts One discrete episode does not justify the diagnosis. 2x weekly for 3 months-- Verbal or Behavioral Physical Findings and Labs: Soft neurological signs (e.g., reflex asymmetries), nonspecic EEG findings, abnormal neuropsychological testing results (e.g., letter reversal difficulties), and accident susceptibility. Blood chemistry (liver and thyroid function tests, fasting blood glucose, electrolytes), urinalysis (including drug toxicology), and syphilis serology may help rule out other causes of aggression. Magnetic resonance imaging (MRI) may reveal changes in the prefrontal cortex, which is associated DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University with loss of impulse control. DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University The diagnosis of intermittent explosive disorder can be made only after disorders associated with the occasional loss of control of aggressive impulses have been ruled out as the primary cause. These other disorders include psychotic disorders, personality change because of a general medical condition, antisocial or borderline personality disorder, and substance intoxication (e.g., alcohol, barbiturates, hallucinogens, and amphetamines), epilepsy, brain tumors, degenerative diseases, and endocrine disorders. Conduct disorder is distinguished from intermittent explosive disorder by its repetitive and resistant pattern of behavior, as opposed to an episodic pattern. Amok is an episode of acute violent behavior for which the person claims amnesia. Amok is usually seen in southeastern Asia, but it has been reported in North America. Amok is distinguished from intermittent explosive disorder by a single episode and prominent dissociative features. Course and Prognosis: Intermittent explosive disorder may begin at any stage of life, but usually appears between late adolescence and early adulthood. The onset can be sudden or insidious, and the course can be episodic or chronic. In most cases, the disorder decreases in severity with the onset of middle age, but heightened organic impairment can lead to frequent and severe episodes. DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University Kleptomania: failure to resist impulses to steal objects not needed for personal use or for monetary value. The objects taken are often given away, returned surreptitiously, or kept and hidden. Persons with kleptomania usually have the money to pay for the objects they impulsively steal. The stealing is not planned and does not involve others. Although the thefts do not occur when immediate arrest is probable, persons with kleptomania do not always consider their chances of being apprehended, although repeated arrests lead to pain and humiliation. These persons may feel guilt and anxiety after the theft, but they do not feel anger or vengeance. Furthermore, when the object stolen is the goal, the diagnosis is not kleptomania; in kleptomania, the act of stealing is itself the goal. Epidemiology The prevalence of kleptomania is not known, but it is estimated to be about 0.6 percent. The male-to-female ratio is 1:3 in clinical samples. Comorbidities: Patients with kleptomania are said to have a high lifetime comorbidity of major mood disorders (usually, but not exclusively, depressive) and various anxiety disorders. Associated conditions also include other disorders such as pathological gambling and compulsive shopping, eating disorders, and substance use disorders, alcoholism in particular. Psychosocial Factors: The symptoms of kleptomania tend to appear in times of significant stress, for example, losses, separations, and endings of important relationships. DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University Anna Freud pointed out that the first thefts from mother's purse indicate the degree to which all stealing is rooted in the oneness between mother and child. Karl Abraham wrote of the central feeling of being neglected, injured, or unwanted. One theoretician established seven categories of stealing in chronically acting-out children: DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University As a means of restoring the lost mother–child relationship 2. As an aggressive act 3. As a defense against fears of being damaged (perhaps a search by girls for a penis or a protection against castration anxiety in boys) 4. As a means of seeking punishment 5. As a means of restoring or adding to self-esteem 6. In connection with, and as a reaction to, a family secret 7. As excitement (lust angst) and a substitute for a sexual act. Biological Factors: Brain diseases and mental retardation have been associated with kleptomania, as they have with other disorders of impulse control. Focal neurological signs, cortical atrophy, and enlarged lateral ventricles have been found in some patients. Disturbances in monoamine metabolism, particularly of serotonin. In one study, 7 percent of first-degree relatives had obsessive-compulsive disorder (OCD). In addition, a higher rate of mood disorders has been reported in family members. Diagnosis: The essential feature of kleptomania is recurrent, intrusive, and irresistible urges or impulses to steal unneeded objects. Patients with kleptomania may also be distressed about the possibility or actuality of being apprehended and may manifest signs of depression and anxiety. Patients feel guilty, ashamed, and embarrassed about their behavior. They often have serious problems with DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University descriptions or a short series of cases. Insight-oriented psychotherapy and psychoanalysis have been successful, but depend on patients’ motivations. Those who feel guilt and shame may be helped by insight-oriented psychotherapy because of their increased motivation to change their behavior. Behavior therapy, DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University including systematic desensitization, aversive conditioning, and a combination of aversive conditioning and altered social contingencies, has been reported successful, even when motivation was lacking. The reports cite follow- up studies of up to 2 years. SSRIs, such as Prozac and (Luvox), appear to be effective in some patients with kleptomania. Case reports indicated successful treatment with tricyclic drugs, trazodone, lithium, valproate, naltrexone, and electroconvulsive therapy. PYROMANIA Pyromania is the recurrent, deliberate, and purposeful setting of fires. Associated features include tension or arousal before setting the fire, fascination with, interest in, curiosity about, or attraction to the activities and equipment associated with firefighting; and pleasure, gratification, or relief when setting fire or when witnessing or participating in their aftermath. Patients may make considerable advance preparations before starting a fire. Pyromania differs from arson in that the latter is done for financial gain, revenge, or other reasons and is planned beforehand. Epidemiology No information is available on the prevalence of pyromania, but only a small percentage of adults who set fires can be classified as having pyromania. The disorder is found far more often in men than in women, with a male-to-female ratio of approximately 8:1. More than 40 percent of arrested arsonists are younger than 18 years of age. DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University Comorbidity Pyromania is significantly associated with substance abuse disorder (especially alcoholism); affective disorders, depressive or bipolar; other impulse control DSM CHAPTER 12 -MILESTONES, BEST EXAM solutions 2022/2023Walden University