Notes: Conduct disorder

 

  Conduct disorder

• Objectives
• Define conduct disorder
• List down subtypes
• Explain the etiological factors
• Describe the predisposing factors
• List down the clinical manifestations
• Explain the differential diagnosis
• Describe the management

Definition

• Conduct disorder is an enduring set of behaviours that evolves over time, usually characterized by aggression and violation of the rights of others.

Subtypes

• Childhood onset type
• Adolescent on set type
• Oppositional defiant disorder

            The disorder is an enduring pattern of negativistic, hostile, and defiant behaviours in the absence of serious violations of social norms or the rights of others.
  Etiology

• Parental factors
  • Chaotic home conditions
  • Divorce
  • Parental psychopathology, child abuse and negligence
  • Sociopathy, alcohol dependence, and substance abuse in the parents
• Socio-cultural Factors
• Socioeconomically deprived children in urban environments
• Unemployed parents, lack of supportive social network, and lack of positive participation in community activities
• Drugs and substance abuse increases the risk
• Psychological factors
• Neurologic Factors
• Child abuse and maltreatment

Predisposing Factors

• Biological influences
• Genetics- Family history of conduct disorder in the family predisposes to conduct disorder
• Temperament-Children with difficult temperament before age of 3 years have high chance of developing conduct disorder
• Biochemical factors-Alterations in nor-epinephrine and serotonin were seen in cases with conduct disorder. Higher levels of testosterone is seen among boys with this disorder
• Psychosocial influences
  • Peer relationship: Poor peer relationship and rejection in turn will lead to aggressive behaviour and conduct disorder
  • Family influences:
• Parental rejection
• Inconsistent management with harsh discipline
• Early institutional living
• Frequent shifting of parental figures
• Large family size

Clinical features

• Frequent lying
• Stealing or robbery
• Running away from home and school
• Physical violence like rape, fire-setting, assault or break-in, use of weapons
• Cruelty towards other people and animals
• Secondary complications such as syphilis, HIV, suicidal and homicidal behaviours

Differential Diagnosis

• Childhood psychiatric conditions
• ADHD and substance abuse often associate with conduct disorder

Treatment

• Behavioural interventions
• Social skill training
• Family education and therapy
• Individual psychotherapy
• Pharmacologic interventions
  • Tb Lithium, Tb.Carbamazepine To treat aggressive behaviour
  • Antipsychotics- To treat psychotic symptoms

Nursing management Diagnoses

• Risk for other directed violence related to characteristics of temperament, peer rejection, negative parental role models, and dysfunctional family dynamics.
• Impaired social interaction related to negative parental role models, impaired peer relations leading to inappropriate social behaviour.
• Defensive coping related to low self esteem and dysfunctional family system.
• Low self esteem related lack of positive feedback and unsatisfactory parent/child relationship.

Management

• Observe the child carefully for high risk behaviour.
• Redirect the violent behaviour to physical activities such as exercise or cleaning ward
• Administer tranquilizing drugs as prescribed
• Use mechanical restraints if needed.
• Set limits on manipulative behaviour
• Maintain a log book on behaviour
• provide positive reinforcement for acceptable behaviour
• Assist in practicing adaptive behaviour
• Provide social skill training
• Guidance and support of parents in managing the childs behaviour.