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Conduct disorder and oppositional defiance disorder (Clinical …
Conduct disorder and
oppositional defiance disorder
Clinical
presentation
Bullying
Cruelty to animals/people
Fighting
Stealing
Lying
School truancy
Setting fires
Destruction of property
Running awat from home
Severe defiance, disobedience
and temper tantrums
Diagnosis
Examination
MSE
A+B, mood, thoughts, feelings,
perceptions, cognition, insight
Growth and development
Any developmental delay
History
PPH
Known psychiatric problems
Previous inpatient events and treatment
FH
Mental health disorders
Relationship with family
PMH
Growth and development
Known medical conditions
Forensic H
Any criminal acts
Any involvement with police
PC/HPC
Antisocial behaviour, types
Any threats to other people, self harm
DH
Meds, allergies
SH
Living arrangements, relationships,
school/college, bullying, school achievement,
smoking, alcohol, drugs
Diganostic criteria
(CD)
Aggression
Antisocial behaviour
Defiance of will of authority
Onset <18y
Persistent >12m in
multiple situations (homw, school)
Management
Conservative
Information, advice, support
Refer for CAMHS assessment if severe/complications
Psychological
Parental training
Indication: young children (<11y)
MOA: group sessions for modelling and feedback
to improve parenting skills
Child-focussed programme
Indication: older children 99-14y)
MOA: group social and cognitive problem solving
(CBT model for behaviour improvement)
Multimodal interventions
Indication: teenagers (11-17y)
MOA: case manager for support and interventions
personalised to the young person
Complications
Violent crime
Poor academic achievement
Psychiatric problems
Unemployment
Relationship problems
Prognosis
Poor but varied
Later onset has better prognosis
Often have behavioural problems continuing into
adulthood e.g. antisocial personality disorder
Definition
Conduct disorder
Psychiatric disorder of persistent
antisocial behaviour significantly deviates from
age and culturally accepted norms
Oppositional-defiant disorder
Enduring negative and hostile behaviour
but without violating social norms
Epidemiology
Starts in children <18y
M>F
Commonest mental/behavioural problems
in children and young people
Pathophysiology
Predisposing factors
Male gender
Low IQ/learning difficulty
Mental health problems e.g. ADHD
FH conduct disorder
Precipitating factors
Parental disocord
Physical/emotional abuse or neglect
Bullying
Frequent caregiver change
HEE household or rejection
Marital conflict/DV
Perpetuating factors
Poor/inconsistent boundaries
Poor adult supervision
Family poverty
Recreational drugs
Involvement with other difficult young people
Risk factors
Learning difficulties
FH
Male gender
Abuse/neglect
DV
Poverty
Drugs
Differentials
Functional
Adjustment disorrder
ADHD
Mood disorder (depression, BPD)
ASD
Antisocial PD
Drug misuse disorder