MEDizzy - A 13-year-old boy is seen by a psychiatrist while he is at a

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Combined Neurology XIII

A 13-year-old boy is seen by a psychiatrist while he is at a juvenile correctional facility. He had reportedly always been a troublemaker, but he had just gotten expelled from school and charged in court after for putting a dead rabbit on his teacher’s desk and then on the same day setting a fire in the school library. He had a history of multiple detentions and suspensions for getting into fights and bullying his classmates and for skipping school. At home, he had enucleated his sister’s pet gerbil’s eyes, and once, when his mother grounded him for staying out all night (though he had a 10:00 PM curfew), he had threatened her with a kitchen knife. He had robbed their 91-year-old neighbor, threatening to strangle her if she did not give him money, and had been arrested at the mall repeatedly for shoplifting. Which of the following disorders does this child’s history suggest?

ExplanationThe disruptive behavior disorders include conduct disorder and oppositional defiant disorder. question 27 depicts conduct disorder, which is characterized by a chronic and pervasive violation of rules (including deceit, theft, and destruction of property), of others’ rights (including physical aggression to people or animals), and age-appropriate societal norms. Individuals with this disorder show little empathy or remorse. Conduct disorder is more common in males. Risk factors for conduct disorder include psychopathology in parents, dysfunctional family environment and poor parenting practices, exposure to physical, sexual, or emotional abuse or neglect, and exposure to violence. A diagnosis of antisocial personality disorder (discussed in questions 64–67), cannot be given to those younger than 18 years of age; some individuals with conduct disorder go on to meet criteria for antisocial personality disorder in adulthood, whereas in others, the conduct disorder remits and they are able to achieve adequate social and occupational adjustment. Management of conduct disorder centers primarily around institution of early multimodal psychosocial interventions to prevent conduct disorder when there are early signs of aggression or deviance in a child. Question 28 depicts oppositional defiant disorder. This is marked by a dysfunctional pattern of hostile and defiant behavior that cannot be explained by a mood or psychotic disorder. Oppositional defiant disorder most frequently emerges between ages 6 and 8, and is more common in males and those of lower socioeconomic status and in urban dwellers. Acute manic episode is discussed in questions 10 and 11, borderline personality disorder in questions 64–67 (note: personality disorder cannot be made in individuals younger than 18 years of age), and antisocial personality disorder in questions 64– 67.