Posted: January 1st, 2023

Oppositional defiant vs Conduct disorder and post traumatic stress vs Adjustment disorder essays

Oppositional defiant vs Conduct disorder and post traumatic stress vs Adjustment disorder essays

DISCUSSION 1

Discuss and answer questions related to the case presentation.

Please include the time consideration for differentiating adjustment disorders from PTSD.

According to the American Psychiatric Association (2013), posttraumatic stress disorder is when the duration of the disturbance last more than one month. Adjustment disorder is when the person has developed emotional or behavioral symptoms that occur within three months of the start of the stressor (American Psychiatric Association, 2013) Oppositional defiant vs Conduct disorder and post traumatic stress vs Adjustment disorder essays.

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What is the difference between an Oppositional defiant disorder and Conduct disorder?

According to the American Psychiatric Association (2013), oppositional defiant disorder is when the patient meets at least four of the symptoms lasting at least six months and the interaction occurs with at least one individual who is not a sibling. The symptoms are under the categories of angry/irritable mood, argumentative/defiant behavior, and vindictiveness (American Psychiatric Association, 2013). Conduct disorder is when the patient meets three of the 15 criteria within the past 12 months and at least one criterion present in the past six months (American Psychiatric Association, 2013). With conduct disorder, the patient is physically destructing property or committing theft and bullying/physical fights (American Psychiatric Association, 2013). Oppositional defiant vs Conduct disorder and post traumatic stress vs Adjustment disorder essays On the other hand, oppositional defiant disorder the patient isn’t destroying anything but is just displaying acts of defiance (American Psychiatric Association, 2013). Oppositional defiant disorder patients aren’t physically defiant just verbally (American Psychiatric Association, 2013).

• For the discussion boards this term please include:
• Any differential diagnoses

Acute stress disorder is a differential diagnosis for this patient due the stress she was under during the event but, acute stress disorder only last from 3 days to 1 month following the exposure to the traumatic event therefore if her symptoms don’t resolve in one month then the diagnosis couldn’t be acute stress disorder (American Psychiatric Association, 2013).

Other posttraumatic disorders and conditions could be a differential diagnosis for the patient depending on her symptoms in the days following the traumatic event (American Psychiatric Association, 2013). The patient does have symptoms at this time due to the traumatic event but, if her symptoms resolve then her diagnosis could be another mental disorder and not PTSD (American Psychiatric Association, (2013).

• Your diagnosis and reasoning

The diagnosis for the patient is posttraumatic stress disorder. According to the American Psychiatric Association (2013), to diagnose this patient with posttraumatic stress disorder, the patient does meet the criteria A which is exposure to actual or threatened death, serious injury, or sexual violence in one or more ways. The patient meets criteria A1: directly experiencing the traumatic event (American Psychiatric Association, 2013).

• Any additional questions you would have asked

I would ask the patient if she were having any flashbacks or nightmares of the incident. Is there anything that triggers memories of the traumatic event? Have you told anyone else about the traumatic event? Are you able to sleep and are you eating? Have you been able to maintain your cleanliness?

• Medication recommendations along with your rationale. Note possible side effects or issues to address if attempting to obtain consent.

For this patient I would start her out on sertraline (Zoloft) 25 mg po daily for her PTSD. The notable side effects for Zoloft are gastrointestinal such as decreased appetite, nausea, diarrhea, constipation, or dry mouth (Stahl, 2021). Zoloft can often affect the central nervous system with insomnia, sedation, agitation, tremors, headache, or dizziness (Stahl, 2021). Other rare side effects are hyponatremia, hypotension, and seizures (Stahl, 2021). The black box warning for Zoloft is that it could cause suicidal ideation in children and young adults (Stahl, 2021) Oppositional defiant vs Conduct disorder and post traumatic stress vs Adjustment disorder essays.

• Any labs and why they may be indicated

There are no labs that need to be started to start on Zoloft. Getting a baseline CBC, and urine tox screen would be good for this patient. Checking the patients’ labs for electrolyte imbalances because Zoloft can cause hyponatremia. Also, a urine tox screen to make sure the patient isn’t using any other substances before starting on Zoloft.

• Screener scales or diagnostic tools that may be beneficial

There are numerous scales and questionnaires that can be conducted to diagnose PSTD. Those scales and questionnaires are the brief trauma questionnaire, trauma assessment for adults-self report, and traumatic life events questionnaire (Lancaster et al., 2016). There are other scales that can be used for symptom severity which are PTSD checklist for DSNM-5 and posttraumatic diagnostic scale for DSM-5 (Lancaster et al., 2016).

• Additional resources to give (Therapy modalities, support groups, activities, etc.)

Psychotherapeutic interventions for PTSD are behavior therapy, cognitive therapy, and hypnosis (Sadock et al., 2017). Other types of therapy that is relatively novel and somewhat controversial is eye movement desensitization and reprocessing (EMDR) (Sadock et al., 2017) Oppositional defiant vs Conduct disorder and post traumatic stress vs Adjustment disorder essays. Group and family therapy have proven to be effective in cases of PTSD as well (Sadock et al., 2017). Therapists need to overcome the patient’s denial of the traumatic event, encourage them to relax, and remove them from the source of the stress (Sadock et al., 20170.

 

DISCUSSION 2

Please include the time consideration for differentiating adjustment disorders from PTSD.

Adjustment disorder symptoms rarely last longer than 6 months and the symptoms start within 3 months while post-traumatic stress disorder (PTSD) symptoms last longer than how long adjustment disorder symptoms last. PTSD is usually not diagnosed until six months after the trauma even though the symptoms may begin immediately after the trauma.

According to the DSM-5, by definition, the disturbance in adjustment disorders begins within 3 months of the onset of a stressor and lasts no longer than 6 months after the stressor or its consequences have ceased (American Psychiatric Association, 2013, p. 287).

According to Kaplan and Sadock (2017, p. 137), for PTSD, “by definition, the symptoms must begin within 3 months of the stressor”.

What is the difference between an Oppositional defiant disorder and Conduct disorder?

The oppositional defiant disorder is seen in children and adolescents with enduring patterns of negativistic, disobedient, and hostile behavior toward authority figures, as well as an inability to take responsibility for mistakes, leading to placing blame on others (Kaplan and Sadock, 2017, p. 814).

Conduct disorder is an enduring set of behaviors in a child or adolescent that evolves over time, usually characterized by aggression and violation of the rights of others (Kaplan and Sadock, 2017, p. 816).

The difference between the two is with conduct disorder, individuals violate other people’s rights or what is considered a norm by the society while in oppositional defiant disorder, people with this disorder may have irritable or angry moods, may have argumentative or defiant behavior, and may be vindictive. Oppositional defiant vs Conduct disorder and post traumatic stress vs Adjustment disorder essays

 

References

American Psychiatric Association. (2013). Adjustment Disorder. In Diagnostic and Statistical Manual of Mental Disorders DSM-5 (5th ed., pp. 287). American Psychiatric Publishing.

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2017). Kaplan & Sadock’s Concise Textbook of Clinical Psychiatry (Fourth ed.). Wolters Kluwer.

 

Module 5 case study

Brief Summary: The patient is a 33year old male who was brought into the psychiatric hospital by police after he attacked a man in the bar after he saw the man putting his arm around his girlfriend. He wrapped his hands around his throat and threatened to rip his throat out. The patient admitted to a history of similar episodes multiple times a year since he was in his late adolescence. He was arrested two months prior for road rage and had been fired from several jobs in his late 20s due to being hot-tempered. According to his girlfriend apart from his outbursts and anger which leads to destroying things, he is fun-loving and charming. The patient stated that he regrets the episodes, and they usually subside within a half-hour, and he feels an instant sense of relief. The patient denies any past psychiatric history or prescription drug use and denies current use of illicit or recreational drug use but admitted to marijuana experimentation in his late teens.

His physical examination and all of his diagnostic testing, and labs were all normal.

Any differential diagnoses

• Disruptive mood dysregulation (DMD): I did not choose this because his outbursts are intermittent while DMD requires that he has a persistent negative mood state most of the day and nearly every day between the outbursts (American Psychiatric Association, 2013, p. 468).
• Antisocial personality disorder or borderline personality disorder: I did not pick this because his outbursts and aggression are much higher than the outbursts seen with antisocial and borderline personality disorder which are much lower (American Psychiatric Association, 2013, p. 468).
• Delirium, major neurocognitive disorder, and personality change due to another medical condition, aggressive type: I did not pick this because based on his physical examination, imaging, and lab testing, there were no medical conditions noted (American Psychiatric Association, 2013. p. 468).
• Substance intoxication or substance withdrawal: I did not pick this because his drug and alcohol screening were negative (American Psychiatric Association, 2013, p. 469).
• Attention-deficit/hyperactivity disorder, conduct disorder, oppositional defiant disorder, or autism spectrum disorder: I did not pick this because the patient did not have any childhood diagnosis of any of these disorders (American Psychiatric Association, 2013, p. 469). v

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Your diagnosis and reasoning

My diagnosis for this patient is Intermittent Explosive Disorder 312.34 (F63.81) (American Psychiatric Association, 2013, p. 466-469).

My reasoning is he has had multiple similar episodes since his late adolescent years. He clearly meets the diagnostic criteria as listed in the DSM-5. The patient meets the following diagnostic criteria:

• A: He has had recurrent behavioral outbursts and an inability to control his aggressive impulses as manifested by three behavioral outbursts involving damage or destruction of property and or physical assault involving an injury to an individual (American Psychiatric Association, 2013, p. 466).
• B: The magnitude of aggressiveness expressed during the recurrent outbursts is grossly out of proportion to the provocation or to any precipitating psychosocial stressors (American Psychiatric Association, 2013, p. 466).
• C: His recurrent aggressive outbursts were not premeditated (APA, 2013, p. 466).
• D: His outburst caused marked distress in the individuals involved and he’s been fired from multiple jobs (American Psychiatric Association 2013, p. 466).
• E: His chronological age meets his developmental level (American Psychiatric Association, 2013. P. 466).
• F: His recurrent aggressive outburst is not due to any other mental disorder (American Psychiatric Association, 2013, p. 466).

Any additional questions you would have asked

• Any family history of intermittent explosive disorder or mental health disorder?
• Any stressors or precursors that trigger the violence?
• I will ask about the patient’s sleep pattern to determine if he is getting enough sleep because not getting enough may be a trigger of his symptoms.
• I will ask the patient if he exercises and encourage this as this may help relieve some of his stress and aggressions.

Medication recommendations along with your rationale. Note possible side effects or issues to address if attempting to obtain consent.

Consent for treatment obtained from the patient prior to prescribing the medications. The medications I recommend are Sertraline and Buspirone. SSRI combined with Buspar has been proven to be effective for the treatment of intermittent explosive disorder particularly in reducing impulsivity and aggression (Sadock et al., 2017).

• Sertraline 25mg one by mouth every day with food or milk.

Side effects of the medication such as headache, nausea, diarrhea, drowsiness, dry mouth, anxiety, nervousness, vomiting, constipation, and sexual dysfunction discussed with the patient. Adverse effects of sertraline such as serotonin syndrome (seizures, arrhythmias, high fever), neuroleptic malignant syndrome (muscle rigidity, cognitive changes), and suicidal ideation were discussed with the patient (Kizior and Hodgson, 2019, p. 2378).

The patient was told that the dry mouth may be relieved by drinking sips of water and chewing sugarless gum and should avoid alcohol while taking sertraline. Should report any worsening depression or suicide ideation immediately (Kizior and Hodgson, 2019, p. 2379).

• Buspirone 5mg one by mouth twice a day (Kizior and Hodgson, 2019, p. 518).

The side effect of the medication such as dizziness, drowsiness, nervousness, fatigue, insomnia, dry mouth, and diarrhea were discussed with the patient, and also made aware that in rare cases muscle pain/stiffness, chest pain, and involuntary movements can occur (Kizior and Hodgson, 2019, p. 518). The patient was told to avoid tasks that requires alertness, and motor skills until the effect of the medication is established (Kizior and Hodgson, 2019, p, 518). The patient was also told to avoid alcohol, and grapefruit products and be consistent if taking it with food (Kizior and Hodgson, 2019, p. 518).

Any labs and why they may be indicated

Baseline labs complete blood count (CBC), renal function, and liver function tests (LFT) will be obtained prior to starting Sertraline and periodically for both medications if the patient remains on the medications long-term (Kizior and Hodgson, 2019, pp. 518 and 2379) Oppositional defiant vs Conduct disorder and post traumatic stress vs Adjustment disorder essays.

Screener scales or diagnostic tools that may be beneficial

The intermittent explosive disorder screening questionnaire (IED-SQ) was used.

According to Coccaro et al., (2017), “a study was designed to develop and test a screening approach to identify individuals with DSM-5 Intermittent Explosive Disorder (IED), a disorder of recurrent, problematic, impulsive aggression and a screening approach to diagnose DSM-5 IED (IED-SQ) was developed by combining items related to life history of aggression and items related to the DSM-5 diagnostic criteria for IED”.  Based on the result of their study, the data suggested that the IED-SQ is a useful screening tool that can quickly identify the presence of IED by DSM-5 criteria in adults (Coccaro et al., 2017).

Additional resources to give (Therapy modalities, support groups, activities, etc.)

• The patient was referred to therapy for cognitive behavioral therapy to help with cognitive restructuring to help him identify his triggers and learn how to deal with and manage difficult situations he finds himself in (Mayo Clinic, 2018).
• Group therapy and family therapy were also recommended to help him learn coping skills and mechanisms from other people who are dealing with the same diagnosis and to help his family learn how to deal and cope with his diagnosis (Sadock et al., 2017, p. 254).
• Diversionary activities and relaxation techniques such as deep breathing exercises and yoga were also discussed with the patient (Mayo Clinic, 2018).
• The patient was told that the medications may take several weeks before the effect is felt (Stahl, 2021).
• The patient was told to return for a follow-up in four weeks for medication assessment.
• The patient was told to report any suicidal thoughts or ideations immediately.
• The patient was told to call 911 or go to the emergency room if any increased suicidal thoughts, ideations, or plans. Patient given information on Delaware Suicide & Crisis Hotlines 1(800) 345-6785, 1(800) 262-9800 or 1(800)-SUICIDE (1-800-784-2433) and 1-800-273-TALK (1-800-273-8255) for USA National Suicide Hotlines if any suicidal ideations/plans or thoughts Oppositional defiant vs Conduct disorder and post traumatic stress vs Adjustment disorder essays.