Depression, ADHD, Conduct & Impulse Disorders — Symptoms and Treatment

Major Depression

Major Depression; Symptoms: insomnia, anorexia, psychomotor agitation, anxiety, anhedonia, lack of concentration, recurring ruminations, suicidal ideation, guilt, low mood.

Drugs: SSRIs (e.g., Zoloft, Prozac), fish oil: disadvantage in young people. Prozac can cause suicidal ideation. Antidepressants can cause lower norepinephrine (NA) levels.

Therapy: CBT, Logotherapy, Mindfulness, Psychodynamic therapy.

Co-occurring: PTSD, Anxiety, ADHD.

Impulse Control & Conduct Disorders

These are problems in emotional and behavioral self-control.

Symptoms:

• Five stages: impulse, tension, pleasure from act, relief from urge, guilt.
• Gambling is an impulse control disorder.

Oppositional Defiant Disorder (ODD)

Childhood disorder characterized by anger-guided disobedience, hostility, and defiance toward authority that goes beyond normal bounds. Children may appear very stubborn and very angry.

If a child already has conduct disorder, ODD cannot be diagnosed. When symptoms persist for 6 months or more, behaviors may include deliberately annoying others, argumentative behavior, frequent temper loss, blaming others, spitefulness, vengefulness, and temper tantrums. Symptoms must cause distress at home and at school and can lead to difficulty making friends.

Co-morbid: ADHD, depression.

Solutions: Parent retraining so they do not reinforce unwanted behavior, CBT, social skills training, home visits. It can progress to antisocial personality disorder if not addressed.

Conduct Disorder

Conduct Disorder: persistent aggressive behavior toward people, animals, or property. Behaviors can be belligerent, destructive, cruel, deceitful, disobedient, and dishonest, including stealing and injuring others. This is a pattern of severe behavior in which the basic rights of others are violated.

Diagnosis often requires 3 or more of these behaviors in the past 12 months. Examples include bullying, threatening, initiating fights, cruelty to people or animals, mugging, forced sexual acts, fire setting, destruction of property, truancy, and running away.

Individuals with conduct disorder may have difficulty reading social cues and may misunderstand others' intentions. There is increased risk for substance abuse and suicide.

Solutions: Multi-system treatment that integrates school and home, structured environment for the child with immediate consequences and a home rules contract.

Treatment: MST (multisystemic therapy). Pharmacology: off-label medications may be used; aggressive behavior could be related to depression and other co-morbid conditions.

Co-morbid: ADHD, depression, learning disabilities, autistic spectrum conditions.

Attention-Deficit/Hyperactivity Disorder (ADHD)

ADHD: Symptoms typically begin between ages 6 and 12 and must be present for at least 6 months. Disruptive behavior and impulsivity must be observed in two or more settings and to a degree greater than peers. ADHD is differentiated into inattentive, hyperactive-impulsive, or combined presentations.

Inattentive: easily distracted, forgets things, misses details, cannot focus on one task, loses things, cannot follow directions.

Hyperactivity/Impulsivity differences: cannot sit still, talks nonstop, is frequently “in motion.”

Co-morbid: learning disorders, Tourette's disorder, ODD, mood disorders (including bipolar disorder and major depression), anxiety, OCD, sleep disorders, substance abuse.

Pharmacology: stimulants (e.g., Ritalin), antidepressants; note recommendations such as minimizing food dyes may be considered in some cases.

Psycho-social treatments: CBT, family therapy, social skills training.

Side effects of drugs: psychosis, mania, dependence (monitor closely).