Description
Bella is 9 years old and in the 4th grade. Bella’s mother sought treatment due to increasing disruptive behaviors over the past year, including non-compliance, physical aggression toward peers, and frequent behavioral meltdowns which resembled the temper tantrums of a much younger child. Tantrums included screaming, yelling, slamming doors, and crying. Bella and her mother both noted that it was difficult for Bella to “move on” when something angered her. She also noted that Bella had an underlying irritable mood, manifesting as Bella appearing “cranky” most of the time and the family feeling they needed to “walk on eggshells” to avoid upset. At school, at least one phone call home per week was being placed due to Bella’s refusal to comply or sometimes to even speak to her teacher for days at a time. Bella and her mother noted that Bella was generally well-liked by peers and teachers, given that she was hardworking and funny, yet her current disruptive behaviors were causing significant interference in making new friends and meeting academic goals. Concept Map InformationWhat is the Main diagnosis for Mary Rose? What are the Key symptoms?What differential diagnoses did you consider and why? What is your treatment recommendation and why? What is the Prognosis.? SEE attached sample of answer
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1
Concept Map 4
F90 Attention-Deficit
Hyperactivity disorder.
F91.3 Oppositional
Defiant disorder
F63.81 Intermittent
Explosive disorder
Differential Diagnosis
Signs & Symptoms
– Bullying.
– Social inadaptation.
– Fights.
– Intimidation.
– Abuse.
– Property destruction.
– Low empathy.
– Violation of rules &
discipline.
– Evasion.
– Lying.
Diagnosis (DSM-5-TR)
F91.1 Conduct Disorder,
childhood-onset type.
Treatment Guidelines
– Behavior therapy.
– Psychotherapy.
– Special education.
– Multisystemic
therapy.
– Medications.
MSE & Criteria
– Persistent & persistent
behavior.
– Physical abuse,
intimidation, and
fights.
– Destruction of
property.
– Deceitfulness/Theft.
– Lack of social
empathy.
– Violation of rules.
– Meet criteria, subtype,
and specifiers.
Prognosis
– Temperamental: behavior, low IQ, issues with intelligence.
– Environmental: family risk factors, social, rejection, abuse.
– Genetic: aggressive s/s
– Physiological: FAS, ADHD, bipolar, depression.
2
Concept Map Information
1. Main Diagnosis
The case displays the diagnosis criteria for conduct disorder, childhood onset in which
there is an evident repetitive and persistent pattern of violation of other people´s rights based on
the expected behavior for the child´s age. Considering the possible 15 criteria, DSM-5-TR
specifies that with at least three of them during more than 6 months the patient can be diagnosed
with the disorder (APA, 2022). In such a case, in Mary Rose´s case is possible to find that:
–
She often bullies, threatens, and intimidates other classmates.
–
She initiates physical fights.
–
She destroys deliberately other´s property.
–
She often truants from school.
–
She has behavior disturbances that impair her for antisocial behavior.
Based on her age (9-year-old), her disorder is framed into the childhood-onset. Moreover, she
has limited prosocial emotions due to the lack of remorse, lack of empathy, and the deficient
affect.
2. Key Signs & Symptoms
As the clinical case describes, she discards rules to behave accordingly, makes emphasis
on annoying others, seeks the opportunity to initiate physical fights, and experiences apparently
emotions or pleasure when intimidate the classmates. In addition, she is active destroying the
property of others while evidences the lack of empathy or remorse with social rules. In addition,
she has begun to wander, escape from the school, and lie when confronted with those events.
3. Differential Diagnosis
3
According to Elmaghraby and Garayalde (2021), the main disorders which can appear as
comorbidity associated with conduct disorder are:
a) Attention-Deficit Hyperactivity disorder in which interruptive behavior and lack of focus
affect the concentration level. The actions seem to occur without the proper thinking ability to
restrict the action according to rules where physical exacerbation leads to excessive responses.
b) Oppositional Defiant disorder based on similarities of the major symptoms in which match the
annoyance, the disobedience with rules and adult´s criteria, the spiteful with high level of
intention and consciousness, the shift in temper (leading to fights), and other criteria.
c) Intermittent Explosive disorder occurs as a result of the inability to control emotions and
impulses and to attach to social rules. Events are predominant with rage, irritability, racing
thoughts, and increased energy. Some somatic effects can be present.
4. Treatment Guidelines and Recommendations
Once the use of tools for screening reveals the occurrence of conduct disorders
(recommended SNAP-IV-R), the history taken also should include the parent´s interview data for
discrimination between the major features of the disorder. The parental report is necessary with
the provision of additional sources and assessment mechanisms for the positive outcome of the
psychosocial/psychiatric interventions (Boland, Verdium, & Ruiz, 2021). The first line integrates
the family with the PMT (Parental Management Training) for the accommodation of expected
child´s behaviors as well as the PCIT (Parent-Child Interaction therapy). As a second alternative,
based on the child´s aggressive pattern, includes the use of pharmacologic intervention with the
integration of antipsychotics. According to guidelines, it is suggested two main medications for
Mary Rose:
4
a) Abilify (Aripiprazole) for irritability at the dose of 2 mg PO x 2 days, following 5 mg PO x 2
days, up to no more than 30 mg qd.
b) Risperdal (Risperidone) for irritability at the dose of 0.5 mg PO qd with increasing of 0.5 mg
q3-7 d up to 3 mg qd.
In any case, it is necessary to evaluate the physical adverse effects of any selection, the impact of
the long-term use, and the improvement from the aggressive pattern.
5. Prognosis
In the case of Mary Rose, the biological and genetic components (environmental risk
factor) appear to influence the predisposition due to parental rejection, experiences of physical
abuse, and inconsistent child-rearing practices (familiar psychopathology to be assessed). In
addition, the social variable with the frequent changes of caregivers and exposure to violence
combined with the history of trauma makes evident a guarded prognosis. Early onset influences
the chances of positive outcomes but makes dependable of the progressive improvement with the
comprehensive advanced psychiatric interventions.
5
References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders:
DSM-5-Tr. APA Publishing.
Boland, R., Verdiun, M., & Ruiz, P. (2021). Kaplan and Sadock’s synopsis of Psychiatry.
Wolters Kluwer Health.
Elmaghraby, R., & Garayalde, S. (2021). Retrieved from https://www.psychiatry.org/patientsfamilies/disruptive-impulse-control-and-conduct-disorders/what-are-disruptive-impulsecontrol-and-conduct-disorders
1
Concept Map 4
F90 Attention-Deficit
Hyperactivity disorder.
F91.3 Oppositional
Defiant disorder
F63.81 Intermittent
Explosive disorder
Differential Diagnosis
Signs & Symptoms
– Bullying.
– Social inadaptation.
– Fights.
– Intimidation.
– Abuse.
– Property destruction.
– Low empathy.
– Violation of rules &
discipline.
– Evasion.
– Lying.
Diagnosis (DSM-5-TR)
F91.1 Conduct Disorder,
childhood-onset type.
Treatment Guidelines
– Behavior therapy.
– Psychotherapy.
– Special education.
– Multisystemic
therapy.
– Medications.
MSE & Criteria
– Persistent & persistent
behavior.
– Physical abuse,
intimidation, and
fights.
– Destruction of
property.
– Deceitfulness/Theft.
– Lack of social
empathy.
– Violation of rules.
– Meet criteria, subtype,
and specifiers.
Prognosis
– Temperamental: behavior, low IQ, issues with intelligence.
– Environmental: family risk factors, social, rejection, abuse.
– Genetic: aggressive s/s
– Physiological: FAS, ADHD, bipolar, depression.
2
Concept Map Information
1. Main Diagnosis
The case displays the diagnosis criteria for conduct disorder, childhood onset in which
there is an evident repetitive and persistent pattern of violation of other people´s rights based on
the expected behavior for the child´s age. Considering the possible 15 criteria, DSM-5-TR
specifies that with at least three of them during more than 6 months the patient can be diagnosed
with the disorder (APA, 2022). In such a case, in Mary Rose´s case is possible to find that:
–
She often bullies, threatens, and intimidates other classmates.
–
She initiates physical fights.
–
She destroys deliberately other´s property.
–
She often truants from school.
–
She has behavior disturbances that impair her for antisocial behavior.
Based on her age (9-year-old), her disorder is framed into the childhood-onset. Moreover, she
has limited prosocial emotions due to the lack of remorse, lack of empathy, and the deficient
affect.
2. Key Signs & Symptoms
As the clinical case describes, she discards rules to behave accordingly, makes emphasis
on annoying others, seeks the opportunity to initiate physical fights, and experiences apparently
emotions or pleasure when intimidate the classmates. In addition, she is active destroying the
property of others while evidences the lack of empathy or remorse with social rules. In addition,
she has begun to wander, escape from the school, and lie when confronted with those events.
3. Differential Diagnosis
3
According to Elmaghraby and Garayalde (2021), the main disorders which can appear as
comorbidity associated with conduct disorder are:
a) Attention-Deficit Hyperactivity disorder in which interruptive behavior and lack of focus
affect the concentration level. The actions seem to occur without the proper thinking ability to
restrict the action according to rules where physical exacerbation leads to excessive responses.
b) Oppositional Defiant disorder based on similarities of the major symptoms in which match the
annoyance, the disobedience with rules and adult´s criteria, the spiteful with high level of
intention and consciousness, the shift in temper (leading to fights), and other criteria.
c) Intermittent Explosive disorder occurs as a result of the inability to control emotions and
impulses and to attach to social rules. Events are predominant with rage, irritability, racing
thoughts, and increased energy. Some somatic effects can be present.
4. Treatment Guidelines and Recommendations
Once the use of tools for screening reveals the occurrence of conduct disorders
(recommended SNAP-IV-R), the history taken also should include the parent´s interview data for
discrimination between the major features of the disorder. The parental report is necessary with
the provision of additional sources and assessment mechanisms for the positive outcome of the
psychosocial/psychiatric interventions (Boland, Verdium, & Ruiz, 2021). The first line integrates
the family with the PMT (Parental Management Training) for the accommodation of expected
child´s behaviors as well as the PCIT (Parent-Child Interaction therapy). As a second alternative,
based on the child´s aggressive pattern, includes the use of pharmacologic intervention with the
integration of antipsychotics. According to guidelines, it is suggested two main medications for
Mary Rose:
4
a) Abilify (Aripiprazole) for irritability at the dose of 2 mg PO x 2 days, following 5 mg PO x 2
days, up to no more than 30 mg qd.
b) Risperdal (Risperidone) for irritability at the dose of 0.5 mg PO qd with increasing of 0.5 mg
q3-7 d up to 3 mg qd.
In any case, it is necessary to evaluate the physical adverse effects of any selection, the impact of
the long-term use, and the improvement from the aggressive pattern.
5. Prognosis
In the case of Mary Rose, the biological and genetic components (environmental risk
factor) appear to influence the predisposition due to parental rejection, experiences of physical
abuse, and inconsistent child-rearing practices (familiar psychopathology to be assessed). In
addition, the social variable with the frequent changes of caregivers and exposure to violence
combined with the history of trauma makes evident a guarded prognosis. Early onset influences
the chances of positive outcomes but makes dependable of the progressive improvement with the
comprehensive advanced psychiatric interventions.
5
References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders:
DSM-5-Tr. APA Publishing.
Boland, R., Verdiun, M., & Ruiz, P. (2021). Kaplan and Sadock’s synopsis of Psychiatry.
Wolters Kluwer Health.
Elmaghraby, R., & Garayalde, S. (2021). Retrieved from https://www.psychiatry.org/patientsfamilies/disruptive-impulse-control-and-conduct-disorders/what-are-disruptive-impulsecontrol-and-conduct-disorders
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