1. Case Study: Conduct Disorder Işıl Sansoy

2. Information About the Patient
Born in 1992
Male
Normal birth
No reported psychiatric diagnosis of parents
Has 4 siblings
He is the fourth child among 5 children
Reported as a child with difficult temperament

3. Information About the Patient
Drop out at sixth grade
A stabbing incident at school
Second time in the hospital
For the last 1.5 year smokes one packet of cigarettes per day
For the last 3 months smoking marijuana

4. Assessment
Wechsler Adult Intelligent Scale IQ score: 79 (borderline intellectual functioning)
Rorschah Inkblot Test
When exposed to intense affective stimulus, he has difficulties with testing the reality.
Becomes anxious when the situation requires solving a problem.
Shows impulsive characteristics.

5. Diagnostic Criteria: DSM-IV TR
Aggression Toward People and Animals
Bullies, threatens or intimidates
Initiates physical fights
Has used a weapon
Is physically cruel to people
Is physically cruel to animals
Has stolen while confronting a victim
Has forced someone into sexual activity

6. Diagnostic Criteria DSM-IV TR
Destruction of Property
Has deliberately destroyed others’ property
Engaged in fire setting with the intention of causing serious damage
Deceitfulness of Theft
Often lies to obtain goods or favors or to avoid
obligations.
Has broken into a house,building or car

7. Diagnostic Criteria DSM-IV TR
Serious Violations of Rules
Is often truant from school, beginning before age 13
Stays out at night despite parental prohibitions, beginning before age 13
Has run away from home overnight at least twice (or once without returning for a lengthy period).

8. Early starter pathway/childhood onset
The most negative long term prognosis
Problematic behaviors emerge in preschool period
Overt behaviors appear before covert behaviors
Family relations are very important in this type.

9. Risk Factors Temperament (difficult temperament)
Genetics (Early childhood onset)
Gender (CD is diagnosed 4 times more in boys)
Family relations (Neglecting parents, marital conflicts, stress?)
Overcrowded family (7 family members)
Economic problems- (his father’s sight loss)
Environmental factors /neighborhood
Exposure to violence through media

10. Protective Factors Living with the family
Social support of the family members
(siblings)

11. Pharmacological Treatment
Risperidal (Risperidone): Neuroleptic, inhibiting dopamine activity in the brain, reduces aggressive behavior.
Side effects: weight gain, sedation, sexual dysfunction, muscle stiffness
Patient does not prefer to use this drug, and even he/she does prefer, she cannot use it a life time. It is just a supportive treatment.

12. Cognitive Problem-Solving Skills Training
Focused on the patients thought processes in interpersonal situations.
Step by step approaches, child is taught to solve problems.
Prosocial behaviors are fostered through modeling or direct reinforcement.
Games, academic activities and stories are used to teach cognitive problem solving skills.
And these skills are applied to real life situations.

13. Treatment Family Based interventions Multicomponent interventions
Community based programs

14. Parent Training
Teaching parents to alter interactions with the child to increase prosocial behavior.
New ways of identifying, defining and observing behavior problems are taught.
Social learning principles, (reinforcements, points for prosocial behavior,loss of privilage)

15. Functional Family Therapy
Focuses on the cognitive, affective and interpersonal processes of the family system.
Aim is to motivate the family for positive change, improve communication skills, modify cognitive sets, expectations, attitudes and affective reactions and establish new interpretations and meanings of behavior.
Solving marital/parental conflicts

16. Functional Family Therapy
Therapist uses modeling, prompting, shaping and rehearsing effective communication skills, and provides feedback and reinforcement for positive changes.

17. Multisystemic Treatments
Parent training and Problem solving skills training are most effective together.
Family is the core focus of intervention.
Patient interacts in many different systems.School is also considered in the treatment program.

18. Prognosis
In this case, the future of the patient does not seem very hopeful.
If the family is engaged in the treatment procedure and receive training, positive outcome is expected.
If the treatment stays limited with the drugs, the problems will come back sooner or later, and there is the risk of developing antisocial personality disorder.