Oppositional Disorder

The oppositional disorder that causes the opposition is a recurrent or persistent negative, deviant or even hostile behavior directed against persons with power. Diagnosis is based on history data. Treatment of a defiant opposition disorder includes individual psychotherapy in combination with family therapy (or with the participation of other persons caring for the child). Sometimes medicament preparations can be used to reduce excitability.

Prevalence varies widely due to high subjectivity of diagnostic criteria; The prevalence of the challenging opposition disorder (CDD) can be up to 15% among children and adolescents. Before puberty, this disorder is much more common in boys than in girls; after puberty, this difference decreases.

Although the challenging opposition disorder is sometimes seen as an "easy option" of conduct disorder, there is only a superficial similarity between them. A distinctive feature of the defiant opposition disorder is hyperexcitability and deviant behavior. A child with a conduct disorder does not seem to have a sense of conscience and justice, and they readily violate the rights of others sometimes without any indication of hyperexcitability. The cause of the evocative opposition disorder is unknown, but it is probably most common among children from families in which adults model relationships with high-profile disputes and interpersonal conflicts. This diagnosis should not be considered as a clearly defined disease, but rather as an indication of the presence of deeper problems that may require further examination and treatment.

Symptoms of a defiant opposition disorder

Children with a defiant opposition disorder tend to easily and often lose their temper, argue with adults, often ignore adults, refuse to follow the rules, purposely interfere with people, blame others for their mistakes or misconduct, easily annoyed and infuriated, vindictive and vindictive. The oppositional disorder causing the disorder is diagnosed if the child has had 4 or more of these symptoms for at least 6 months. Symptoms should also be pronounced and provocative. Care must be taken to diagnose to avoid overdiagnosis of the challenging opposition disorder in the case of mild and moderate opposition behavior, which is observed from time to time in almost all normal children and adolescents.

Some drugs used to treat bipolar disorder

A drug	Indications	Starting dose	Maintenance dose	Remarks
Lithium	Treatment in an acute period and supporting	300 mg 2 times in	300-1200 mg 2 times a day	The dose is gradually increased to reach a blood level of 0.8-1.2 mEq / L

Antipsychotics

Chlorpromazine	Acute phase	10 mg once	50-300 mg 2 times a day	It is rarely used due to the fact that newer drugs have fewer side effects
Olanzapine	Acute phase	5 mg once a day	Up to 7.5 mg 2 times	Weight gain can be a limiting side effect in some patients
Risperidone	Acute phase	1 mg once a day	Up to 3 mg 2 times in	High doses increase the risk of neurological side effects
Quetiapine	Acute phase	25 mg twice daily	Up to 200 mg 2 times	Sedation may limit the increase in dose
Olanzapine / fluoxetine fixed combination	Bipolar Depression	6 mg / 25 mg once daily	To 12mg / 50mg once a day	Limited experience in children
Aripiprazole	Acute phase	5 mg once a day	Up to 30 mg once daily	Extremely limited experience in children
Ziprasidone	Acute phase	20 mg twice daily	Up to 80 mg 2 times in	Extremely limited experience in children

Antiepileptic drugs

Divalproeks	Acute phase	250 mg 2 times in	Up to 30 mg / kg divided into 2 doses	The dose is gradually increased until the blood level reaches 50-120 m kg / ml
Lamotrigine	Supportive therapy	25 mg once	Up to 100 mg 2 times	Follow the recommendations for dosing on the insert to the preparation
Carbamazepine	Acute phase	200 mg 2 times in	Up to 600 mg 2 times	In connection with the induction of metabolic enzymes, dose adjustment may be necessary

¹ The dose range is approximate. There is considerable variability in both the therapeutic effect and adverse reactions; The starting dose is exceeded only if necessary. This table does not replace the full information on the use of drugs.

Note. When treating these drugs, there is a low but very serious danger of developing a wide range of serious side effects. Therefore, you should carefully weigh the benefits and likely risks of prescribing such drugs.

BOR-like symptoms are often seen in children with attention deficit hyperactivity disorder (ADHD) in the absence of treatment. VOR-like symptoms often disappear with adequate treatment of ADHD. In addition, severe depressive disorder in children can be mistaken for VDD, as in some children the predominant symptom is hyperexcitability, and not a decrease in mood (an important difference between children and adults with severe depressive disorder). Since hyperexcitability is also a hallmark of BDD, differential diagnosis requires the presence of anhedonia and neuro-vegetative symptoms in children with severe depressive disorder (eg, sleep and appetite disorders); in children these symptoms are often overlooked.

The prognosis and treatment of a defiant opposition disorder

The prognosis depends on the detection and successful treatment of underlying mood disorders, ADHD and family relationships disorders. Even in the absence of treatment, a gradual improvement is noted in most cases of BPD over time.

First of all, the therapy of choice is a behavior modification program based on well-deserved punishment and encouragement for committed acts, which is being developed to form a more socially acceptable behavior in the child. In addition, many children with VOR do not have or lack sufficient social skills, so group therapy can be effective for them, which fosters behavioral skills in society. Sometimes, drugs used to treat depressive disorders can be effective.