1.  General guidelines about Conduct Disorder

·       A disorder diagnosed in childhood or adolescence age group characterized by aggressive behavior, deceitfulness, destruction of property or violation of rules that is persistent and repetitive, and within a one year period.

·       A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated. These behaviors include aggressive conduct that causes or threatens physical harm to other people or animals, nonaggressive conduct that causes property loss or damage, deceitfulness or theft, and serious violations of rules. The onset is before age 18.

·       Disorders characterized by a repetitive and persistent pattern of dissocial, aggressive, or defiant conduct. Such behaviour should amount to major violations of age- appropriate social expectations; it should therefore be more severe than ordinary childish mischief or adolescent rebelliousness and should imply an enduring pattern of behaviour (six months or longer). Features of conduct disorder can also be symptomatic of other psychiatric conditions, in which case the underlying diagnosis should be preferred.

·       Examples of the behaviours on which the diagnosis is based include excessive levels of fighting or bullying, cruelty to other people or animals, severe destructiveness to property, fire- setting, stealing, repeated lying, truancy from school and running away from home, unusually frequent and severe temper tantrums, and disobedience. Any one of these behaviours, if marked, is sufficient for the diagnosis, but isolated dissocial acts are not.

These children may show any one or more of the following

·       Excessive level of fighting or bullying

·       Cruelty to animals or other people

·       Fire setting

·       Stealing

·       Repeated lying

·       Truancy from school and running away from home

·       Frequent and severe temper tantrums, defiant proactive behaviour and persistent severe disobedience

History taking and examination including MSE                                                                                                            Annexure 1 Special emphasis

·       Medical history

2.  a) Investigations required

a.    Psychometric investigations: Delinquent Activities Scale (DAS)/ Problem Behaviour Check List (PBCL)

b.  Laboratory: (if physical complications are present)

b)  Comorbidity: Depression. Attention deficit hyperactivity disorder (ADHD) and Learning Disorder.

c)    Differential Diagnosis: Mood disorder, psychotic disorder that precipitate excessive indulgence in negative behaviors and hostility towards other.

3.  Treatment

a)  Psychopharmacology

·       Only if anxiety and depression is comorbid

·       Symptomatic and supportive (if necessary)

b)  Psychosocial Intervention

a.  If patient is in early stage

i)    Psychoeducation – Nature of illness, etiology, progression, consequences, prognosis, treatment.

ii)   Family Therapy – family should always be involved and attempt should be made to help the family to provide consistent upbringing

iii)  Behaviour modification with positive reinforcement

iv)    Children may be involved with a group of normal children which may provide them proper role models to emulate

b.  If patient is in mid or late stage

i)  Cognitive Behaviour Therapy

ii)  Aversion Therapy

4.  Follow-up

a.  Psychiatry OPD/ DMHP

·       Initially once in two weeks for 2 months

·       Monthly check up for 1 year.

b.  Physical check-up at OPD

c.  Through telephonic conversation/TeleManas 14416/18008914416

5.  Referrals

a.   Depending upon the severity and complications of the patient, he/she may need to be referred to Psychiatry department.

b.  To TeleManas

c.  To the nearest DMHP

d.  To psychiatry OPD at Kulikawn Hospital an ZMC

e.  To higher centers outside Mizoram through Referral Boar