Course: National

Diploma in Nursing

Case Study: Conduct Disorder

Name: Nunkoo.G
Matabudul.A
Marooday.K
Muthoorah.H.R
Oochotaya. S. A

Cohort: May 2023

Date of submission: 28th February 2025

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Acknowledgment
We would like to express our sincere gratitude to the management
and staff of Brown-Sequard Mental Health Care Hospital, especially
the dedicated team in the Adolescent Ward, for their support and
guidance throughout our case study.
A heartfelt thank you to our teachers at the School of Nursing of
Pamplemousses for their dedication to teaching and mentoring us.
Your knowledge, encouragement, and passion for nursing have been
instrumental in shaping our understanding and skills in mental health
care.
We are also deeply grateful to the patient we had the opportunity to
assess. Your willingness to share your experiences has helped us gain a
deeper understanding of patient-centered care. This experience has
been
incredibly enriching, and we sincerely appreciate everyone who has
contributed to our learning journey.

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Contents

Introduction ......................................................................................................... 4 Case

presentation ................................................................................................. 5 Assessment and
Data Collection.......................................................................... 9 Nursing
Diagnosis ...............................................................................................15 Nursing
interventions and care plan. .................................................................20 Health Education
and counselling .....................................................................30
Conclusion ...........................................................................................................31
References ...........................................................................................................32

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Introduction

This case study focuses on a patient diagnosed with Conduct Disorder

at Brown Sequard Healthcare Center, a center known for its expertise
in mental health care. The aim of the study is to examine the patient's
background, symptoms, contributing factors, and therapeutic
interventions, and to provide insights into the treatment of behavioral
disorders in clinical settings.
By examining this case, we aim to highlight the complexity and the
impact on individuals and their environments, and the effectiveness
of different treatment approaches. In doing so, we hope to contribute
to a deeper understanding of this disorder and improve early
intervention and
rehabilitation strategies.

4
Case presentation
This a case study of patient Adrien who was admitted to male
adolescent ward at BROWN Sequard Mental Health Care Centre and
was being treated for conduct disorder.
Patient Profile
Name: Adrien (Fictitious Name)
Age: 12 years old
Gender: Male
Date of Birth: 14th August 2013
Residence: La Rue Madame, Vacoas
Nationality: Mauritian
Date of Admission: 15 January 2025
Living Situation: Adrien lives with his father and grandmother. His
mother passed away due to a drug overdose. He has a strained
relationship with his stepmother and stepsister.
Education: Patient was going to Phoenix Government School up to
grade 6 and did not pass his exam. The patient has a history of
academic difficulties and disciplinary issues in school.History of poor
academic performance, frequent suspensions, and difficulty
maintaining focus in class.
Psychosocial Factors:
• Family Environment:
Exposure to parental mental health issues and substance
use, particularly alcohol abuse.
Witnessed and experienced domestic violence, primarily from
his father while under the influence.
Limited emotional support and a lack of secure parental
attachment, contributing to feelings of insecurity and
mistrust.

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 • Parental Discipline:
Inconsistent and permissive parenting practices with a lack of
clear boundaries.
History of neglect, including failure to provide emotional
support, structure, and supervision.
Limited guidance and inadequate monitoring of his
educational progress and social behavior.
•Emotional and Social Development:
Experiences of emotional neglect, including a lack of affection
and positive reinforcement.
Feelings of isolation and abandonment due to minimal
parental involvement.
Potential emotional dysregulation resulting from chronic
exposure to trauma and inconsistent caregiving.
Community Environment:
Adrien lives in a high-crime neighborhood with several risk factors that
may negatively impact his development, including:
Limited Positive Role Models: Few examples of positive adult
figures to provide guidance and mentorship.
Lack of Structured Activities: Minimal access to recreational
programs, extracurricular activities, or safe community spaces.
Peer Influences: Increased vulnerability to negative peer groups
and potential involvement in delinquent behavior.
Occupation:
Currently under the care of his father, with no formal
employment or educational engagement.
Limited participation in structured activities, contributing to
social isolation and a lack of skill development.
Potential dependence on unstable family dynamics for basic
needs and emotional support.

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REASON FOR REFERRAL:
• His Father reports defiant behavior at home, frequent rule-
breaking, and episodes of running away overnight.
• Adrien’s behavior has progressively worsened over the past two
years, resulting in multiple suspensions and involvement with
local juvenile authorities.
• Teachers reported that he has been bullying other students,
engaging in fights, and stealing from peers.
• Adrien exhibits an extreme disregard for rules, authority figures,
and the well-being of others. His school has noted that his
aggression escalates rapidly, often without provocation.
• The patient was brought to Brown Sequard Mental Health
Care Centre by police officers of Vacoas Police Station.
• The father of Adrien sought help of police because he was
becoming violent, aggressive and unmanageable at home despite
being scolded for his behavior many times.
• The patient was self-inflicting himself when things does not
go according to him and was trying to swallow metal
objects.

Complaints regarding the patient.

 The patient uses foul language regularly.
 Adrien returns home late in the evening after playing with friends.
 the patient has no interest in school. He claims that he likes to go
to meet his friends and play football, cards, and video or mobile
games.
 He steals money from his father and occasionally from stepmother to
buy food and drinks.
 Patient has on numerous accounts threatened his stepmother that he
will break items on the house if money is not given to him.
 Parents claim that he is aggressive towards his teachers and peers.
 The patient showed outburst of aggression when asked about
his actions.

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Present illness:
Adrien is displaying an abnormal behavior at this (12 years old) age
which is not in conformity with the rules and regulations of the society.
At this age, the patient should be enjoying his adolescence and
developing his
academically skills. The patient does not show any sign of respect
towards those older than him. Recently he tried to put fire in his room if
money is not given to him.
He displays risk taking behaviors which his parents can no longer
endure. They had to seek support from police. After being brought to
the hospital by the police officers and being examined by a child
psychiatrist, a provisional diagnosis was formulated which amount to
conduct disorder and
oppositional behavior.
Past illness:
The patient has no history of chronic illnesses, surgeries
or hospitalizations.

Past Psychiatric History:

• No previous psychiatric hospitalizations.
• No history of suicidal ideation.

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Assessment and Data Collection
Mental Status Examination:
Appearance:
• Patient’s height is 1m65 and weights about
65kg. • Body frail and unhealthy.
• His grooming was appropriate at the time of the day.

Attitude:
• He was very open and cooperative.
• Actively listens and responds appropriately.
• Participates in therapy or structured activities without defiance.

Level of consciousness:
• Conscious and alert.

Orientation:
• He was well oriented to place but not to time and date.

Speech and Language:

• The patient was talking very rapidly with adequate volume
and there was fluctuation in speech.

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Mood and Affect:
Mood: Stable and positive, with less irritability than before.
Affect: Appropriate and congruent with conversation.
Displays genuine emotion when discussing personal experiences.

Thought Process:
• Shows increased empathy (e.g., “I understand how my
actions affect others”).
• Recognizes previous mistakes and is willing to change
behaviors.
• Expresses positive goals (e.g., wanting to do better in
school, improve relationships).

Perception:
• No signs of hallucinations or paranoia.
• Better awareness of social cues and how others perceive them.

Insight and Judgment:

• Developing insight into past behaviors.
• Acknowledges consequences and is motivated to make
better choices.
• Shows improved impulse control in difficult situations.

Impulsivity and Risk Assessment:

• Decreased impulsivity; able to pause before reacting.
• Less aggression and defiance in social interactions. •
Open to accepting help and guidance from caregivers or
professionals.

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Physical Examination:

General Appearance & Vital Signs:

• Well-nourished and hydrated.
• Vital signs within normal range (Heart rate, BP, RR, Temp).
• No abnormality in pulse, temperature and blood sugar
level. • No signs of malnutrition or dehydration.

Skin & Extremities:

• Some visible bruises, cuts, or scars suggestive of recent fights
or self-harm.
• Skin intact, no infections or rashes.
• Normal nail hygiene.

Neurological Exam:
• No signs of head trauma or neurological
deficits. • Patient was able to perform Romberg
test.

Psychomotor Activity:
• Appropriate movements, no restlessness or
agitation. • No tremors or tics.

More further diagnostic reports made by psychiatrist:

EEG Test: The posterior dominant rhythm consisted pf bilaterally
symmetrical of moderate amplitude 8th alpha activity. Reactivity to eye
opening was symmetrical. Activation techniques did not reveal
significant charge. No Epileptic form activity noted.
This is a key finding, indicating that no abnormal electrical
discharges typical of seizures or epilepsy were observed during
the EEG.

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Interview between patient and Nursing students.
Nursing Student (NS):
Bonzour Adrien, kouma ou eter?
(Good morning Adrien, how are you?)

Adrien (A):
Bonzour. Mo bien, merci.
(Good morning. I'm fine, thank you.)

NS:
Nou bien kontan pou koze avek ou. Ou ti konnen ki nou lor enn etid
pou aprann enn pe plis lor ou, pou ede ou pli bien?
(We're happy to talk to you. Did you know we're here to learn more
about you, so we can help you better?)

A:
Wi, mo konner. Mo pa
problem.
(Yes, I know. It's okay.)

NS:
Kouma ou ti pe viv avan ou vinn isi?
(How were you living before coming here?)

A:
Mo lavi ti bien difisil. Mo ti ena bokou problem avek mo papa, avek
mo belle mere. Mo pas avek bann dimoun ki pa krwar en zanfan.

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(My life was very difficult. I had a lot of problems with my father, with
my stepmother. I lived with people who didn’t care for a child.)

NS:
Sa ti fer ou santi kouma?
(How did that make you feel?)

A:
Mo santi mo enn dimoun ki pa ete konpran. Mo ti touzour senti enn
traka.
(I felt like no one understood me. I was always feeling troubled.)

NS:
Ou santi ou kouma avek lafamiy? Eski ou ena bon relasion avek ou
papa, ou mar?
(How do you feel about your family? Do you have a good relationship
with your father and stepmother?)

A:
Mo pa bien kontan avek ma mar. Mo pa kontan avek li. Mo pa
konn pourkwa. Li pa vreman konpran mo.
(I'm not happy with my stepmother. I don’t like her. I don't know why.
She doesn't really understand me.)

NS:
Eski ou ena enn zoli souvnir de zot letan ansien avek ou mama?
(Do you have any good memories of the time you spent with your
mother?)

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A:
Non, mo mama ti mor avan. Mo pa kontan sa. Mo pa bien konpran sa.
(No, my mother passed away. I don't like that. I don’t really
understand it.)

NS:
Nou konpran, sa ti bien difisil pou ou. Mo krwar seki ou pe viv la, nou
kapab ede. E ki ou santi, si ou koz avek nou?
(We understand, that must have been very hard for you. I think what
you're going through now, we can help. How would you feel if you
talked to us?)

A:
Mo pa trouv problem. Si sa pou ede, mo pou esey.
(I don't see a problem. If that can help, I'll try.)

NS:
Nou sezi. Ou ti bien koze. Nou pou rod enn fason pou ede ou depli
trouma ek sa bann zolis lakaz.
(We appreciate it. You spoke very well. We will find a way to help you
heal and deal with these challenges.)

This conversation is intended to make Adrien feel heard and

understood, with the nursing students attempting to engage in a
compassionate and open dialogue while addressing his past
experiences.

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Nursing Diagnosis.

(I)Defining Conduct Disorder: Characteristics, Diagnosis, and Clinical

Perspectives.
Conduct Disorder is a behavioral condition that typically manifests in
childhood or adolescence, characterized by persistent aggression, rule-
breaking, and disregard for others (DSM-5, 2023)."They might act in
ways that are hostile, damaging, and dishonest, which could infringe on
the rights of others. Instead of seeing them as mentally sick, adults and
other children could view them as "bad" or delinquent.
The World Health Organization describes conduct disorder as a type of
disruptive behavior disorder characterized by persistent patterns of
behavior that violate the rights of others or major societal norms. This
includes behaviors such as excessive fighting or bullying, cruelty to
animals or people, severe destructiveness to property, and stealing.CD
is classified under "Disorders of Psychological Development and
Behavioral Disorders" in the ICD-11 (International Classification of
Diseases, 11th Revision).
According to the Crime, Justice and Security Statistics for the Republic
of Mauritius, the juvenile delinquency rate increased from 4.6 per 1,000
population in 2022 to 7.4 per 1,000 population in 2023.That increase in
juvenile delinquency rates—from 4.6 to 7.4 per 1,000 population—
suggests a growing concern regarding youth behavioral issues in
Mauritius. This rise could be linked to factors such as family instability,
socio-economic
challenges, and lack of access to mental health support. Given that
conduct disorder is often associated with delinquent behaviors, these
statistics reinforce the importance of early intervention, structured
support systems, and improved mental health services for at-risk
youth.
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There are three types of conduct disorder:
• Childhood onset occurs when the signs of conduct disorder appear
before age 10.There is more persistent of severe aggression and
has higher risk of developing antisocial personality disorder
(ASPD) in adulthood.
• Adolescent onset occurs when the signs of conduct disorder
appear during the teen years. They are less aggressive but still
engage in fights, stealing and vandalism.
• Unspecified-onset type means the age the person meets the
criteria for Conduct Disorder, but there’s not enough information
to say when it started and is unknown.

The signs and symptoms of conduct disorder.

Conduct disorder characteristics emerge gradually over time. Children
who suffer from conduct disorders are often impulsive and challenging
to control. They don't appear to care about other people's emotions.

The main behaviors of conduct disorder:

• Abuse of others' fundamental rights and/or hostility toward
people and animals.
• Property destruction.
• Stealing, lying, or deceiving.
• Severe rule infractions.
• Bullying.
• Physical aggression, sometimes with a
weapon. • Verbal altercations.
• Threatening.
• Placing the blame for one's own actions on others.

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Also, the symptoms of conduct disorder can be mild, moderate, or
severe:
Mild
If a child exhibits mild symptoms, they demonstrate minimal behavioral
issues beyond those necessary for diagnosis. Their conduct problems
result in relatively minor harm to others and may include behaviors
such as dishonesty, truancy, or staying out late without parental
consent.
Moderate
A child is classified as having moderate symptoms if they exhibit
several behavioral issues. These conduct problems can vary in severity
and may affect others to differing degrees. Examples include acts such
as vandalism and theft.
Severe
A child is classified as having severe symptoms if they display
behavioral issues beyond the diagnostic criteria. These conduct
problems can cause substantial harm to others and may include
serious offenses such as sexual assault, weapon use, or burglary.
The causes conduct disorder:
Genetic Factors:
Family history of antisocial behavior, mental health disorders, or
substance abuse increases the risk.
Inherited traits, such as impulsivity or aggression, may predispose
children to develop CD.
Neurobiological Factors:
Differences in brain structure or function, particularly in areas related
to impulse control, empathy, and aggression (e.g., the prefrontal
cortex and amygdala).
Chemical imbalances (e.g., neurotransmitter dysregulation) may
contribute to behavioral problems.

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Environmental Factors:
Parental neglect, abuse, or harsh discipline can increase the likelihood
of CD.
Growing up in unstable or violent family environments (e.g.,
domestic violence, substance abuse in the home).
Peer influences or associating with delinquent peers can
normalize antisocial behavior.
Psychological and Social Factors:
Traumatic childhood experiences, such as physical or emotional
abuse, witnessing violence, or severe stress, can trigger CD.
Lack of positive role models or insufficient parental supervision
and discipline.
Socioeconomic factors, including living in impoverished or high-
crime areas, may increase the likelihood of developing CD.
Cognitive Factors:
Children with CD may exhibit distorted thinking patterns, such as
blaming others for their behavior or justifying harmful actions.
Deficits in emotional regulation and empathy contribute to the
persistence of conduct problems.

Nursing Diagnosis:
1. Risk for violence:
• The cause: The patient struggles with impulse control, has
a history of aggressive behavior, and frequently gets into
fights.
• Signs:Physical aggression, destruction of property, verbal
threats.

2. Impaired Social Interaction:

• The cause: The patient has difficulty forming healthy
relationships due to defiant behavior, lack of empathy,
and involvement with delinquent peers.
• Signs: Disciplinary issues at school and having conflicts.
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 3. Ineffective Coping:
• The Cause: The patient was exposed to domestic violence by
his father and developed unhealthy ways of handling
emotions such as aggression. The death of his mother and
the sense of attachment by his family were devoid to him.
There was lack of emotional connection.
• Signs: The anger outburst of his father under alcohol
influence, lack of emotional love and the death situation.

4. Deficient Parental Coping:

• The Cause: The father is struggling to manage the child’s
behavior and is completely submerged in the current
problems. • Signs: The father reports feelings of helpless,
inconsistent rule enforcement, self-harm to himself and
posing a real danger to his other family members.

5. Risk for Other-Directed Violence:

• The Cause: The patient shows poor impulse control, a lack
of remorse, and a pattern of escalating aggressive behavior.
• Signs: frequent fights, threatening family members and
putting fire in his room.
DSM-5 Diagnostic Criteria for Conduct Disorder:
Adrien meets several criteria for Conduct Disorder, including:
1. Aggression to Peoples: Engaging in bullying, physical fights, and
cruelty to others.
2. Destruction of Property: Deliberate acts of vandalism and
destruction of property.
3. Deceitfulness or Theft: Persistent lying and stealing money.
4. Serious Violation of Rules: Truancy, running away from home, and
refusal to follow parental authority.

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Nursing interventions and care plan.

Pharmacological approach
The doctor prescribed a combination of medications, including:
1. Tab Tegretol 20 mg Bd
2. Tab Risperidone 0.5 mg Nocte

3. Tab Largactil 12.5 mg Nocte

Possible side effects and the symptoms

• Tegretol
Tegretol is an anticonvulsant. It works by decreasing nerve impulses
that cause seizures and pain.

• Drowsiness ( patient might feel restless, tired sleepy and

lightheaded)
• Blurred vision ( trouble in focusing)
• Nausea and stomach pain ( complaints of upset stomach
or loss of appetite)
• Confusion (patient might be forgetful and loss of focus
when talking).

• Tab Risperidone
Risperidone is an atypical anti-psychotic used to treat schizophrenia
and bipolar disorder, as well as aggressive and self-injurious
behaviors that works by affecting chemical messengers in the brain
(neurotransmitters) like dopamine. It does not cure your condition
but it helps to keep your symptoms under control.

• Fatigue or sedation (the patient may report feeling worn out

or appear lethargic).
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 • Weight gain (they might discuss how their clothing fit tighter
or how their appetite has increased).

• Restlessness (anxiety ↑ they may complain of being unable

to sit still or move around in their chair).

• Muscle stiffness or tremors: (They may report

experiencing stiffness or difficulty moving fluidly).

• Tab Largactil
Largactil known as an anti-psychotic drug is used to treat various
problems such as severe depression or behavioral disturbances.
Largactil can also be used to treat nausea, vomiting, severe pain and
unstoppable hiccups. This medicine belongs to a group of drugs known
as phenothiazine, which act on the central nervous system. It alters the
thoughts and elevates the mood, improving the person’s ability to
think, feel and behave.

• Severe lethargy (the patient may find it difficult to remain

awake or may appear disinterested in the discussion).

• Constipation or dry mouth (Complaints about difficulty using

the restroom or constant thirst).

• Muscle stiffness or tremors (Hands that shake visibly or

difficulty walking normally).

• Light sensitivity (They could talk of headaches or discomfort

in bright environments).

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Key Considerations:
• Start with a low dosage and increase based on response
as risperidone have a sedative and drowsiness effect.

• The timing of administration at night helps to manage sedative

effects while having a sleep.

• Food intake to minimize stomach uptake.

• Monitoring of vitals and especially weight gain for diabetes

and cholesterol in drugs like risperidone.

• Regular monitoring and follow up such as blood investigations

and effectiveness.
Observations made:
1. First and foremost Adrien’s vital signs were within normal
range which indicated no drastically change of his health
condition. The doctor started with a high dosage of risperidone
and tegretol to assess tolerance. Mild sedation and drowsiness
were reported on that day.

2. On the second week of treatment there was a slight adjustment of

titration based on response and tolerance including largactil
which was used to treat agitation. As the patient felt more relaxed
the doctor lowered the dosage but had maintained the drugs.

3. On the third week the psychiatrist continued the same

medication with a follow up for the discharge plan according to
the patient progress made.

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Nursing Management in Ward

On Admission:
The Ward orientation was completed, and nurses conducted careful
monitoring. The patient was introduced and assigned a bed for rest.
A secure environment was created, and all potential harmful objects
were removed from the area due to concerns about self-harm and
aggression.
Nursing care and Management were carried following:
1. Behavioral Management:
The nurse should be able to establish clear boundaries and rules so as
to set firm but non punitive behavioral expectations. The nurse should
use structured routine and predictability leading to clearly define
acceptable and unacceptable behaviors.
A nurse should proceed with:
• Positive Reinforcement: Reward good behavior (e.g.,
praise, privileges).
• Time-Out & Logical Consequences: If the patient breaks
rules, remove privileges in a structured way.
• Modeling & Role-Playing: Teach social skills through examples
and practice.

2. De-escalation and Crisis Management:

• Use calm communication and avoid power
struggles. • Redirect aggressive behavior before
escalation.
• If needed, apply crisis intervention protocols,
including seclusion/restraint only as a last resort.

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3. Therapeutic Interventions:
• Psychotherapy & Counseling

Encourage participation in Cognitive Behavioral Therapy

(CBT) sessions.
Provide group therapy to enhance social skills and peer
interaction. Offer anger management training for impulse
control.

For example: the therapist help him to replace

destructive thoughts by with constructive ones (I can
solve problems without violence).

• Anger Management Therapy:

A nurse should taught the patient relaxation techniques like

deep breathing and counting to ten before reacting
impulsively which enables himself to control and take
responsibility of the actions.

• Family & Caregiver Involvement:

Conduct family therapy sessions to improve communication.

Educate parents on consistent discipline and positive
reinforcement.
The therapist helps the family set clear rules, improve
communication, and reinforce positive behaviors through a
reward system.

• Educational & Occupational Activities:

Facilitate structured learning or tutoring within the ward.

24
 Introduce creative therapies (art, music, or sports) to
channel emotions constructively.

4. Medication Management:
Monitor for Side Effects
Watch for sedation, weight gain, agitation, or mood
swings. Ensure medication adherence and assess
effectiveness.
Ensure patient has swallowed medicines properly by checking
his mouth and under tongue.
Patient should be instructed about the importance of drug
therapy Any side effects shown the nurse should inform the
doctor so that action can be taken.
Patient should report any abnormality related to the drug.

5. Nutrition.
The nurse should monitor the patient's nutritional intake, focusing on
food quantity and quality. A diet high in sugar can contribute to
hyperactivity and impulsivity, making dietary management essential.

6. Hygiene.
Proper grooming and cleanliness should be maintained in ward for
self-discipline and promote wellness. It increases self-esteem and
social acceptance with good hygiene habits.

7. Sleep and Rest.

The nurse should observe Adrien’s sleeping pattern as this phase of
the night the patient will likely have less sleep keeping a low
environment stimulus. Low lighting and low level of noise will reduce
sleeping
disturbances. Conditions like depression, anxiety, medication effects
like insomnia or drowsiness may cause irritability and aggression. So
monitoring the patient’s sleep will identify trauma and sleeping
disturbances.
25
8. Socialization.
Healthier social interactions and coping mechanisms should be
encourage by the nurse as it increase self confidence in patient.
Group interaction and like group therapy sessions where patient
can interact with peers in a supervised settings.

9. Rehabilitation.
Encourage participation in social skills groups that focus
on communication, teamwork, and anger
management.
Demonstrate appropriate social behavior and problem-solving
skills. Use structured role-playing exercises to teach conflict
resolution and empathy.
Coordinate care with psychiatrists, social workers, and counselors
for a holistic approach.

10. Discharge Planning and Follow up.

• Develop a Behavior Management Plan

Provide a personalized care plan for home and school.

Educate caregivers on triggers and strategies to manage
outbursts.
Ensure Continuity of Care
Schedule psychiatric follow-ups and therapy
sessions.
Coordinate with school counselors, social workers, and
outpatient services.
26
Nursing Care Plan:
Assessment Details

Subjective - Reports of aggressive behavior towards peers,

Data family members, or animals. - Verbal expressions of
defiance or hostility. - History of stealing, lying, or
violating rules at home, school, or in the community.
Objective Data - Observed frequent episodes of impulsivity and
aggressive outbursts. - Noncompliance with
hospital rules and staff instructions. - Destructive
behaviors (e.g., vandalism, property damage). -
Poor academic performance or school suspension
Diagnosis history.
Details

1. Risk for Self-directed or Other-directed related to impaired

Violence impulse control and aggression.

2. Impaired Related to difficulty adhering to societal norms

Social as evidenced by oppositional and defiant
Interaction behaviors.

3. Ineffective Related to dysfunctional family relationships and lack

of
Coping positive role models.

Planning Goals & Expected Outcomes

1. The patient will demonstrate a decrease in

aggressive behaviors within one week of
2. intervention.
The patient will verbalize understanding of hospital
rules and adhere to them during the admission
3. The patient will develop and demonstrate at least
one positive coping strategy for handling
frustration.
4. The patient will engage in at least one social
interaction daily without displaying aggressive
behavior.

27
Interventions Rationale

Maintain a Safe • Monitor patient closely for aggressive tendencies.

Environment. • Remove potential hazards or objects that may
be used for harm.
• Reducing environmental triggers helps prevent
violent incidents.
Implement • Use a reward system for appropriate behaviors.
Behavioral • Enforce consistent consequences for rule-breaking.
Management • Structure and reinforcement help modify
Strategies disruptive behavior.
Encourage • Provide a nonjudgmental space for the patient
Verbalization of to express emotions.
Feelings • Encourage the use of “I” statements instead
of aggressive language.
• Encouraging verbal expression helps the
patient replace aggression with
Social communication.
Interactio • Patient interacts appropriately with peers and
n staff without aggressive incidents.
• Establish a therapeutic relationship by using calm
and non-judgmental approach.
• Build trust through active listening and validation.
6. Patient progress and Outcomes.
After three weeks of stay period, Adrien responded well to
the interventions:
• By attending occupational therapy sessions to improve
impulse control and emotional regulation.
• Adrien also participated in family therapy sessions to
improve communications and reduce conflict at home.
• Patient was compliant to medicine such as stimulants and
mood stabilizers with no side effects reported.
• Engaged in school activity where the teachers asked him to
perform curriculum activities outlining learning experience.
• He was also involved in recreational therapy where activities like
singing, listening to radio, playing games, sports are introduced
to relief and relaxed.
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Changes in Symptoms & Behavior:
• The frequency of verbal aggression and physical aggression has
decreased compared to his first week. No recent physical
altercations have been reported.
• His continuation to show authority figures towards members of
staffs has slightly decreased.
• He has made a significant improvement in thinking before acting to
a situation.
• The patient actively avoids conflicts with peers and has
demonstrated moderate behavioral improvement.
• Shows effort in anger management.

Overall progress:
• Moderate improvement noted in verbal aggression and
rule compliance.
• Further monitoring and therapy adjustments required for
sustained progress.

29
Health Education and counselling.
Health education for a patient with Conduct Disorder (CD) should focus
on behavioral management, emotional regulation, and social skills
development. It should also involve caregivers, teachers, and mental
health professionals to ensure a structured and supportive
environment.
As patient will receive discharge, a nurse duty is to provide
health education such as:
1. Encourage positive reinforcement for good behavior (e.g.,
praise, rewards for following rules).
2. Educate parents on setting boundaries and enforcing
discipline consistently.
3. Encourage regular physical activity to reduce aggression
(e.g., sports, yoga).
4. Promote adequate sleep, as poor rest can worsen symptoms.
5. Teach the importance of nutritious meals to support brain health.
6. Encourage family therapy to improve relationships
and communication.
7. Support parents in avoiding harsh punishment and using
structured discipline.
8. Identify and minimize situations that provoke aggression
(e.g., bullying, conflict at home).
9. Reduce exposure to violent media content (e.g., video games,
TV shows).

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Conclusion
As we reach to the end of our study conduct disorder can be a severe
behavioral disorder having long-term effects like substance abuse,
criminal behavior, poor academic performance, and damaged social
relationships.
However, by addressing the emotional, cognitive, and
environmental aspects that contribute to disruptive behaviors,
rehabilitation efforts can greatly improve outcomes.
Adrien’s case highlights the complex interplay between family
dynamics, childhood trauma, and mental health. His early exposure to
loss, neglect, and rejection—particularly the death of his mother due
to drug overdose and his father's refusal to take custody haslikely
contributed to his
emotional distress and behavioral issues. His difficulties in school,
disciplinary problems, and aggressive behavior further indicate
unresolved trauma and an unstable support system.
His abnormal behavior, which began at the age of 12, suggests that
emotional distress and potential underlying psychiatric conditions may
have been overlooked or mismanaged. The strained relationship with
his
stepmother and stepsister, coupled with a lack of emotional security
from his father, may have intensified his feelings of isolation and
resentment.

Admission to Brown Sequard Mental Health Care Centre provides

an opportunity for Adrien to receive professional psychological
support, therapy, and possibly medical intervention. A holistic
approach—incorporating psychiatric care, counseling, and social
support—will be essential in addressing his emotional and
behavioral challenges.
Additionally, efforts to improve his relationship with his father and
integrate him into a stable, nurturing environment will be crucial for
his long-term well-being.
This case underscores the importance of early intervention, family
support, and mental health awareness in preventing further
deterioration of a child’s psychological state. Moving forward, a multi-
disciplinary approach involving mental health professionals, social
workers, and educators will be vital in helping Adrien reintegrate into
society and lead a more stable life
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References

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