Lithium and conduct disorder

Lithium administration has been effective in treating severe aggression in children and adolescents with Conduct Disorder. An overview of the pertinent literature is presented. Side effects associated with lithium administration are discussed. Guidelines for lithium administration are given, including dosage regulation, monitoring of serum lithium, as well as of side effects and laboratory measures. When prescribed judiciously, under careful monitoring, lithium can be an important part of the comprehensive treatment program.     

Diagnosis and pharmacotherapy of conduct disorder

Lavin Michael R. and Arthur Rifkin: Diagnosis and Pharmacotherapy of Conduct Disorders. Prog. Neuro- Psychopharmacol. & Biol. Psychiat. 1993, 17(6): 875–885.

1. 1. There are few double-blind, placebo-controlled studies of the drug treatment of conduct disorders in children and adolescents.

2. 2. The diagnosis of conduct disorders involves a persistent pattern of behavior in which the basic rights of others and standards of society are violated.

3. 3. There is frequent comorbidity associated with conduct disorders including attention-deficit hyperactivity disorder, oppositional defiant disorder, mood disorders and substance abuse.

4. 4. Childhood Conduct disorder is associated with a significant risk for adult psychopathology.

5. 5. A variety of treatment approaches may be employed to combat conduct disorders.

6. 6. The use of neuroleptics, lithium carbonate, stimulants and other agents is reviewed.

Neuroanatomical correlates of attention‐deficit–hyperactivity disorder accounting for comorbid oppositional defiant disorder and conduct disorder

Aim: An increasing number of neuroimaging studies have been conducted to uncover the pathophysiology of attention‐deficit–hyperactivity disorder (ADHD). The findings are inconsistent, however, at least partially due to methodological differences. In the present study voxel‐based morphometry (VBM) was used to evaluate brain morphology in ADHD subjects after taking into account the confounding effect of oppositional defiant disorder (ODD) and conduct disorder (CD) comorbidity. Methods: Eighteen children with ADHD and 17 age‐ and gender‐matched typically developing subjects underwent high‐spatial resolution magnetic resonance imaging. The regional gray matter volume differences between the children with ADHD and controls were examined with and without accounting for comorbid ODD and CD in a voxel‐by‐voxel manner throughout the entire brain. Results: The VBM indicated significantly smaller regional gray matter volume in regions including the bilateral temporal polar and occipital cortices and the left amygdala in subjects with ADHD compared with controls. Significantly smaller regional gray matter volumes were demonstrated in more extensive regions including the bilateral temporal polar cortices, bilateral amygdala, right occipital cortex, right superior temporal sulcus, and left middle frontal gyrus after controlling for the confounding effect of comorbid ODD and CD. Conclusion: Morphological abnormalities in ADHD were seen not only in the regions associated with executive functioning but also in the regions associated with social cognition. When the effect of comorbid CD and ODD was taken into account, there were more extensive regions with significantly smaller volume in ADHD compared to controls.     

Primary prevention of conduct disorder

Conduct disorders represent one of the most troubling and persistent childhood psychiatric disorders. This serious condition has a poor long-term prognosis and entails a wide range of negative consequences over the life span. No single intervention strategy has been identified that successfully alters its negative course. This article reviews developmental findings and previous intervention efforts and provides a rationale for approaching the problem of Conduct Disorder through primary preventive intervention. A comprehensive, family-based prevention model and specific clinical strategies for intervention are described. A case example is used to illustrate the integration of program components.     

Current perspectives on conduct disorder

Conduct disorder refers to a pattern of severe antisocial and aggressive behavior manifested in childhood or adolescence. This psychiatric diagnosis has been one of the most widely studied of all childhood disorders, and this extensive body of research has documented a large number of dispositional and contextual risk factors that can play a role in the etiology of this disorder. In this article, we provide a model for understanding these risk factors that use developmental theory to specify how these risk factors can negatively affect normative developmental mechanisms to place a child at risk for acting in an aggressive and antisocial manner, and recognize that there may be different mechanisms operating among individuals with this disorder. This approach for understanding the development of conduct disorder has important implications for diagnostic classi.cation systems and for designing more effective interventions for youth with conduct disorder.     

Developmental pathways to conduct disorder

This article highlights how a developmental approach to understanding the causes of conduct disorder (CD) could be critical for understanding and preventing delinquent and violent behavior in youth. The approach recognizes that there may be multiple causal pathways leading to CD. It also integrates developmental research and theory with research on antisocial and aggressive behavior to explain how normal developmental mechanisms may be disrupted to place a child at risk for showing problem behavior. The article reviews research outlining several such pathways that differ in the age at which serious conduct problems develop and that differ on the presence or absence of callous-unemotional traits. The presence of these different developmental pathways has important implications for how research is conducted to study CD and interventions are implemented to prevent or treat children who have CD.     

Attention-deficit/hyperactivity disorder and comorbid oppositional defiant disorder or conduct disorder

Comorbid oppositional defiant disorder (ODD) and conduct disorder (CD) are common in clinically referred children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Early recognition and treatment of co-occurring ADHD and ODD and/or CD is important because comorbidity influences symptom severity, prognosis, and treatment. Research on treatment supports the importance of behavior therapies for ODD and multimodal psychosocial interventions delivered simultaneously and intensively for CD with adjunctive medication for ADHD symptoms. Clinical trials are beginning to show that stimulants and atomoxetine are effective for ADHD and ODD symptoms when the disorders occur together. It is presently unclear if ODD in the absence of ADHD responds to pharmacotherapy. More research is needed examining the effects of commonly prescribed ADHD medications on CD symptoms. Research suggests a high prevalence of lifetime comorbidity with ODD in clinically referred patients with ADHD.     

Familial risks, conduct disorder and violence

OBJECTIVE: The aim was to investigate the impact of familial risk factors on the development of violent behaviour and conduct disorder (CD) by gender in a sample of adolescent psychiatric patients. METHODS: The study sample consisted of 278 adolescents (age 12-17) consecutively admitted to psychiatric inpatient care between April 2001 and January 2004. DSMIV psychiatric diagnoses were obtained from the Schedule for Affective Disorders and Schizophrenia for School Aged Children-Present and Lifetime (K-SADS-PL). RESULTS: Logistic regression analyses revealed that girls who had been physically abused at home had a 4.2-fold risk of having conduct disorder with violent behaviour (95% CI 1.4-12.2) compared to those not exposed to domestic violence. A broken primary family also increased the risk for having both violent CD (OR 7.8 95 % CI 1.7-36.4) and non-violent CD (OR 7.0 95% CI 1.5-33.5) among girls. Among boys, no statistically significant association was found between any familial risk factors and later CD. CONCLUSIONS: The results suggest that being physically abused by parents may influence the development of conduct disorder including violent behaviour among girls. This emphasizes the importance of early recognition of domestic violence. In girls, the absence of primary family seems to associate strongly with the development of CD, and should be taken into consideration by physicians and other professionals working with young people.     

Behavioral and developmental disorders among conduct disorder

The purpose of the present study was to clarify the percentage of children with conduct disorder (CD) who also have behavioral and developmental disorders. A survey of comorbidity observed in children with CD, was carried out on 33 subjects from a disciplinary facility for children. Female teachers as the mother were interviewed as regards the subjects' condition using the semistructured interview, and male teachers as the father were interviewed for their psychosocial problems. The subjects underwent the Wechsler Intelligence Scale for Children (WISC)-III and their conditions were diagnosed according to Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV). Of the 33 children, 27 were diagnosed as having CD. Of the 27 CD children, 18 (67%) were diagnosed as having attention deficit hyperactivity disorder (ADHD), and 19 (70%) had oppositional defiant feature (ODF). Eight children (30%) were diagnosed as having mental retardation and in seven children (26%), the verbal IQ was significantly lower than the performance IQ. Two (7%) were diagnosed as having pervasive developmental disorders (PDD). Of 27 children diagnosed with CD, 23 (85%) had some behavioral and developmental disorders. The classification of these behavioral and developmental disorders into the following three types appeared to be clinically useful: type 1, ADHD and ODF; type 2, low intelligence, especially low verbal intelligence; and type 3, PDD. To understand and treat children with CD, the accurate diagnosis of these underlying behavioral and developmental disorders is indispensable.     

品行障碍门诊病案分析及其家庭因素调查

目的 探讨家庭环境及其父母教养方式对品行障碍患者的影响,为实施有效的心理干预措施提供依据.方法 以2009年1月～2011年10月期间就诊的76例品行障碍者(年龄8～18岁)作为研究组,与不符合品行障碍的健康志愿者76例(对照组)做比较;采用家庭环境量表( FES- CV)及父母教养方式评价量表( EMBU)对所有受试者进行问卷调查.结果 在家庭环境中,研究组家庭亲密度、情感表达、成功性、知识性及控制性因子评分显著低于对照组(P＜0.01),而矛盾性因子评分显著高于对照组(P＜0.01);在教养方式上,研究组父母的情感温暖与理解因子评分显著低于对照组(P＜0.01),而惩罚严厉及拒绝、否认、父亲过分干涉因子评分显著高于对照组(P＜0.01).结论 品行障碍患者家庭环境及父母的教养方式与正常者有明显不同,他们存在较多的心理问题,应及时地针对性的进行心理干预.