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.     

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.     

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.     

Baseline predictors of response to divalproex in conduct disorder

BACKGROUND: Successful treatment of conduct disorder remains difficult. On the basis of a positive response to divalproex among adolescent boys with conduct disorder, we conducted an analysis of the impact of baseline comorbid diagnoses and personality factors on the likelihood of treatment response to divalproex. METHOD: Seventy-one adolescent boys with conduct disorder (DSM-IV) and a history of at least 1 offense against persons were randomly assigned to receive high- or low-dose divalproex for 7 weeks. Evaluations included best estimate diagnoses, the Clinical Global Impressions-Severity of Illness scale (CGI-S) and CGI-Improvement scale (CGI-I), the 62-item Weinberger Adjustment Inventory (WAI-62) assessment of distress and restraint, the Response Evaluation Measure assessment of immature and mature defenses, and the Achenbach Youth Self-Report assessment of overall psychopathology. All were conducted at study entry and exit, and the WAI-62 was conducted weekly throughout the 7-week study period. Treatment response was defined as a rating of much improved or very much improved on the CGI-I. Data were collected from June 1997 to April 1998. RESULTS: Fifty-eight subjects completed the study and were eligible for inclusion in the analysis. Plasma divalproex level (p = .003) and immature defenses (p = .004) were significant positive predictors of treatment response, while restraint (p = .01) and level and range of psychopathology (p = .04) were significant predictors of nonresponse. Comorbidities or distress (p = .06) were not significantly associated with treatment outcome. CONCLUSION: Predictors of response to divalproex treatment for conduct disorder were identified, despite the small sample size in this study. The pattern of positive and negative predictors of response to divalproex, an antikindling agent, tends to support a model of kindling-reinforced reactive/affective/defensive/impulsive aggression among adolescent boys with conduct disorder. Additional studies are needed to identify more subtle predictors of treatment response and to clarify the mechanisms contributing to the development of conduct disorder.     

Adolescents' responses to peers with depression or conduct disorder

OBJECTIVE: To determine how young people are likely to respond to a peer with mental illness, or who has severe behavioural problems. METHOD: A mental health literacy survey was conducted with 1137 adolescents in years 8, 9 and 10 in South Australia and the Australian Capital Territory. Respondents were presented with a vignette of either a 16-year-old boy meeting criteria for conduct disorder or a 16-year-old girl meeting criteria for major depression. As part of the survey, respondents were asked to write in words what they would do if the person in the vignette was a friend of theirs and they wished to help. Responses were coded into categories. RESULTS: Over half the sample (53%) described positive social support as the only action they would take to help. A further 23% said they would engage an adult such as a parent, teacher or school counsellor to help with the situation. Those responding to the conduct disorder vignette were more likely to describe engaging an adult to help and males were more likely to say they would do nothing. Female students tended to answer differently to the conduct disorder and depression vignettes, while male students responded similarly to the two vignettes. CONCLUSIONS: Many adolescents do not respond to friends' distress in ways which are likely to facilitate appropriate help. Mental health education in schools should include skills for offering help and encouraging peers to seek help.     

Response to emotional stimuli in boys with conduct disorder

OBJECTIVE: Boys with conduct disorder are at risk of persistently showing antisocial behavior in adult life, particularly if they have an additional diagnosis of attention deficit hyperactivity disorder (ADHD). In the search for biological risk factors that predispose children to the development of antisocial personality disorder, research has provided substantial data suggesting that autonomic hyporesponsiveness indicates a greater likelihood of future antisocial behavior. The purpose of this study was to examine autonomic arousal in boys with conduct disorder, comorbid conduct disorder and ADHD, and ADHD only. METHOD: In addition to self-ratings, electrodermal responses to pleasant, neutral, and unpleasant slides were obtained for 21 boys with conduct disorder and 54 boys with ADHD plus conduct disorder. Forty-three boys with a diagnosis of ADHD only were recruited as a clinical comparison group, and 43 boys with no conduct disorder or ADHD were included as a healthy comparison group. All subjects were ages 8-13 years. RESULTS: Compared to the healthy subjects and the subjects with ADHD only, the boys with conduct disorder and with ADHD plus conduct disorder reported lower levels of emotional response to aversive stimuli and lower autonomic responses to all slides independent of valence. CONCLUSIONS: Although the self-report data supported a deficit in reactivity to explicit fear cues, the psychophysiological data indicated that boys with conduct disorder both with and without a comorbid condition of ADHD are characterized by a generalized deficit in autonomic responsivity in an experimental situation in which children were exposed to complex visual stimuli of unpredictable affective quality. Psychophysiological findings may point to a deficit in associative information processing systems that normally produce adaptive cognitive-emotional reactions.     

Diagnostic criteria for aggressive conduct disorder

The purpose was to develop operational criteria for the diagnosis of aggressive conduct disorder. The necessary symptoms were found in discriminant analyses of data from a series of boy patients. A formula based on 8 key symptoms succeeded in accurately diagnosing a series of girl patients.     

Brain maturation in conduct disorder versus borderline personality disorder

Conduct disorder (CD) and borderline personality disorder (BPD) have been associated with abnormalities in brain function. The present study assessed whether adolescents with significant symptoms of CD and BPD display abnormal brain maturation. Participants recruited from the community were categorized as CD only, BPD only, CD plus BPD, or controls with neither CD nor BPD. Brain maturation was estimated by the amplitude difference in the P300 event-related brain potential between participants < versus > or = 17 years old. With increasing age, controls and BPD only participants exhibited a P300 amplitude decline. This pattern was not evident in the CD only and CD plus BPD groups. The different brain maturation patterns seen in adolescents with CD versus BPD symptoms may contribute to differences in age-of-onset, clinical course, and resistance to treatment.     

Youth with conduct disorder: a challenge to be met

Conduct disorder is one of the most common psychiatric disorders in children and adolescents between the ages of four and 16. This paper summarizes the literature on conduct disorder, from definition and diagnosis to treatment and prevention. In addition, it reports on the deliberations and recommendations of a group of clinicians and researchers who met at a retreat to discuss ways to improve the quality of treatment and develop prevention strategies for youth with conduct disorder. This retreat was held under the auspices of the Institute for the Study of Antisocial Behaviour in Youth.