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PubMed2005

Paternal alcoholism and offspring conduct disorder: evidence for the 'common genes' hypothesis.

Not only are alcoholism and externalizing disorders frequently comorbid, they often co-occur in families across generations; for example, paternal alcoholism predicts offspring conduct disorder just as it does offspring alcoholism. To clarify this relationship, the current study examined the 'common genes' hypothesis utilizing a children-of-twins research design. Participants were male monozygotic (MZ) and dizygotic (DZ) twins from the Vietnam Era Twin Registry who were concordant or discordant for alcohol dependence together with their offspring and the mothers of those offspring. All participants were conducted through a structured psychiatric interview. Offspring risk of conduct disorder was examined as a function of alcoholism genetic risk (due to paternal and co-twin alcohol dependence) and alcoholism environmental risk (due to being reared by a father with an alcohol dependence diagnosis). After controlling for potentially confounding variables, the offspring of alcohol-dependent fathers were significantly more likely to exhibit conduct disorder diagnoses than were offspring of nonalcohol-dependent fathers, thus indicating diagnostic crossover in generational family transmission. Comparing offspring at high genetic and high environmental risk with offspring at high genetic and low environmental risk indicated that genetic factors were most likely responsible for the alcoholism-conduct disorder association. The observed diagnostic crossover (from paternal alcoholism to offspring conduct disorder) across generations in the context of both high and low environmental risk (while genetic risk remained high) supported the common genes hypothesis.

Adolescent↗
PubMed1995

Axis I and personality comorbidity in adolescents with conduct disorder.

This study was undertaken to investigate psychiatric comorbidity in male and female adolescents with conduct disorder diagnoses. Twenty-five hospitalized adolescents (11 females, 14 males) with conduct disorder were evaluated using structured diagnostic interviews for Axis I and personality disorders. The most common Axis I comorbid diagnoses were: depressive disorders (major depression and/or dysthymia), 64 percent; anxiety disorders (separation anxiety disorder, overanxious disorder, panic disorder, obsessive-compulsive disorder, phobias, and/or posttraumatic stress disorder), 52 percent; substance abuse, 48 percent; and attention-deficit hyperactivity disorder, 28 percent. Common Axis II disorders included passive-aggressive personality disorder, 56 percent, and borderline personality disorder, 32 percent. When compared with the male subjects, the females had significantly more total Axis I disorders and a trend toward more total personality disorders, anxiety disorders, depression, and borderline personality disorders. These findings support conduct disorder as a complex illness with extensive Axis I and II involvement as well as some gender differences in presentation.

Adolescent↗
PubMed1996

DSM-III-R and DSM-III criteria for conduct disorder in preadolescent girls: specific but insensitive.

OBJECTIVE: To determine whether DSM-III and DSM-III-R criteria for conduct disorder identify girls in the general population with early-onset, persistent, and pervasive antisocial behavior. METHOD: 2,251 girls, representative of all girls entering kindergarten in Qúebec, were assessed using parent and teacher ratings of antisocial behavior; a subsample was then rated for the next 6 years (ages 7 to 12) by parent and teacher. At age 10 years, the girls who been rated as antisocial in kindergarten, along with a random sample of those not rated as antisocial, were assessed for DSM-III and DSM-III-R diagnoses of conduct and oppositional defiant disorder using a structured psychiatric interview (Diagnostic Interview Schedule for Children) administered to the parent, teacher, and/or child (n = 381). RESULTS: Of the girls with early-onset, persistent, and pervasive antisocial behavior, 3% met DSM-III-R criteria and 22% met DSM-III criteria for conduct disorder. Conduct disorder was not diagnosed at all in girls who had not been initially rated as antisocial in kindergarten. Lowering the threshold for a DSM-III-R conduct disorder diagnosis to two symptoms and adding the criterion of violation of rules increased the rate of diagnosis to 35% in the pervasively antisocial girls but only to 1% in girls who did not have persistent antisocial behavior. CONCLUSIONS: DSM-III-R criteria for conduct disorder do not identify most preadolescent girls with early-onset, pervasive, and persistent antisocial behavior. Modifications to the DSM-III-R criteria resulted in increased sensitivity without a loss of specificity.

Age of Onset↗
PubMed2006

Pharmacological aspects of the treatment of conduct disorder in children and adolescents.

In recent years, the rates of psychosocial disorders in children and adolescents have increased, with behavioural manifestations of conduct disorder being one of the most common reasons for referrals to community psychiatrists. Childhood conduct problems are associated with a variety of psychiatric disorders in adult life that extend beyond antisocial behaviour. An increased awareness of the costs of conduct disorder to individuals, families and society has led to advancements in the pharmacological and nonpharmacological therapeutic modalities for this disorder. Despite this, patients with conduct disorder are difficult to treat as the patterns of maladaptive behaviours they exhibit are diverse and can vary as a function of age and sex. A multidisciplinary approach to the treatment of conduct disorder, which includes behavioural parent training, interpersonal skills training, family therapy and the use of psychotropic agents targeted at a particular cluster of symptoms, can increase the overall effectiveness of each of the applied interventions. Aggression, hyperactivity, impulsivity and mood symptoms are the most sensitive proximal targets. Evidence suggests that antipsychotics, antidepressants, mood stabilisers, antiepileptic drugs, stimulants and adrenergic drugs can be well tolerated and effective therapeutic options for individuals with conduct disorder and comorbid psychiatric conditions. However, the most successful therapeutic outcomes are likely to be achieved by combining the current advances in psychopharmacology with behavioural and psychosocial interventions, aimed at modifying the excessive patterns of maladaptive behaviours observed in conduct disorder.

Adolescent↗
PubMed1988

[Rhythm and conduction disorders immediately after ventricular fulguration].

UNLABELLED: Forty-four patients with ventricular tachycardias (VT) refractory to medical treatment underwent 73 sessions of endocavitary electrode catheter ablation. The clinical series included 16 cases of post-infarction VT, 14 cases of arrhythmogenic right ventricular dysplasia, 6 cases of dilated cardiomyopathy, 6 cases of idiopathic VT, 1 case of sequela of myocarditis and 1 case of VT consecutive to surgical repair of a congenital cardiopathy. Cardiomegaly was present in 30 patients, and 16 patients had an ejection fraction of less than 30 p. 100. None of the patients were receiving digitalis or class I antiarrhythmic drugs when ablation was performed. A total of 235 shocks of 100 to 320 J (mean 221 +/- 42 J) were delivered. 115 shocks (49 p. 100) were complicated by dysrhythmia and/or disorders of conduction; 29 shocks (12 p. 100) induced 13 ventricular fibrillations and 16 ventricular tachycardias. No relation was found between energy delivered, shock synchronization, haemodynamic status, heart cavity treated, underlying heart disease, CK MB levels and these arrhythmias. On the other hand, ablations performed while the patients were experiencing VT increased the risk of arrhythmia (p less than 0.02). 36 AV blocks, 21 left bundle branch blocks, 12 right bundle branch blocks and 11 sinus bradycardia were observed. With the exception of one right bundle branch block and one left posterior hemi-block, all blocks were transient. IN PRACTICE: (1) electrode catheter ablation may be complicated by disorders of cardiac rhythm or conduction in 50 p. 100 of the cases; (2) these disorders can easily be corrected by stimulation or defibrillation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Associations of the serotonin transporter promoter polymorphism with aggressivity, attention deficit, and conduct disorder in an adoptee population.

Prior studies of the Iowa Adoption cohorts have demonstrated that the degree of adoptee aggressiveness and conduct disorder has a significant genetic component. Other studies have implicated the neurotransmitter serotonin or polymorphisms in the serotonin transporter gene (5HTT) as an important source of variability in "externalizing" behaviors such as aggressivity, conduct disorder, and attention deficit-hyperactivity disorders (ADHD). Following this lead, we genotyped a subgroup of adoptees (n = 87) at high risk for these kinds of disorders with respect to the serotonin-transporter-linked promoter region (5HTTLPR) polymorphism, and used ordinal logistic regression to conduct an association study. Primary analysis failed to detect a main effect between 5HTTLPR status and subscales of aggressivity, conduct disorder, or attention deficit. However, when biologic parent status and sex of proband were considered, certain interactions between 5HTTLPR and other genetic risk factors were evident. One type of interaction with the LL variant of 5HTTLPR increased externalizing behavior in individuals with antisocial biologic parentage; a second interaction with one or more 5HTTLPR short variants (SS or SL) appeared to increase externalizing behaviors in conjunction with a genetic diathesis for alcoholism. Gender of adoptee also appeared to interact with 5HTTLPR. Male individuals with the short variant were more likely to have higher symptom counts for conduct disorder, aggressivity, and ADHD. In contrast, among females, the short variant (SS, SL) was associated with lower levels of such behavior. The results support the hypothesis that gene-biological family history interactions are involved in the externalizing behaviors studied and constitute interesting findings for future replication.

Adolescent↗
PubMed2003

Parenting and the development of conduct disorder and hyperactive symptoms in childhood: a prospective longitudinal study from 2 months to 8 years.

BACKGROUND: This study investigated the early processes involved in the development of symptoms of conduct disorder and hyperactivity. METHOD: The study employed a prospective design, over a period from 2 months to 8 years. Detailed observational data of early and later mother-child interactions were collected, infant prefrontal function (the A not B task) was assessed, and symptoms of child conduct disorder and hyperactivity were rated by maternal report at age 5 and 8 years. RESULTS: The principal findings of the study were that emotional dysregulation on the A not B task at 9 months predicted symptoms of conduct disorder at 5 and 8 years, and delayed object reaching times on the same task predicted hyperactive symptoms at 5 years. These two developmental trajectories were associated with distinct patterns of early parenting that were strongly influenced by infant gender. Thus, in boys early emotional dysregulation was predicted by rejecting and coercive parenting, and delayed reaching on the A not B task by coercive parenting, whereas in girls only continuity from earlier infant behaviour could be demonstrated. There was strong continuity between these early infant behaviours and later child disturbance that was partially mediated by parenting for conduct disorder symptoms (maternal hostile parenting in boys, and maternal coercive parenting in girls), but not for hyperactive symptoms. CONCLUSIONS: These data would suggest that only in boys was there evidence for the existence of a sensitive period for the development of hyperactive symptoms, and to a lesser extent, conduct disorder symptoms.

Age Factors↗
PubMed1998

Executive cognitive functioning, temperament, and antisocial behavior in conduct-disordered adolescent females.

The authors assessed whether low executive cognitive functioning (ECF) and a difficult temperament are related to aggressive and nonaggressive forms of antisocial behavior (ASB) in 249, 14-18-year-old, conduct-disordered females and controls. ECF was measured using neuropsychological tests; temperament was measured using the Dimensions of Temperament Survey-revised; and ASB was assessed using psychiatric symptom counts for conduct disorder. The conduct-disordered females exhibited lower ECF capacity and a greater difficult temperament compared with the controls. The combined influence of low ECF and difficult temperament was significantly related to both forms of ASB. In comparison with low ECF, difficult temperament was more strongly related to nonaggressive ASB, whereas in comparison with difficult temperament, low ECF was more strongly related to aggressive ASB. Last, ECF mediated the relation between difficult temperament and aggressive ASB.

Adolescent↗
PubMed1992

[Assessment of clinical course of myocardial infarction complicated by atrioventricular conduction disorders].

The aim of the study was to assess the clinical course of myocardial infarction complicated by atrioventricular conduction disorders. The patient group consisted of 155 subjects, 117 men and 38 women, aged 31-91 (mean = 61 years). Analysis included the type and frequency of AV conduction disorders with respect to the infarct site and size, the presence of complications, therapy used with particular consideration of temporary electrical stimulation. AV conduction disorders were found in 15.8% of patients with myocardial infarction. They were found significantly more frequently in those with the inferior myocardial infarction. The patients with the infarction complicated by AV conduction disorders showed more extensive myocardial necrosis, with the degree of the block correlating with the infarct size, more frequent occurrence of such complications as cardiogenic shock, pulmonary edema. Despite the use of electrical stimulation the mortality rate in the myocardial infarction complicated by complete AV block was high, reaching 50.7%.

Adult↗
PubMed2003

Brain maturation and subtypes of conduct disorder: interactive effects on p300 amplitude and topography in male adolescents.

OBJECTIVE: Adolescents with conduct disorder problems are, on average, at increased risk for a variety of unfortunate adult outcomes, including substance dependence. This study was designed to identify the neurophysiological correlates of different categories of conduct disorder problems as well as the relationship between these correlates and the maturational status of the brain. METHOD: The subjects were 94 males, aged 14-19 years, recruited from the community. None were recruited from treatment or juvenile justice programs. The subjects varied in the type and number of conduct problem behaviors exhibited prior to age 15. Groups were operationally defined by the relative number (0 versus > or =1) of DSM-IV conduct disorder diagnostic criteria within each of four categories: rules violations, aggression, deceitfulness/theft, and destructiveness. Age was included as an additional grouping factor. P300 electroencephalographic potentials were recorded while subjects performed a task in which rare auditory stimuli were used to signal a change in stimulus-response mapping during a succeeding set of trials. RESULTS: Analyses revealed that boys with a history of rules violations failed to exhibit the normal maturational increase in P300 amplitude found in boys without a history of rules violations. Topographic analyses of current source densities suggest that the source of the maturational deficit involved P300 generators within the frontal brain. Parietal generators of P300 matured normally. CONCLUSIONS: The present results are interpreted as reflecting a decrement in frontal brain maturation among boys potentially at risk for substance dependence, antisocial personality disorder, or other forms of adult psychopathology.

Adolescent↗
PubMed1998

Adult physical health outcomes of adolescent girls with conduct disorder, depression, and anxiety.

OBJECTIVE: To examine the young adult physical health outcomes of adolescent girls with behavior problems. METHOD: Girls with conduct disorder, girls with depression, girls with anxiety, and healthy girls (N = 459) who had been evaluated at age 15 years were followed up at age 21, when general physical health, substance dependence, and reproductive health were assessed. RESULTS: After control for potentially confounding variables including prior health, adolescent conduct disorder predicted more medical problems, poorer self-reported overall health, lower body mass index, alcohol and/or marijuana dependence, tobacco dependence, daily smoking, more lifetime sexual partners, sexually transmitted disease, and early pregnancy. Adolescent depression predicted only adult tobacco dependence and more medical problems; adolescent anxiety predicted more medical problems. CONCLUSIONS: The robust link between female adolescent conduct disorder and poor physical health in adulthood suggests that intervention with girls who have conduct disorder may be a strategy for preventing subsequent health problems.

Adolescent↗
PubMed1996

MMPI profiles of depressed adolescents with and without conduct disorder.

This study examined whether adolescents with depression would produce significantly different MMPI profiles from adolescents with depression and conduct disorder. Twenty-four adolescents who met DSM-III-R criteria for major depression or dysthymia were included in the study. Nine of these 24 subjects also met DSM-III-R criteria for Conduct Disorder. Results indicated that depressed only adolescents had significantly higher elevations on scales 2 and 0 while those with depression and conduct disorder had significantly higher elevations on scales F and 9. These findings suggest that the presence of conduct disorder in depressed adolescents may lead to a veiling of their affective symptoms, thus potentially causing clinicians to underdiagnose depression in such cases.

Adolescent↗
PubMed1977

Cardiac conduction disorders in six infants with "near-miss" sudden infant deaths.

Cardiac conduction disorders caused sudden serious illnesses in six infants that might have been fatal if diagnosis and treatment had been delayed. These cases provide circumstantial evidence to support a link between cardiac conduction disorders and some sudden infant deaths. A further potential long-term effect of these disorders is illustrated in one child in whom psychomotor retardation seemed to develop after an episode of cerebral hypoxia that was probably by an arrhythmia associated with the Wolff-Parkinson-White syndrome. Cardiac conduction disorders may be detected by routine neonatal ECG screening, and it may therefore be appropriate to start prophylactic antiarrhythmic treatment in certain children before clinical signs develop.

Arrhythmias, Cardiac↗
PubMed1997

Test of two views of impulsivity in hyperactive and conduct-disordered children.

The nature of impulsivity in hyperactive and conduct-disordered children was examined in two experiments, one involving a priming task, the other a delayed reaction time task. Four groups of children, aged 7 to 8 years and with IQs in the normal range, were recruited for study: (1) a pure hyperactive group (HA), (2) a hyperactive/conduct-disordered group (HA+CD), (3) a pure conduct-disordered group (CD), and (4) a normal control group (N). When the stimulus configuration and presentation were simple and well organized, none of the three clinical groups displayed any sign of impulsivity at the input/perceptual stage; there was no tendency to rush responding before adequate consideration of the relevant stimuli, i.e. a trading of accuracy for speed. Instead, the HA children were found to be disinhibited at the output/motor stage, i.e. failing to temporarily withhold activated responses. This deficit was found to be specific to the HA children; it was not observed in the CD and HA+CD children.

Analysis of Variance↗
PubMed1994

Conduct disorder: long-term outcomes and intervention effectiveness.

OBJECTIVE: To review the literature on conduct disorder in two areas: long-term outcome and the effects of interventions. METHOD: The sources of the articles for review were computer searches, but the articles were selected for this review to illustrate key findings in the long-term outcome area and to review critically four intervention strategies to prevent or treat conduct disorder, namely, parent- and family-targeted programs, social-cognitive programs, peer and school-based programs, and community programs. RESULTS: Conduct problems in childhood predict the same increased rates of psychiatric disorder overall in men and women but the patterns are different: for externalizing disorders, the prediction is stronger in men and for internalizing disorders, the prediction is stronger in women. In the intervention domain, the literature provides limited evidence of the effectiveness of either primary or secondary prevention. CONCLUSIONS: Prospective studies of community samples of children provide the best opportunity to understand more thoroughly the adult outcomes of conduct disorder. Because of the heavy burden of suffering of conduct disorder, and the limited effectiveness of clinical interventions, there is a compelling argument in favor of an increased emphasis on primary prevention efforts.

Adolescent↗
PubMed1986

Conduct disorder and hyperactivity: I. Separation of hyperactivity and antisocial conduct in British child psychiatric patients.

The distinction between hyperactivity and conduct disorder was explored in a mixed group of 64 children referred to psychiatric clinics because of antisocial or disruptive behaviour. A semi-structured interview measure (the Parental Account of Children's Symptoms, PACS) proved to have adequate inter-rater reliability, internal consistency and factorial validity. The PACS scales of defiance and hyperactivity, and similar subscales from Conners' Teacher Rating Scale, were tested against laboratory and clinical measures of activity, attention, cognitive performance, psychosocial background and family relationships. The hyperactivity (but not the defiance) scales were associated with greater activity, younger age, poorer cognitive performance and abnormalities on a developmental neurological examination. The defiance (but not the hyperactivity) scales were associated with impairment of family relationships and adverse social factors. It was concluded that a dimension of inattentive, restless activity should be separated from one of antisocial, defiant conduct in children with psychiatric disorder.

Antisocial Personality Disorder↗
PubMed2000

Multivariate analysis of associations of 42 genes in ADHD, ODD and conduct disorder.

In a previous study (Comings DE et al. Comparison of the role of dopamine, serotonin, and noradrenergic genes in ADHD, ODD and conduct disorder. Multivariate regression analysis of 20 genes. Clin Genet 2000: 57: 178-196) we examined the role of 20 dopamine, serotonin and norepinephrine genes in attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD), using a multivariate analysis of associations (MAA) technique. We have now brought the total number of genes examined to 42 by adding an additional 22 candidate genes. These results indicate that even with the inclusion of these additional genes the noradrenergic genes still played a greater role in ADHD than any other group. Six other neurotransmitter genes were included in the regression equation - cholinergic, nicotinic, alpha 4 receptor (CHNRA4), adenosine A2A receptor (ADOA2A), nitric oxide synthase (NOS3), NMDAR1, GRIN2B, and GABRB3. In contrast to ADHD and ODD, CD preferentially utilized hormone and neuropeptide genes These included CCK, CYP19 (aromatase cytochrome P-450), ESR1, and INS (p = 0.005). This is consistent with our prior studies indicating a role of the androgen receptor (AR) gene in a range of externalizing behavors. We propose that the MAA technique, by focusing on the additive effect of multiple genes and on the cummulative effect of functionally related groups of genes, provides a powerful approach to the dissection of the genetic basis of polygenic disorders.

Adolescent↗