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PubMed2000

A double-blind pilot study of risperidone in the treatment of conduct disorder.

OBJECTIVE: To examine whether risperidone is superior to placebo in the treatment of youths with conduct disorder. METHOD: This was a 10-week, randomized, double-blind, placebo-controlled study with 2 parallel arms. Ten youths were randomly assigned to receive placebo and 10 youths were randomly assigned to receive risperidone. Patients were seen weekly throughout the trial. Medications could be increased at weekly intervals during the first 6 weeks of the study from an initial dose of 0.25 mg or 0.50 mg each morning, depending on patient weight. Patients weighing less than 50 kg had a maximum total daily dose of risperidone of 1.5 mg. Patients weighing 50 kg or greater had a maximum total daily dose of risperidone of 3.0 mg. The primary outcome measure was the Rating of Aggression Against People and/or Property Scale. RESULTS: Risperidone was superior to placebo in ameliorating aggression on most measures. Risperidone was reasonably well tolerated, with none of the risperidone-treated patients developing extrapyramidal side effects. CONCLUSIONS: These data provide preliminary evidence that risperidone may have efficacy in the treatment of youths with conduct disorder. Because of the small sample size and the brief length of this study, further research is necessary to confirm these findings.

Adolescent↗
PubMed2003

Drug-use initiation and conduct disorder among adolescents in drug treatment.

This study investigated effects of drug-use initiation and conduct disorder (CD) among 1031 adolescents who participated in the Drug Abuse Treatment Outcomes Studies for Adolescents (DATOS-A) sponsored by the National Institute on Drug Abuse (NIDA). The mean age of first drug use was 12.7 (S.D.=2.2), 57% met DSM-III-R criteria for CD, and earlier initiators were more likely to have CD. About 78% of the adolescents with CD reported that their first CD symptom occurred prior to drug-use initiation. The proportions of adolescents who had prior treatment were similar (about 28%) across all groups, but earlier initiators reported a greater number of treatment episodes and younger ages at their first treatment. Conduct disordered adolescents revealed greater problems prior to DATOS-A treatment, but they appeared to be more motivated and ready for treatment. Although adolescents with CD still showed worse outcomes after treatment, the impact of CD appeared to lessen when pretreatment differences were controlled. To a lesser extent, adolescents who began using drugs at earlier ages had greater alcohol and drug use and other problems at intake, but their treatment outcomes appeared to be similar to later initiators. There were few significant interaction effects of initiation and CD. Findings from this study highlight the importance of better understanding the progression of drug use, treatment utilization, and psychiatric comorbidity among adolescents with substance abuse problems.

Adolescent↗
PubMed1994

The Overt Aggression Scale in a study of lithium in aggressive conduct disorder.

This article describes an open study of lithium carbonate in conduct-disordered children. The objective of the study was to investigate the effectiveness of lithium in reducing aggression and the usefulness of the Overt Aggression Scale (OAS), as a measure of treatment effect. The subjects, 8 children, ages 9.2 to 16.9 years (mean +/- standard deviation [SD] = 12.48 +/- 2.97), were treated for 4 weeks with lithium. Optimal dosages ranged from 1200 to 1800 mg/day (mean = 1350 +/- 227) with corresponding serum lithium levels ranging from 0.86 to 1.39 mEq/L (mean = 1.05 +/- 0.17). OAS results indicated that aggression decreased significantly over time. The findings from the OAS agreed with findings from a more general measure, the Global Clinical Consensus Rating, leading to the conclusion that the OAS is a promising outcome measure for treatment studies of aggression in children. Further placebo-controlled studies of lithium carbonate in reducing aggressive behavior in conduct-disordered children, employing a specific measure such as the OAS, are warranted.

Adolescent↗
PubMed1997

Practice parameters for the assessment and treatment of children and adolescents with conduct disorder. American Academy of Child and Adolescent Psychiatry.

These practice parameters address the diagnosis, treatment, and prevention of conduct disorder in children and adolescents. Voluminous literature addresses the problem from a developmental, epidemiological, and criminological perspective. Properly designed treatment outcome studies of modern psychiatric modalities are rare. Ethnic issues are mentioned but not fully addressed from a clinical perspective. Clinical features of youth with conduct disorder include predominance in males, low socioeconomic status, and familial aggregation. Important continuities to oppositional defiant disorder and antisocial personality disorder have been documented. Extensive comorbidity, especially with other externalizing disorders, depression, and substance abuse, has been documented and has significance for prognosis. Clinically significant subtypes exist according to age of onset, overt or covert conduct problems, and levels of restraint exhibited under stress. To be effective, treatment must be multimodal, address multiple foci, and continue over extensive periods of time. Early treatment and prevention seem to be more effective than later intervention.

Adolescent↗
PubMed1997

Modeling genetic and environmental influences in the etiology of conduct disorder: a study of 2,682 adult twin pairs.

The etiology of conduct disorder (CD) was examined retrospectively in a sample of 2,682 male, female, and unlike-sex adult twin pairs from the community-based Australian Twin Register. Model-fitting analyses indicated a substantial genetic influence on risk for CD, accounting for 71% of the variance (95% confidence interval [CI] = 32-79%). There was not a statistically significant effect of the shared environment in the best-fitting model of CD, but a modest effect of the shared environment on the risk for CD could not be rejected (95% CI = 0-32%). The magnitude of genetic and environmental influences for CD liability did not vary significantly for boys and girls, and the specific genetic and environmental mechanisms important for the development of CD appeared to be largely the same for both sexes. The fit of a multiple-threshold model raises the possibility that CD may not necessarily be a discrete entity but rather an extreme of the normal variation in conduct-disordered behavior found in the general population.

Adult↗
PubMed1981

[Rhythm and conduction disorders caused by cardiac glycosides].

Cardiac glucosides could cause almost all kinds of rhythm and conduction disorders. In 648 patients treated with cardiac glucosides, rhythm and conduction disorders were recorded in 124 patients--19.1 per cent (58 males and 60 females), aged from 17 to 76. Ventricular extrasystoles rank first according to incidence--47 per cent; ventricular bigeminy--24.3 per cent; AV block stage I--23.4 per cent, etc. From all the 124 patients registered with intoxications induced by cardiac glucosides--one patient died, very likely due to ventricular fibrillation--0.89 per cent lethality. Toxic symptoms with initial saturation with digitalis preparation is most frequently observed in patients with grave myocardial lesions as well as rheumatic activity, accompanied by cardiac decompensation and a parallel administration of potent diuretic treatment that favours hypopotassemia and glucoside intoxication.

Adolescent↗
PubMed2005

Alcohol expectancies, conduct disorder and early-onset alcoholism: negative alcohol expectancies are associated with less drinking in non-impulsive versus impulsive subjects.

AIMS: Research suggests that positive alcohol expectancies promote excessive alcohol use while negative alcohol expectancies discourage excessive alcohol use. Evidence suggests that disinhibitory characteristics, such as conduct disorder and impulsivity, are associated with a general neglect of long-term negative outcomes. This study assessed whether negative expectancies would be associated more strongly with lower levels of alcohol use for low- compared with high-impulsive individuals. DESIGN: Positive and negative alcohol expectancies, alcohol use and impulsivity were assessed in a sample of 99 young adults with alcohol dependence (AD) and conduct disorder (CD), 77 with AD and no CD and 124 controls. FINDINGS: AD/CD subjects had higher proximal (same day) and distal (next day) negative alcohol expectancies, even though they drank more alcohol, compared with AD-alone and control subjects. Distal negative expectancies were associated more strongly with lower levels of drinking for low-impulsive compared with high-impulsive subjects. Proximal negative expectancies were associated more strongly with higher alcohol consumption for high- versus low-impulsive subjects. CONCLUSIONS: Impulsivity and conduct disorder may be important factors in determining how much distal negative alcohol expectancies may discourage excessive alcohol consumption.

Adolescent↗
PubMed2002

The Maudsley long-term follow-up of child and adolescent depression: 3. Impact of comorbid conduct disorder on service use and costs in adulthood.

BACKGROUND: Depression in childhood or adolescence often has morbidity implications continuing into adulthood, generating needs for specialist services and support. AIMS: To estimate the patterns of service use and costs in adulthood of former patients. METHOD: Service use and other cost-related data were collected from former patients. Comparisons were made between those people with and without comorbid conduct disorder in childhood and with data for the general population. RESULTS: Data on 91 people with depression (only) and 49 with comorbid conduct disorder revealed high adulthood service utilisation rates and costs. Inpatient care and criminal justice services were used more frequently by the comorbid group and total costs were significantly higher. There were also indications of higher service use by the comorbid group than the general adult population. CONCLUSIONS: The high and enduring long-term costs associated with childhood depression and conduct disorder give further reason for early and effective intervention.

Adolescent↗
PubMed1994

Use of the Draw-A-Person with conduct-disordered children.

The Draw-A-Person test was administered to 40 conduct-disordered and 40 nonconduct-disordered children and adolescents. There were 20 boys and 20 girls, ages 10 to 16 years, in each group. Two independent judges rated the drawings for presence or absence of indicators of aggressiveness that should accompany a conduct disorder, but no significant differences were found between groups or sexes.

Adolescent↗
PubMed1995

Lithium in hospitalized aggressive children with conduct disorder: a double-blind and placebo-controlled study.

OBJECTIVE: To assess critically the efficacy and safety of lithium and replicate earlier findings in a larger sample of aggressive children with conduct disorder and to assess the utility of the Profile of Mood States (POMS) in this population. METHODS: Children hospitalized for treatment-refractory severe aggressiveness and explosiveness and with diagnosed conduct disorder were subjects in this double-blind, placebo-controlled clinical trial. After a 2-week placebo baseline period, children were randomly assigned to lithium or placebo treatment for 6 weeks of placebo. The main outcome measures were the Global Clinical Judgments (Consensus) Scale, Children's Psychiatric Rating Scale, Conners Teacher Questionnaire, Parent-Teacher Questionnaire, and the POMS. RESULTS: Fifty children (mean age 9.4 years) completed this study. The mean optimal daily dose of lithium was 1,248 mg and the mean serum level was 1.12 mEq/L. Lithium was superior to placebo, although the effects on some measures were more modest than in a previous study. CONCLUSIONS: Lithium appears to be an effective treatment for some severely aggressive children with conduct disorder. Although the POMS appeared to be reliable, it did not detect any response to lithium.

Aggression↗
PubMed2005

Psychopathy, conduct disorder, and stigma: does diagnostic labeling influence juvenile probation officer recommendations?

This study investigated the potential influence of labeling a juvenile as psychopathic. Juvenile probation officers (JPOs; N = 260) rendered hypothetical recommendations based on eight mock psychological evaluations. The evaluations varied the presence of two diagnostic criteria (antisocial behavioral history and psychopathic personality traits) and diagnostic labels (psychopathy, conduct disorder, no diagnosis) in order to distinguish criterion effects from labeling effects. The diagnostic criteria of antisocial behavior had a substantial effect on JPO recommendations (effect sizes .50-.79), while the diagnostic criteria of psychopathic personality traits had a more limited effect. Surprisingly, diagnostic labels had little effect, and there were no appreciable differences between conduct disorder and psychopathy diagnoses. These findings illustrate the importance of distinguishing diagnostic criterion effects from diagnostic labeling effects.

Adult↗
PubMed2005

Symptom-based subfactors of DSM-defined conduct disorder: evidence for etiologic distinctions.

Past research investigating the structure of conduct disorder (CD) symptoms has provided evidence of a phenotypic distinction between aggressive and rule-breaking subfactors of CD. However, evidence of etiologic distinctions between these subfactors has not been reported to date. In the current study, the authors investigated this issue in a sample of 1,151 male twins who were 17 years of age. The results indicate that aggressive and rule-breaking CD subfactors have both common and distinct etiologic influences, with shared environmental influences playing a significant role in rule-breaking behaviors. The authors discuss implications of these findings for the assessment and treatment of CD.

Adolescent↗
PubMed1997

MMPI-A and Rorschach indices related to depression and conduct disorder: an evaluation of the incremental validity hypothesis.

This investigation extends the earlier research by Archer and Gordon (1988) by examining the extent to which combining indices from the newly released MMPI-A and the revised Rorschach Comprehensive System furnishes incremental validity in terms of improved diagnostic prediction. The predictive accuracy of selected MMPI-A and Rorschach variables conceptually related to diagnoses of depression and conduct disorder were compared in a clinical sample of 152 adolescents. Results of multivariate analyses of variance revealed some significant differences between diagnostic groups on several MMPI-A scales, and 1 significant difference on the Rorschach involving the Vista variable. Stepwise discriminant function analyses resulted in 2 MMPI-A scales and 2 Rorschach variables that collectively accounted for a small proportion of variance in the diagnosis of depression, and 3 MMPI-A scales that accounted for a significant component of variance in the conduct disorder diagnosis. Classification accuracy results indicated that the hit rate for depression diagnosis did not improve using an optimal linear combination of the 4 variables over the rates produced by the single use of either the MMPI-A Depression content scale (A-DEP) or Scale 2. For the conduct disorder diagnosis, the optimal linear combination of MMPI-A Conduct Problems (A-CON), Cynicism (A-CYN), and Immaturity (IMM) scales served as the best predictor, and no Rorschach variables contributed significantly to classification accuracy. Our results replicated the findings of Archer and Gordon (1988) in indicating that the combined use of MMPI-A and Rorschach variables does not appear to produce incremental increases in accuracy of diagnostic classification.

Adolescent↗
PubMed2004

Platelet 5-HT uptake in boys with conduct disorder.

Dysregulation of serotonergic function has been found to be associated with aggression in animals, human adults and adolescents. However, studies with children have shown conflicting results. The objective of this study was to investigate whether the kinetic characteristics (Vmax and Km) of 5-HT uptake in platelets are different in children with the diagnosis of conduct disorder according to ICD-10 and healthy age-matched controls. In addition to the standardized assessment of general psychopathology, methods assessing narrowband aggressive symptoms (Child Behavior Checklist) and emotional reactivity to an experimentally induced provocation (Taylor's competitive reaction time task) were used in both groups. We found a trend for a lower mean Vmax of platelet 5-HT uptake in 14 conduct-disordered boys compared with healthy controls (n=15). If, however, 2 patients with a low degree of aggression and emotional reactivity were excluded, the difference became significant (mean=4.27, SD=3.49 in patients and mean=8.45, SD=4.63 in controls). A significant negative correlation was found between parent-rated aggression scores and Vmax (r=-0.41, p < 0.05, n=29). These data suggest that dysfunction of 5-HT transport mechanisms might be associated with specific behavioral symptoms in conduct-disordered children.

Adolescent↗
PubMed1997

Summary of the practice parameters for the assessment and treatment of children and adolescents with conduct disorder.

This summary of the practice parameters describes the diagnosis, treatment, and prevention of conduct disorder in children and adolescents. The rationales for these recommendations are based on a review of the scientific literature and clinical consensus, which are contained in the complete document. Clinical features of youths with conduct disorder include predominance in males, low socioeconomic status, and familial aggregation. Important continuities to oppositional defiant disorder and antisocial personality disorder have been documented. Extensive comorbidity, especially with other externalizing disorders, depression, and substance abuse, has been documented and has significance for prognosis. Clinically significant subtypes exist according to age of onset, overt or covert conduct problems, and levels of restraint exhibited under stress. To be effective, treatment must be multimodal, address multiple foci, and continue over extensive periods of time. Early treatment and prevention seem to be more effective than later intervention.

Adolescent↗
PubMed1984

The Birmingham Trial of permanent pacing in patients with intraventricular conduction disorders after acute myocardial infarction.

Patients surviving 2 weeks after myocardial infarction who had persistent conduction disorder (right bundle branch block alone or associated with left anterior or posterior hemiblock [LPH] or LPH alone) were allocated at random to permanent pacing or control groups. Throughout follow-up, up to 5 years, there was no significant difference in survival: at 2 years 14 of 23 (61%) of paced patients had died compared with 11 of 27 (41%) control patients. Progression of conduction disorder was not observed and measurement of infranodal conduction time (HV interval) did not predict outcome. Ventricular tachyarrhythmias were an important cause of death in these patients and pacing appears to offer no benefit.

Bundle-Branch Block↗
PubMed1999

The impact of parenting on conduct disorder in Jamaican male adolescents.

The present study examined the feasibility of using a new theoretical model to determine the association between parenting factors and conduct disorder in Jamaican male adolescents. The issues are discussed within the framework of family, peer group, and biological factors associated with conduct disorder.

Adolescent↗
PubMed1987

Conduct disordered adolescents from a community sample.

This study reports on a group of adolescents with conduct disorder in a community sample. Utilizing structured interviews for the adolescents and their parents, and strict requirements for caseness, conduct disorder was found to be the most common psychiatric problem (along with anxiety disorders). Various instruments were used. The findings, including approaches to conflict resolution in adolescents and their parents, are discussed.

Adolescent↗