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PubMed2001

Acute effects of D-fenfluramine on simultaneous measures of aggressive escape and impulsive responses of adult males with and without a history of conduct disorder.

RATIONALE: The role of serotonin in human aggression was evaluated by administering D-fenfluramine and comparing the effects on laboratory measures of aggression, escape and impulsivity among subjects with and without a history of conduct disorder. METHODS: Ten male subjects with a history of criminal behavior participated in experimental sessions that measured aggressive and impulsive responses. Five subjects had a history of childhood conduct disorder (CD+) and five control subjects did not. Aggression was measured using the Point Subtraction Aggression Paradigm (PSAP), which provides subjects with an aggressive, escape and monetary reinforced response options. Impulsive responses were measured using a paradigm that gives subjects choices between small rewards after short delays versus larger rewards after long delays. RESULTS: Acute doses (0.1, 0.2 and 0.4 mg/kg) of D-fenfluramine produced significant decreases in aggressive responses in CD+ subjects and large decreases in escape responses for CD+ subjects and smaller decreases for control subjects. Impulsive responses were decreased slightly and monetary reinforced responses were not changed in either group. Decreases in aggressive responses were not selective, since escape responses were also decreased, but such effects could not be attributed to a non-specific sedative action because monetary reinforced responses were increased and reaction times were decreased, indicative of central nervous system stimulation. CONCLUSIONS: Release of serotonin by D-fenfluramine is the possible mechanism for reductions in aggressive responses. These results are consistent with a large body of data linking reduced serotonin function and aggressive behavior.

Adult↗
PubMed1998

Common genetic risk factors for conduct disorder and alcohol dependence.

The association between retrospectively reported childhood conduct disorder (CD) and a history of alcohol dependence (AD) was examined in a sample of 2,682 male, female, and unlike-sex adult twin pairs. There was a strong association between CD and AD in both men (tetrachoric r = .34, odds ratio = 2.8) and women (tetrachoric r = .53, odds ratio = 9.9). Genetic factors accounted for most of the association between CD and AD liability in men and women, with the remainder of the association being due to nonshared individual-specific environmental factors. Genetic influences common to CD and AD accounted for 17% and 35% of the genetic variation in AD liability in men and women, respectively, and accounted for 11% and 23% of the total variation in AD liability in men and women, respectively. The results suggest that there are common genetic risk factors for CD and AD or that CD itself is an important genetically influenced risk factor for AD.

Adult↗
PubMed2004

Psychopharmacology of conduct disorder: current progress and future directions.

Behavioural manifestations of conduct disorder (CD) among children and adolescents are one of the most common referrals to community psychiatrists. Patients with CD are difficult to treat. The patterns of maladaptive behaviours they exhibit are diverse and can vary as a function of age and gender. Although different pharmacological interventions have been reported as potentially promising options in the treatment of CD, no medication has yet received a formal approval from the licensure authorities, either in the US or Europe. This article reviews efficacy results and associated adverse effects from selected clinical trials that have the strongest outcome evidence for the treatment of CD in children and adolescents. Critical issues in the effectiveness of the evidence-based pharmacotherapy for CD are raised and future directions of the psychopharmacology of CD are examined.

Comorbidity↗
PubMed1997

Maternal smoking during pregnancy and the risk of conduct disorder in boys.

BACKGROUND: Previous animal and human studies have indicated that prenatal exposure to nicotine is associated with adverse reproductive outcomes, including altered neural structure and functioning, cognitive deficits, and behavior problems in the offspring. Our study extends previous research on humans by controlling a broad range of correlates of maternal smoking during pregnancy to determine if smoking is associated with behavior problems in the offspring severe enough to qualify for DSM-III-R diagnosis. METHODS: Subjects were 177 clinic-referred boys, ages 7 to 12 years at the time of the first assessment, who underwent longitudinal assessment for 6 years using annual structured diagnostic interviews. Correlates of maternal smoking during pregnancy and previously identified demographic, parental, perinatal, and family risk factors for the disruptive behavior disorders were controlled in logistic regression analyses. RESULTS: Mothers who smoked more than half a pack of cigarettes daily during pregnancy were significantly more likely to have a child with conduct disorder (odds ratio, 4.4; P = .001) than mothers who did not smoke during pregnancy. This association was statistically significant when controlling for socioeconomic status, maternal age, parental antisocial personality, substance abuse during pregnancy, and maladaptive parenting. CONCLUSIONS: Maternal smoking during pregnancy appears to be a robust independent risk factor for conduct disorder in male offspring. Maternal smoking during pregnancy may have direct adverse effects on the developing fetus or be a marker for a heretofore unmeasured characteristic of mothers that is of etiologic significance conduct disorder.

Adult↗
PubMed2002

Family and parenting interventions for conduct disorder and delinquency: a meta-analysis of randomised controlled trials.

AIMS: To determine whether family and parenting interventions benefit children and adolescents with conduct disorder and delinquency. METHODS: Meta-analysis of eight randomised controlled trials involving 749 children and adolescents (aged 10-17 years) with conduct disorder and/or delinquency. Criminality, academic performance, future employment, problem behaviour, family functioning, parental mental health, and peer relations were evaluated. RESULTS: Family and parenting interventions significantly reduced the time spent by juvenile delinquents in institutions (weighted mean difference 51.34 days). There was also a significant reduction in the risk of a juvenile delinquent being rearrested (relative risk 0.66) and in their rate of subsequent arrests at 1-3 years (standardised mean difference -0.56). CONCLUSIONS: The evidence suggests that family and parenting interventions for juvenile delinquents and their families have beneficial effects on reducing time spent in institutions and their criminal activity. In addition to the obvious benefit to the participant and their family, this may result in a cost saving for society.

Adolescent↗
PubMed1983

Intervention approaches to conduct disorders in young children.

The scope of the problem in regard to childhood aggression or conduct disorders is large and far exceeds the resources for dealing with them. Moreover, such children are at high risk for developing serious adolescent and adult psychological problems. Nurse practitioners are placed in strategic positions to be able to screen for, identify and treat early signs of conduct disorders in young children. This review describes assessment procedures and the essential components of a parent training program designed to help families reduce childhood aggression. By intervening with families early, nurse practitioners may be able to design effective preventive programs and improve the prognosis for these children.

Adult↗
PubMed1994

Case study of a conduct-disordered youngster: building ego defenses and improving object relations within a therapeutic alliance.

The classification of Conduct Disorder, sometimes seen as a nonspecific designation descriptive of antisocial behavior, is illuminated through case study of a youngster admitted for acute hospital treatment. Drawing on psychodynamic theory and treatment, principles are used in illustrating how individual, historical, family, and trauma factors may contribute to disordered self-esteem and behavior, which may become a focus of therapeutic intervention. A concluding section delineates the possibility of two varieties of Conduct Disorder related, respectively, to trauma or failures in socialization. These may have implications for treatment and setting.

Adolescent↗
PubMed2001

Depressive conduct disorder: symptom patterns and correlates in referred children and adolescents.

BACKGROUND: In order to examine the validity of the ICD-10 diagnostic category of depressive conduct disorder (DCD), a sample of 58 patients (mean age 11.6) with this diagnosis consecutively referred to a teaching hospital was compared with 151 patients with conduct disorder (CD) (mean age 12.3) and with 128 patients with depressive disorder (DD) (mean age 14.2). METHOD: Data on symptom profile, sociodemographic characteristics, duration of disorder, family history and psychosocial background were collected using the Maudsley item sheet. Comparison of the three groups was performed using SPSS. RESULTS: Controlling for age and gender differences, the DCD group had fewer biological depressive symptoms, fewer anxiety symptoms, less guilt and lower severity of overall depression compared to the DD group. They also displayed more self-injurious behaviour and had more adverse psychosocial circumstances than the DD subjects. Compared to the CD group, the DCD patients were less overtly aggressive and violent than the CD subjects, in addition to having significant depressive symptoms and a more frequent history of abuse. LIMITATIONS: The study was based on case-control and diagnosis had been reached after the discussion of clinicians involved in assessment. CONCLUSIONS: Overall, the results tentatively support the validity of this diagnostic subgrouping.

Adolescent↗
PubMed1993

Self-other differentiation among psychotic and conduct-disordered adolescents as measured by human figure drawings.

24 psychotic-spectrum adolescents were compared with 23 conduct-disordered adolescents on a self-other drawing differentiation task. Of the 24 psychotic-spectrum disordered adolescents, 14 received the diagnosis of Psychotic Disorder NOS (Group 1) and the remaining 10 had diagnoses of Schizophrenia, Bipolar Disorder with Psychotic Features, and Schizoaffective Disorder (Group 2). Interestingly, less impaired adolescents (Groups 1 and 3, the conduct-disordered group) showed significantly more difficulty than the more impaired adolescents (Group 2) on self-other differentiation as measured by their differentiated drawings.

Adolescent↗
PubMed2000

Epidemiology of physical and sexual abuse in young persons diagnosed with conduct disorder: a retrospective chart review.

The purpose of this study was to examine the existence of a history of physical and/or sexual abuse in adolescents diagnosed with Conduct Disorder. A retrospective chart review was undertaken at a Midwestern inpatient mental health facility. Files of adolescents diagnosed with Conduct Disorder, and who were admitted to this inpatient facility in 1995, were reviewed (n = 18). Fisher's exact probability tests were performed comparing the data gathered with statistics compiled by the U.S. Department of Health and Human Services (1998). The results suggest that the frequency of physical and sexual abuse is significantly greater than rates for the population at large. Implications for future research are discussed.

Adolescent↗
PubMed2002

Effective treatments of school-aged conduct disordered children: recommendations for changing clinical and research practices.

The present article discusses reviews, meta-analytical and other relevant outcome studies of treating school-aged conduct-disordered children. Meta-analytical studies of Parent Management Training and Cognitive-behavioural Therapy for the child have demonstrated that these interventions affect conduct disorder in children positively. However, most studies involved in these meta-analyses are conducted in research conditions and are not representative of the treatment effectiveness in everyday clinical practice. We believe there is a gap between the so-called efficacy studies in research conditions and the effectiveness studies in clinical practice and we discuss how clinical and research practice could be brought together.

Adolescent↗
PubMed1990

The MMPI and Jesness Inventory as measures of effectiveness on an inpatient conduct disorders treatment unit.

There is a paucity of research on the effectiveness of inpatient treatment of conduct disorders. The purpose of the present study was to determine what effect a locked behavioral/cognitive treatment setting would have upon the Minnesota Multiphasic Personality Inventory (MMPI) and Jesness Inventory scores of adolescent inpatients. Fifty consecutive admissions (30 males, 20 females) to a conduct disorders unit were administered the MMPI and Jesness Inventory pre- and posttreatment. Statistically significant changes were found on both inventories. Males responded to treatment more favorably than did females. Improvement on the test scores could not conclusively be linked to the treatment due to the absence of a control group; however, combined with previous research, the results indicate areas of improvement in the sample's pathology.

Adolescent↗
PubMed1995

[Symptomatic bradycardia with amiodarone in patients with pre-existing conduction disorders].

Amiodarone has been shown to improve survival in patients with impaired left ventricular function and ventricular trachyarrhythmias. The clinical applicability, however, is limited by numerous often serious adverse effects. 70 patients receiving the treatment with amiodarone for ventricular tacharrhythmias were investigated regarding the development of symptomatic bradycardia. Group 1 consisted of 25 patients with preexisting conduction disorders, 5 had first degree heart block, 10 had right bundle branch block, and 7 had left bundle branch block on electrocardiographic examination. The 3 remaining patients showed asymptomatic sinus node dysfunction defined as sinus arrest or sinuatrial block. Amiodarone caused symptomatic bradycardia in 6 of the group 1 patients (II degrees-III degrees AV block in 3 patients with preexisting I degree AV block or right bundle branch block; intermittent sinus arrest or SA block in the 3 cases with previous sinus node dysfunction). 45 patients had no conduction disorders before the administration of amiodarone (group II). None of these patients developed symptomatic bradycardia. The difference to group I was significant (p < 0.0005). Thus, patients with preexisting conduction disorders have a substantial risk of developing symptomatic bradycardia under amiodarone therapy, with an incidence of 24% in group I patients of our collective.

Aged↗
PubMed1995

Four-year longitudinal study of conduct disorder in boys: patterns and predictors of persistence.

A prospective study of conduct disorder (CD) was conducted using 4 annual structured diagnostic interviews of 171 clinic-referred boys, their parents, and their teachers. Only about half of the 65 boys who met criteria for CD in Year 1 met criteria again during the next year, but 88% met criteria for CD again at least once during the next 3 years. For most boys with CD, the number of symptoms fluctuated above and below the diagnostic threshold from year to year but remained relatively high. Lower socioeconomic status, parental antisocial personality disorder (APD), and attention-deficit hyperactivity disorder were significant correlates of CD in Year 1, but the interaction of parental APD and the boy's verbal intelligence predicted the persistence of CD symptoms over time (i.e., only boys without a parent with APD and with above-average verbal intelligence clearly improved).

Child↗
PubMed1994

[Late prognosis of patients after myocardial infarction complicated by atrioventricular conduction disorders].

The purpose of the study was to follow-up postmyocardial infarction patients with atrioventricular conduction disorders complicating the acute phase of the disease. The study population consisted of 42 patients, 30 men and 12 women, aged 42 = 91 years (x = 65.2 +/- 12.6). Inferior and anterior myocardial infarction developed in 28 and 16 patients, respectively. The follow-up ranged from 1 to 5 years (x = 3.6). Within the first year there were 14 deaths, and 28 patients had control check-up. All the patients were submitted for physical examination, routine electrocardiography, 24-hr continuous ECG recording. At 1 year none of the patients developed new conduction disorders, whereas 71.4% of the patients revealed arrhythmias in ECG recording. Within 5 years there were 20 deaths (47.66%). A group of those who died, when compared with survivors was characterized by higher mean age, significantly more frequent presence of arterial hypertension and prior myocardial infarction.

Adult↗
PubMedDate not supplied

[Ventricular response in atrial fibrillation : normal conduction, consequences of conduction disorders and preexcitation syndromes. Therapeutic implications].

Atrial fibrillation is the most common arrhythmia in man. It is characterized by: 1) a rapid and irregular atrial electrical activity, 2) an irregular ventricular response which follows complex laws in the absence of advanced disorder of atrio-ventricular conduction. The study of these laws of complex transformation which govern the ventricular response can be approached by histograms of the RR interval: the shortest interval between two QRS complexes corresponds approximately to the functional refractory period of the atrio-ventricular conduction pathways--the longest interval corresponds to the maximal intranodal hidden conduction in the central part of the node. Depending on the values obtained and the morphological type of the distribution, we can diagnose all degrees of atrio-ventricular conduction disorders. This has great practical significance in patients receiving or about to receive cardiotonics or antiarrhythmics. In the same way, in cases of pre-excitation syndrome, this method can be used to evaluate the refractory period of the accessory pathway and to guide treatment.

Atrial Fibrillation↗
PubMed2006

Timing of menarche and the origins of conduct disorder.

CONTEXT: Precocious onset of menses (ie, age < or =11 years) has repeatedly been identified as a risk factor for higher rates of delinquency or conduct disorder (CD) in girls. Although this association is often conceptualized as environmentally mediated (via processes such as affiliation of early-menstruating youth with older, more deviant peers), such conclusions are premature as biological and genetic explanations have yet to be fully considered. OBJECTIVE: To uncover the origins of the association between CD and timing of menarche. DESIGN, SETTING, AND PARTICIPANTS: The sample consisted of a population-based birth cohort of 708 mid-adolescent female twins assessed as part of the ongoing Minnesota Twin Family Study. We conducted 2 sets of analyses: standard bivariate analyses to uncover possible common genes and moderator analyses to evaluate possible moderation of genetic influences on CD by timing of menarche. MAIN OUTCOME MEASURES: Conduct disorder was assessed via individual semistructured interviews with mothers and adolescents. Menarcheal status and age at menarche were assessed via the Pubertal Development Scale. RESULTS: The results argued against common genetic influences but did provide evidence of etiological moderation of CD by timing of menarche. The heritability of CD was strongest (67%) in girls with average timing of menarche (ie, age 12-13 years) and substantially weaker (8%) in those with early onset. Those with late initiation of menses (ie, age >13 years) similarly exhibited weaker genetic influences (29%). Shared environmental influences showed the opposite pattern, as they were far stronger for those with precocious and delayed onset vs those with average onset. CONCLUSIONS: Our findings provide indirect support for psychosocial interpretations of the impact of precocious menarche and, to a lesser extent, delayed menarche on CD development. Further, they lend support to the notion that in some cases, genetic influences on psychopathology may be strongest in the "average, expectable" environment.

Age Factors↗