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PubMed2002

Total serum cholesterol level, violent criminal offences, suicidal behavior, mortality and the appearance of conduct disorder in Finnish male criminal offenders with antisocial personality disorder.

Associations between low total serum cholesterol (TC) levels and antisocial personality disorder (ASPD), violent and suicidal behavior have been found. We investigated the associations between TC levels, violent and suicidal behavior, age of onset of the conduct disorder (CD) and the age of death among 250 Finnish male criminal offenders with ASPD. The CD had begun before the age of 10 two times more often in non-violent criminal offenders who had lower than median TC levels. The violent criminal offenders having lower than median TC levels were seven times more likely to die before the median age of death in the study material. The violent offenders having lower than median TC levels were eight times more likely to die of unnatural causes. The mean TC level of these male offenders with ASPD was lower than that of the general Finnish male population. Low TC levels are associated with childhood onset type of the CD, and premature and unnatural mortality among male offenders with ASPD. The TC level seems to be a peripheral marker with prognostic value among boys with conduct disorder and antisocial male offenders.

Adolescent↗
PubMed1989

ADDH and conduct disorder: degree of diagnostic overlap and differences among correlates.

The objective of this paper was to determine the degree of diagnostic overlap between attention deficit disorder with hyperactivity (ADDH) and conduct disorder (CD) and to see whether ADDH children show a different pattern of demographic, familial, and developmental correlates compared to CD children. The sample for this study consisted of 2,697 4- to 16-year-olds who participated in the Ontario Child Health Study. In terms of diagnostic overlap, ADDH and CD occurred together more often than by chance alone, particularly among girls. Pure groups of ADDH and CD children differed in a variety of ways. In general, ADDH children were younger and had experienced more developmental delays and less psychosocial disadvantage than the CD children. No differences were found with respect to associated impairments, a measure of severity. Children with both ADDH and CD (a mixed group) appeared to represent a true hybrid disorder rather than one diagnosis or the other. These findings support the validity of ADDH compared to CD, at least in terms of the pattern of correlates.

Adolescent↗
PubMed1994

Cellular immunity in depressed, conduct disorder, and normal adolescents: role of adverse life events.

OBJECTIVE: To determine whether adolescents with major depressive disorder have disturbances in their cellular immunity and to study whether the immunological changes detected are specific to depression or are general responses to stress. METHOD: Twenty subjects with major depressive disorder, 17 nondepressed subjects with conduct disorder, and 17 normal adolescents were recruited. Subjects were assessed with a clinical interview for DSM-III-R and a modified version of the Coddington Life Events Checklist. Blood samples were drawn for total white blood cells, lymphocytes subsets, natural killer cell activity, lymphocyte proliferation response to phytohemagglutinin, and cortisol plasma levels. RESULTS: Overall, there were no significant between-group differences in any of the cellular immune measurements. Natural killer cell activity was significantly negatively correlated with past year and lifetime adverse life events across all effector-target cell ratios. Controlling for diagnoses and socioeconomic status yielded similar results. There were no significant effects of age, sex, race, sleep, nutrition, cigarette use, menstrual cycle, or cortisol on any of the immunological variables. CONCLUSIONS: In this sample of adolescents, we found that independent of the diagnoses and socioeconomic status, increases in adverse life events were associated with low natural killer cell activity.

Adolescent↗
PubMed2001

Dehydroepiandrosterone sulphate and corticotropin levels are high in young male patients with conduct disorder: comparisons for growth factors, thyroid and gonadal hormones.

Childhood conduct disorder (CD) may originate in a stressful upbringing, and be associated with unusual physical or sexual development and thyroid dysfunction. We therefore explored circulating levels of hormones from adrenal, gonadal and growth hormone axes associated with stress, aggression and development in 28 CD patients and 13 age-matched healthy children (10-18 years old). The CD group had higher levels of dehydroepiandrosterone sulphate (DHEA-S), corticotropin (ACTH) and free tri-iodothyronine (fT(3)) if under 14 years. There were no differences for gonadal hormones or maturity ratings which were not associated with aggression. Smaller physical measures in CD children correlated with DHEA-S and growth factors (e.g. insulin-like growth factor I) increased ACTH and fT(3) correlated with restless-impulsive ratings, and DHEA-S with 'disruptive behaviour'. Imbalances in the adrenal and growth axes may have neurotropic repercussions in development.

Adolescent↗
PubMed2003

Diagnostic threshold for conduct disorder in girls and boys.

Concerns about gender bias in the diagnostic criteria for conduct disorder (CD) have prompted some researchers to recommend that the diagnostic threshold in girls be lowered. Since CD is a highly familial condition, the authors assessed the diagnostic validity of subthreshold CD in girls using family study methodology. They compared the rates of antisocial disorders (CD and antisocial personality disorder) in relatives of four groups of index children: children with attention deficit hyperactivity disorder (ADHD) and full, subthreshold, or no CD diagnoses and non-ADHD/non-CD control subjects. Results showed no interaction between gender and familiality across the four groups. Furthermore, there was no significant evidence of familiality of subthreshold CD. From a family genetic perspective, the diagnostic threshold for CD does not appear to differ by gender. The current results support the possibility that differential rates of CD reflect actual differences in rates of antisocial behavior across gender.

Antisocial Personality Disorder↗
PubMed2002

Sex differences in shared genetic and environmental influences between conduct disorder symptoms and marijuana use in adolescents.

The association between conduct disorder (CD) symptoms and marijuana use (MU) was assessed in 1,480 adolescent twins participating in the National Longitudinal Study on Adolescent Health. A strong association was found between CD and MU for both males (r=.38, P<.01) and females (r=.31, P<.01). Structural equation modeling on age-corrected rank normalized scores using the program Mx indicated significant gender differences in the genetic and environmental contributions to MU. Additive genetic influences were comparable in size for males (29%) and females (24%). However, for females the influence of common environmental influences was greater (58%) than for males (36%). There was also evidence of greater common environmental influences for females, as well as greater genetic influences for males for CD, but these differences did not reach significance. In addition, for CD common environmental influences did not differ significantly from zero. Additive genetic influences accounted for 61% of the variance in CD, with the remainder being of unique environmental origin. Bivariate genetic analyses suggested a moderate genetic correlation between CD and MU (r(g)=.28) and a low unique environmental correlation (r(e)=.14). These results suggest that CD and MU share genetic influences, while environmental influences tend to be more specific to each behavior. These findings may have implications for the prevention and treatment of CD and substance use among adolescents.

Adolescent↗
PubMed1999

The EARLY ALLIANCE prevention trial: an integrated set of interventions to promote competence and reduce risk for conduct disorder, substance abuse, and school failure.

Describes the EARLY ALLIANCE interventions, an integrated set of four programs designed to promote competence and reduce risk for early-onset conduct disorder, substance abuse, and school failure. These interventions are evaluated as part of a prevention trial that begins at school entry and targets child functioning and socializing practices across multiple contexts (school, peer group, family) and multiple domains (affective, social, and achievement coping-competence). The paper presents the conceptual foundation of the four interventions, including a synopsis of the risk and protective factors associated with conduct disorder and related outcomes, and of the coping-competence model driving EARLY ALLIANCE. The developmental rationale, intended impact, and procedures are described for each intervention: a universally administered classroom program and indicated, peer, reading-mentoring, and family programs. Interventions are currently being tested in a prevention trial, which is briefly summarized.

Adolescent↗
PubMed1976

[Epicardial scintigraphy in 4 cases of ventricular tachycardia caused by reentry of blood after myocardial infarct. Study of intra-ventricular conduction disorders in sinus rhythm and in tachycardia, and their relations to anatomical data].

Ventricular pericardial cartography in sinus rhythm (SR) and during ventricular tachycardia (VT) in four cases of myocardial infarction has yielded additional information in the study of conduction disorders in myocardial ischaemia: 1. The significant slowing of activity in SR as well as in VT is demonstrated by this direct method. It is associated with a diminution in amplitude of the pericardial potentials in the zones affected by the ischaemia; 2. Cartography during VT accentuates or reveals disorders of conduction which are slight or latent in SR; 3. Disorders of intra-ventricular conduction are found to be related either to segmental blocks on the branches of the bundle of His, or as focal blocks (peri-infarct block) on the left side, whose nature can be shown up even during VT; 4. Secondary activation of the myocardial fiber found to be related either to segmental blocks on the bundle of His during VT is demonstrated.

Arrhythmia, Sinus↗
PubMed2001

Trends and outcomes in the hospitalization of older Americans for cardiac conduction disorders or arrhythmias, 1991-1998.

OBJECTIVE: To identify epidemiological trends and measure outcomes in elderly patients hospitalized for cardiac conduction disorders or arrhythmias. DESIGN: Review of the standard 5% samples of the Medicare Provider Analysis and Review Files to characterize 144,512 discharges from 1991 through 1998 in which the principal diagnosis was a conduction disorder or arrhythmia, using the corresponding Enrollment Databases for denominator data. SETTING: Short-stay hospitals in the United States. PARTICIPANTS: Medicare beneficiaries age 65 and older in the standard 5% sample. MEASUREMENTS: Diagnosis-specific trends and rates; discharges by year; cumulative age-, race-, and sex-specific discharge rates; mean length of stay in hospital and in intensive care; mean Medicare reimbursement to the hospital; case-fatality rate in hospital; discharge destinations of patients discharged alive. RESULTS: Annual hospitalizations for sinoatrial node dysfunction, atrial flutter, atrial fibrillation, or ventricular fibrillation increased more rapidly than did the elderly Medicare beneficiary population. Hospitalizations with a principal diagnosis of ventricular extrasystoles or asystole showed steep secular declines. Discharge rates for sinoatrial node dysfunction, a group of rhythms with a nonsinus pacemaker, atrial fibrillation, Mobitz I, or complete atrioventricular block all increased steeply and continuously with patient age. In contrast, discharge rates for atrial flutter or ventricular tachycardia or fibrillation peaked among 75- to 84-year-old patients. White men were at uniquely high risk of hospitalization for atrial flutter or ventricular tachycardia or fibrillation, and, among the white majority, men had higher discharge rates than women for nine of the 11 commonest rubrics. Whites, particularly white women, had the highest discharge rates for atrial fibrillation. Blacks, especially black women, were at disproportionate risk for hospitalization for the group of nonsinus pacemaker rhythms. Diagnosis-specific mean resource costs were strongly correlated with each other and with mean Medicare reimbursement but not with case-fatality rate. CONCLUSION: Medicare claims data demonstrated striking differences among and within diagnoses of heart blocks or arrhythmias in terms of the populations at greatest risk for hospitalization. This variation should be explored further to generate and test hypotheses about differential causation or delivery of care.

Black or African American↗
PubMed2004

Malingered ADHD in adolescents diagnosed with conduct disorder: a brief note.

This brief note cautions clinicians about the possibility of adolescents with Conduct Disorder malingering the symptoms of Attention Deficit Hyperactivity Disorder (ADHD) to obtain medication. Presented are some guidelines to consider when the diagnosis of ADHD is indicated in forensic settings with adolescents such as the need for a comprehensive assessment and the importance of exploring the possibility of malingering.

Adolescent↗
PubMed1984

Aggressive conduct disorder: the influence of social class, sex and age on the clinical picture.

Past studies have shown that aggressive conduct disorder is more common in boys and in families of low socioeconomic status, and that affected children are usually seen in child psychiatry clinics before the age of 10. In this work we aimed to find how socioeconomic status, sex and age at admission influence the clinical picture of this disorder. We divided a series of 58 affected children into two groups on each of the three factors and compared the groups on 175 variables. We found little evidence that the children's difficulties varied with social class, sex or age. This apparent constancy of the clinical picture reinforces the idea that aggressive conduct disorder is a valid, though broadly defined, psychiatric syndrome.

Age Factors↗
PubMed1997

Clinical efficacy of methylphenidate in conduct disorder with and without attention deficit hyperactivity disorder.

BACKGROUND: Stimulants are not considered appropriate for the treatment of children with conduct disorders (CDs). The postulated differences in stimulant effect between children with attention deficit hyperactivity disorder (ADHD) and CD led to the hypothesis that methylphenidate hydrochloride, which is effective in ADHD, would not significantly improve symptoms of CD. METHODS: We randomly assigned 84 children with CD, between the ages of 6 and 15 years, to receive methylphenidate hydrochloride (up to 60 mg/d) or placebo for 5 weeks. Behavior was evaluated by parent, teacher, and clinician reports and by direct classroom observations. Two thirds of the children also met criteria for ADHD. RESULTS: Contrary to prediction, ratings of antisocial behaviors specific to CD were significantly reduced by methylphenidate treatment. The magnitude of methylphenidate effect indicated meaningful clinical benefit. Partialling out severity of ADHD did not alter the significant superiority of methylphenidate on CD ratings specifically (P < .001). CONCLUSIONS: Methylphenidate has short-term positive effects on children and adolescents with CD. Key aspects of antisocial adjustment appear to be treatment responsive. This effect was independent of severity of the children's initial ADHD symptoms.

Adolescent↗
PubMed2004

Comparing the validity of clinician-generated diagnosis of conduct disorder to the diagnostic interview schedule for children.

Clinician diagnoses of conduct disorder (CD) were compared to the diagnoses of CD generated by a structured interview against an observed criterion. Participants were 534 youth from a large residential program in the Midwest for delinquent youth. Rates of in-program CD behaviors were gathered from staff observations of the youth over a 9-month time period. Youth diagnosed with CD by the Diagnostic Interview Schedule for Children (DISC) displayed significantly more CD behaviors in the first 6 months of treatment compared to both youth without an externalizing disorder and youth diagnosed with CD by a clinician. Youth diagnosed with CD by a clinician had rates of CD identical to youth without an externalizing disorder. Clinicians may have weighted contextual information more heavily, as this group was significantly more likely to have an arrest record. Results support the use of structured interviews and provide evidence that typical clinician diagnoses may lack adequate validity.

Adolescent↗
PubMed1997

Conduct disorder, substance dependence, and adolescent motherhood.

Of 26 teenage mothers in a nonclinical sample, one-third were found to have a diagnosis of conduct disorder; of these, two-thirds were also diagnosed with substance abuse or dependence. Conduct disorder as a risk factor for adolescent pregnancy and substance use is discussed, as are the implications for preventive intervention.

Adolescent↗
PubMed1999

Conduct disorder in girls: a review of the literature.

The study of Conduct Disorder (CD) has primarily been limited to boys. The lack of research resulted from a premise that CD in girls was rare. However, CD in girls is a relatively common psychiatric diagnosis, and appears to be associated with several serious outcomes, such as Antisocial Personality Disorder and early pregnancy. Understanding gender differences in the course and severity of CD may lead to important information about etiology. Empirical studies on precursors, developmental course, risk factors and treatment for CD in girls are reviewed, while highlighting similarities and differences between girls and boys. Generally, CD symptoms in girls are stable. Precursors to CD in girls probably include Oppositional Defiant Disorder and temperamental factors, but also may include certain negative cognitions. What distinguishes CD in girls is the high risk they have to develop comorbid conditions, especially internalizing disorders. Risk factors for CD in girls partly overlap with those known for boys, but some factors appear to be highly salient for girls. Finally, there may be some significant effects of gender on treatment efficacy. Implications of these findings for future etiologic research are discussed.

Adolescent↗
PubMed2001

CSD/BEM localization of P300 sources in adolescents "at-risk": evidence of frontal cortex dysfunction in conduct disorder.

BACKGROUND: Longitudinal studies have demonstrated that childhood conduct disorder is a significant risk factor for a wide range of adult psychiatric disorders. The present study attempted to identify neurophysiologic differences that might underlie this risk factor. METHODS: The study examined 158 subjects, aged 14 to 20 years. Each subject was assigned to one of four groups defined by the factorial combination of the subject's gender and the relative number (-/+) of conduct problems exhibited before age 15. Event-related electroencephalographic potentials were recorded from each subject while he or she performed a memory scanning task. Each trial consisted of the brief presentation of either two or four consonant letters, a 2-sec memorization period, and a single "probe" letter. The subject was instructed to mentally compare the probe with the memory set and execute a discriminative (match vs. mismatch) key-press response. RESULTS: Analyses of P300 event-related potentials elicited by the probe stimuli revealed a significant interaction between probe stimulus membership and conduct problems: the P300 difference between trials with matching versus mismatching probes was significantly greater in the control (CP-) group than in the CP+ group. Current source density analyses, utilizing a realistic head-shape boundary element model, revealed that CP- subjects exhibited a robust activation of the left prefrontal cortex on matching versus mismatching trials. Among CP+ subjects, the degree of prefrontal cortex activation was not significant. CONCLUSIONS: The P300 results are consistent with those reported from previous studies of adolescents with conduct problems. Our study is unique in implementing current source density-boundary element method techniques for modeling P300 sources in "at-risk" adolescents. These techniques lend greater anatomical precision to the conclusion that conduct problems are associated with a specific dysfunction of the frontal brain.

Adolescent↗
PubMed2005

Reboxetine as an optional treatment for hyperkinetic conduct disorder: a prospective open-label trial.

BACKGROUND AND PURPOSE: Hyperkinetic conduct disorder (HCD) has been identified as a common psychiatric diagnosis among children and adolescents. This disorder affects many life aspects of both child and family. The aim of this study was to examine the efficacy of the selective norepinephrine reuptake inhibitor (SNRI), reboxetine, in treating children with HCD and its influence on associated symptoms, such as aggressiveness, impulsivity, anxiety, and depression. METHODS: Fifteen children, 5-14 years of age, diagnosed with HCD, participated in a 12- week, prospective, open-label trial with reboxetine (4-8 mg/d). They were examined for changes in: ADHD symptoms, as measured by the Conners Abbreviated (10-item) Teacher Rating Scale, aggression, as measured by the Yudofsky Overt Aggression Scale (OAS), impulsivity, as measured by the Plutchik impulsivity scale (IS), anxiety, as measured by the Revised Children's Manifest Anxiety Scale (RCMAS), and depressive mood, as measured by the Hamilton Rating Scale for Depression (HAM-D). RESULTS: There was a significant symptomatic improvement for HCD symptoms and associated symptoms. CONCLUSION: Our findings suggest that reboxetine may be effective in the treatment of HCD and associated symptoms.

Adolescent↗
PubMed2000

Cohort differences in genetic and environmental influences on retrospective reports of conduct disorder among adult male twins.

BACKGROUND: Rates of child and adolescent conduct disorder (CD) have increased steadily over the past several decades. What is not known is whether the underlying genetic and environmental influences on individual differences in CD have also changed. METHODS: Retrospective reports of antisocial behaviour prior to age 18 were obtained from a population-based sample of 2769 adult males from male-male twin pairs born between 1940 and 1974. Using a summary score of number of CD symptoms, structural equation modelling was used to investigate whether mean level and variation in CD increased with more recent cohorts, and whether any increase in variance could be explained by familial or non-familial factors. RESULTS: Both mean level CD symptoms and variation were increased in more recent cohorts. Model fitting indicated that the primary increase in variance was due to familial factors, most notably, an increase in the shared environmental influences on CD, from 0.01 (95 % CI = 0.00; 0.27) to 0.30 (95 % Cl = 0.01; 0-44). Heritability estimates remained largely unchanged, although an increase in genetic factors could not be ruled out. CONCLUSIONS: Secular changes in sociodemographic factors responsible for increasing rates of CD may also account for the greater magnitude of shared environmental influences on variation in CD found among more recent cohorts.

Adult↗