Turgay Atilla
Department of Psychiatry, The Scarborough Hospital, Toronto, Canada.
Essent Psychopharmacol. 2005;6(5):277-90.
Conduct disorder (CD) is one of the most common psychiatric disorders in childhood and adolescence. It is characterized by a variety of chronic antisocial behaviors, a repetitive and persistent pattern of behavior that violates the basic rights of others, major age-appropriate societal norms, or both. Aggressive behavior, lying, stealing, fire-setting, and running away from home and school are the most frequent manifestations of CD and are often accompanied by hyperactivity, impulsive behavior, explosiveness, cognitive and learning problems, and poor social skills. The rate of comorbidity is high, with attention-deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) being the most common; comorbid anxiety and depressive disorders are also seen, especially in adolescents. The diagnostic process should include the use of structured interviews, and scores from reliable and valid rating scales that cover all psychiatric disorders must be considered in the differential diagnosis, because CD alone is an extreme rarity and multiple disorders are almost always the rule rather than exception. Treatment should include parenting skills training combined with training of the child to improve his or her relationships with peers, academic performance, and compliance with legitimate demands of authority figures. The appropriate use of medications and integration of patient/parent education and support, as well as individual, group, family, residential, and inpatient treatment may be beneficial for patients with CD and ADHD. The article describes a number of psychopharmacological agents that are used in patients with CD with ADHD and other comorbid disorders. Drugs that may be useful include psychostimulants; atomoxetine (Strattera); antidepressants (imipramine [Tofranil], desipramine [Norpramin]); Selective Serotonin Reuptake Inhibitors (SSRIs); atypical antipsychotics such as risperidone (Risperdal); or mood regulators including lithium (Eskalith).
品行障碍（CD）是儿童和青少年期最常见的精神障碍之一。其特征是存在多种慢性反社会行为，即一种重复且持续的行为模式，这种行为模式侵犯他人基本权利、违反主要的适龄社会规范，或两者皆有。攻击行为、说谎、偷窃、纵火以及离家逃学是品行障碍最常见的表现形式，并且常伴有多动、冲动行为、易激惹、认知和学习问题以及社交技能差。共病率很高，注意缺陷多动障碍（ADHD）和对立违抗障碍（ODD）是最常见的共病；也可见共病焦虑和抑郁障碍，尤其是在青少年中。诊断过程应包括使用结构化访谈，在鉴别诊断中必须考虑来自可靠且有效的评定量表的评分，这些量表涵盖所有精神障碍，因为单纯的品行障碍极为罕见，多种障碍几乎总是常态而非例外。治疗应包括育儿技能培训以及对儿童的训练，以改善其与同伴的关系、学业表现以及对权威人物合理要求的依从性。适当使用药物以及将患者/家长教育与支持相结合，还有个体、团体、家庭、寄宿和住院治疗，可能对品行障碍和注意缺陷多动障碍患者有益。本文描述了一些用于患有品行障碍合并注意缺陷多动障碍及其他共病障碍患者的精神药物。可能有用的药物包括精神兴奋剂；托莫西汀（择思达）；抗抑郁药（丙咪嗪[托弗尼尔]、地昔帕明[诺普明]）；选择性5-羟色胺再摄取抑制剂（SSRIs）；非典型抗精神病药物如利培酮（维思通）；或情绪稳定剂包括锂盐（依斯卡尔）。
