Masi Gabriele, Milone Annarita, Manfredi Azzurra, Pari Cinzia, Paziente Antonella, Millepiedi Stefania
IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, 56018 Calambrone (Pisa), Italy.
Compr Psychiatry. 2008 Mar-Apr;49(2):146-53. doi: 10.1016/j.comppsych.2007.08.009. Epub 2007 Oct 24.
Studies on referred children and adolescents with conduct disorder (CD) have relevant implications for prevention and treatment. We addressed this issue in a large sample of youths with CD, considering age at onset, sex, and response to treatments as variables.
The sample consisted of 198 patients (153 males and 45 females; age range, 8-18 years; mean age, 13.2 +/- 2.6 years), consecutively diagnosed as having CD during a 5-year period. The diagnoses were based on fulfillment of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria, according to historical information, prolonged observations, and a clinical interview (Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version). Three subtypes of aggressive behaviors-"predatory" (controlled, planned, and goal-oriented), "affective" (impulsive, explosive, and unprofitable), and "mixed" (with both the features)-were considered in this study.
Patients with prepubertal onset were younger at referral and had a poorer socioeconomic status. Their condition was more severe at the baseline, but their response to treatments did not differ from those with adolescent onset. Predatory and affective aggression and attention deficit hyperactivity disorder comorbidity were higher in children with prepubertal-onset CD. Regarding to sex, females were older and had a lower socioeconomic status. Their condition was more severe at the baseline and presented higher scores in self-aggression, but they responded better to treatments. Rates of attention deficit hyperactivity disorder were significantly lower in females, whereas other comorbidities (including substance abuse) were similar between sexes. Nonresponders to treatments received less frequently a psychosocial intervention, have more severe condition at the baseline, presented a more severe verbal and physical aggression, a lower affective/predatory index, and a higher rate of substance abuse.
Age at onset and sex may be critical variables for prognosis of CD. Psychosocial intervention can significantly improve the treatment response.
对患有品行障碍（CD）的儿童和青少年进行研究，对预防和治疗具有重要意义。我们在大量患有CD的青少年样本中探讨了这个问题，将发病年龄、性别和对治疗的反应作为变量。
样本包括198名患者（153名男性和45名女性；年龄范围8至18岁；平均年龄13.2±2.6岁），在5年期间连续被诊断为患有CD。诊断基于符合《精神障碍诊断与统计手册》第四版标准，依据历史信息、长期观察以及临床访谈（学龄儿童情感障碍和精神分裂症量表 - 目前和终生版）。本研究考虑了攻击行为的三种亚型——“掠夺性”（可控、有计划且目标导向）、“情感性”（冲动、爆发且无益处）和“混合性”（兼具两者特征）。
青春期前发病的患者在转诊时年龄较小，社会经济地位较低。他们在基线时病情更严重，但对治疗的反应与青春期发病的患者无异。青春期前发病的CD儿童中，掠夺性和情感性攻击以及注意力缺陷多动障碍共病率更高。在性别方面，女性年龄较大，社会经济地位较低。她们在基线时病情更严重，自我攻击得分更高，但对治疗反应更好。女性注意力缺陷多动障碍的发生率显著较低，而其他共病（包括药物滥用）在性别之间相似。对治疗无反应者较少接受心理社会干预，在基线时病情更严重，表现出更严重的言语和身体攻击、较低的情感/掠夺性指数以及更高的药物滥用率。
发病年龄和性别可能是CD预后的关键变量。心理社会干预可显著改善治疗反应。
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