Robins L N, Price R K
Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110.
Psychiatry. 1991 May;54(2):116-32. doi: 10.1080/00332747.1991.11024540.
Children with conduct disorder have long been known to be at high risk for developing externalizing disorders, alcohol and drug abuse, and antisocial personality. Relationships of conduct disorder to other adult psychiatric disorders, on the other hand, have not been definitively shown. Taking advantage of the large community sample (N = 19,482) interviewed in the NIMH Epidemiologic Catchment Area Program, the authors examined the effects of childhood conduct problems on ten DSM-III psychiatric disorders: somatization, phobia, panic, obsessive-compulsive, depression, mania, alcohol use disorder, drug use disorder, schizophrenia and antisocial personality. Each of the ten adult disorders showed an increase in prevalence with an increasing number of conduct problems, although effects were stronger for externalizing disorders. The predictive power of conduct problems was similar for males and females. The effect of conduct problems on nonexternalizing disorders was found to be largely mediated through externalizing disorders, particularly for men but direct effects also occurred for both sexes. These findings raise questions about the conventional view of psychiatric disorders as divisible into externalizing and internalizing disorders. They also suggest that the increasing rates of conduct problems in younger cohorts may be responsible in part for the rising rates of other disorders. Thus, prevention of and early intervention with conduct disorder may hold promise for reducing rates of a broad range of disorders.
长期以来，人们都知道患有品行障碍的儿童极有可能发展为外化性障碍、酒精和药物滥用以及反社会人格。另一方面，品行障碍与其他成人精神障碍之间的关系尚未得到确切证实。利用美国国立精神卫生研究所（NIMH）流行病学集水区项目中所访谈的大型社区样本（N = 19482），作者们研究了儿童期品行问题对十种《精神疾病诊断与统计手册》第三版（DSM - III）精神障碍的影响：躯体化障碍、恐惧症、恐慌症、强迫症、抑郁症、躁狂症、酒精使用障碍、药物使用障碍、精神分裂症和反社会人格。随着品行问题数量的增加，这十种成人障碍的患病率均有所上升，尽管对外化性障碍的影响更为强烈。品行问题对男性和女性的预测能力相似。研究发现，品行问题对非外化性障碍的影响在很大程度上是通过外化性障碍介导的，尤其是对男性而言，但对两性也都存在直接影响。这些发现对将精神障碍传统地分为外化性和内化性障碍的观点提出了质疑。它们还表明，较年轻队列中品行问题发生率的上升可能部分导致了其他障碍发生率的上升。因此，预防品行障碍并进行早期干预可能有望降低多种障碍的发生率。
