Herpertz Sabine C, Huebner Thomas, Marx Ivo, Vloet Timo D, Fink Gereon R, Stoecker Tony, Shah N Jon, Konrad Kerstin, Herpertz-Dahlmann Beate
Department of Psychiatry and Psychotherapy, University of Rostock, Germany.
J Child Psychol Psychiatry. 2008 Jul;49(7):781-91. doi: 10.1111/j.1469-7610.2008.01905.x.
Boys with early onset of conduct disorder (CD), most of whom also meet diagnostic criteria of a comorbid attention deficit hyperactivity disorder (ADHD), tend to exhibit high levels of aggression throughout development. While a number of functional neuroimaging studies on emotional processing have been performed in antisocial adults, little is known about how CD children process emotional information.
Functional magnetic resonance imaging data were analyzed in 22 male adolescents aged 12 to 17 years with childhood-onset CD (16 of them with comorbid ADHD) compared to 22 age-matched male healthy controls. In order to consider the likely confounding of results through ADHD comorbidity, we performed a supplementary study including 13 adolescent subjects with pure ADHD who were compared with healthy controls. To challenge emotional processing of stimuli, a passive viewing task was applied, presenting pictures of negative, positive or neutral valence.
When comparing CD/combined disorder patients with healthy controls, we found enhanced left-sided amygdala activation in response to negative pictures as compared to neutral pictures in the patient group. In addition, these boys exhibited no reduced activation in the orbitofrontal, anterior cingulate and insular cortices. By contrast, children with pure ADHD did not show any abnormalities in amygdala activation but showed decreased neural activity in the insula only in response to negative pictures.
Increased rather than reduced amygdala activation found in our study may indicate an enhanced response to environmental cues in adolescents with early-onset CD (most of whom also met the condition of ADHD), and is not consistent with the assumption of a reduced capacity to take note of affective information in the social environment. Further studies with an emphasis on developmental aspects of affect regulation are needed to clarify the relationship between CD and adult personality pathology associated with different modes of persistent antisocial behavior.
患有早发性品行障碍（CD）的男孩，其中大多数也符合共病注意力缺陷多动障碍（ADHD）的诊断标准，在整个发育过程中往往表现出高度攻击性。虽然已经对反社会成年人进行了一些关于情绪处理的功能性神经影像学研究，但对于患有品行障碍的儿童如何处理情绪信息知之甚少。
对22名年龄在12至17岁的患有儿童期起病的品行障碍的男性青少年（其中16人患有共病ADHD）的功能性磁共振成像数据进行了分析，并与22名年龄匹配的男性健康对照进行比较。为了考虑ADHD共病可能对结果产生的混淆影响，我们进行了一项补充研究，纳入了13名患有单纯ADHD的青少年受试者，并将他们与健康对照进行比较。为了挑战对刺激的情绪处理，采用了被动观看任务，呈现负性、正性或中性效价的图片。
将患有品行障碍/合并症的患者与健康对照进行比较时，我们发现与中性图片相比，患者组对负性图片的反应中左侧杏仁核激活增强。此外，这些男孩在眶额皮质、前扣带回皮质和岛叶皮质中没有表现出激活降低。相比之下，患有单纯ADHD的儿童在杏仁核激活方面没有表现出任何异常，但仅在对负性图片的反应中岛叶神经活动降低。
我们的研究发现杏仁核激活增加而非降低，这可能表明患有早发性品行障碍（其中大多数也符合ADHD的条件）的青少年对环境线索的反应增强，这与在社会环境中注意情感信息能力降低的假设不一致。需要进一步开展侧重于情感调节发展方面的研究，以阐明品行障碍与与不同持续反社会行为模式相关的成人人格病理学之间的关系。
