Masi Gabriele, Manfredi Azzurra, Milone Annarita, Muratori Pietro, Polidori Lisa, Ruglioni Laura, Muratori Filippo
IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry , Calambrone, Pisa, Italy.
J Child Adolesc Psychopharmacol. 2011 Feb;21(1):51-5. doi: 10.1089/cap.2010.0039.
A crucial issue in youths with disruptive behavior disorders, including oppositional defiant disorder and conduct disorder, is the refractoriness to treatments. A multimodal approach with individual therapy to improve social skills and self-control and family and school interventions is the best psychosocial treatment. Predictors of poor response to psychosocial treatment remain understudied. We aimed at exploring whether callous (lack of empathy and guilt) and unemotional (shallow emotions) (CU) trait and type of aggression (predatory vs. affective) can affect response to psychosocial treatment in referred youths with disruptive behavior disorders.
The sample consisted of 38 youths (28 boys and 10 girls, age range: 6-14 years, mean age: 13.1 ± 2.6 years) diagnosed as having oppositional defiant disorder or conduct disorder according to Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria and a clinical interview (Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version), who completed a 6-month therapeutic program at our hospital. Patients were assessed according to severity and improvement (Clinical Global Impressions-Severity score [CGI-S] and CGI-Improvement score), functional impairment (Children's Global Assessment Scale [C-GAS]), type of aggression, predatory versus affective (Aggression Questionnaire), and CU dimension (Antisocial Process Screening Device and the Inventory of CU Traits).
Among the 38 patients, 21 (55.3%) were responders and 17 (44.7%) were nonresponders, according to CGI-Improvement score and CGI-S. Nonresponders were more impaired at the baseline according to CGI-S and C-GAS. Nonresponders presented higher scores of predatory aggression, whereas affective aggression did not differ between groups. Nonresponders presented higher scores in CU trait of Antisocial Process Screening Device and in Inventory of CU total score (callous trait), but these differences did not survive Bonferroni correction.
Severity at the baseline and predatory aggression are negative predictors of psychosocial treatment, but the role of the callous trait needs more exploration in larger samples. Further research may increase our diagnostic and prognostic capacities, thus improving our treatment strategies.
在患有破坏性行为障碍（包括对立违抗障碍和品行障碍）的青少年中，一个关键问题是对治疗的难治性。采用个体治疗以提高社交技能和自我控制能力，并结合家庭和学校干预的多模式方法是最佳的心理社会治疗方法。对心理社会治疗反应不佳的预测因素仍未得到充分研究。我们旨在探讨冷酷（缺乏同理心和内疚感）和无情（情感浅薄）（CU）特质以及攻击类型（掠夺性与情感性）是否会影响被转诊的患有破坏性行为障碍的青少年对心理社会治疗的反应。
样本包括38名青少年（28名男孩和10名女孩，年龄范围：6 - 14岁，平均年龄：13.1 ± 2.6岁），他们根据《精神疾病诊断与统计手册》第4版（DSM - IV）标准以及临床访谈（学龄儿童情感障碍和精神分裂症量表 - 目前和终生版）被诊断为患有对立违抗障碍或品行障碍，并在我们医院完成了为期6个月的治疗项目。根据严重程度和改善情况（临床总体印象 - 严重程度评分[CGI - S]和CGI - 改善评分）、功能损害（儿童总体评估量表[C - GAS]）、攻击类型（掠夺性与情感性，攻击问卷）以及CU维度（反社会过程筛查工具和CU特质量表）对患者进行评估。
根据CGI - 改善评分和CGI - S，在这38名患者中，21名（55.3%）为反应者，17名（44.7%）为无反应者。根据CGI - S和C - GAS，无反应者在基线时功能损害更严重。无反应者的掠夺性攻击得分更高，而情感性攻击在两组之间没有差异。无反应者在反社会过程筛查工具的CU特质以及CU总量表（冷酷特质）得分更高，但这些差异在Bonferroni校正后不再显著。
基线时的严重程度和掠夺性攻击是心理社会治疗的负性预测因素，但冷酷特质的作用需要在更大样本中进一步探索。进一步的研究可能会提高我们的诊断和预后能力，从而改进我们的治疗策略。
