Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029, United States.
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029, United States.
Eur Neuropsychopharmacol. 2018 Dec;28(12):1429-1438. doi: 10.1016/j.euroneuro.2018.09.001. Epub 2018 Nov 19.
Longitudinal studies have shown that clinical precursors of antisocial personality disorder (ASPD) include attention-deficit/hyperactivity disorder (ADHD) and more notably comorbid ADHD and conduct disorder (CD). Despite existing evidence for the purported role of abnormal serotonergic function in aggressive youth and adults, little evidence exists on the role of serotonin in the progression from childhood disruptive behavior disorders to adult psychopathology, including ASPD. This study examined the relation between serotonergic function in children diagnosed with ADHD and the development of ASPD in early adulthood. We hypothesized that low serotonin response to a pharmacological probe in childhood would predict the development of adult ASPD. Towards this goal we divided 40 adults (M = 37, F = 3), ages 23-26 (m-24.57, sd-2.33) diagnosed with childhood ADHD into 2 groups: participants with (n = 21) and without (n = 19) ASPD. We used logistic regression to assess whether serotonergic measures in childhood assessed via prolactin and cortisol responses to a fenfluramine challenge, would selectively predict the development of ASPD in early adulthood. Logistic regression models showed that low central serotonergic response in childhood indexed by cortisol response significantly predicted adult ASPD (Wald = 4.427, p = .035) but not ADHD diagnosis in adulthood. Adults without ASPD had the highest serotonergic response whereas adults with adolescent ASPD (i.e. early onset ASPD) had the lowest response. Thus we provide new evidence of the link between low serotonergic function in childhood and the development of ASPD in adulthood, particularly for boys with adolescent onset of ASPD. These findings are relevant for understanding the contribution of childhood neurobiology to risk for later ASPD.
纵向研究表明，反社会人格障碍（ASPD）的临床前体包括注意缺陷/多动障碍（ADHD），更值得注意的是共患 ADHD 和品行障碍（CD）。尽管有证据表明异常 5-羟色胺能功能与攻击性青少年和成年人有关，但关于 5-羟色胺在从儿童破坏性行为障碍到包括 ASPD 在内的成年精神病理学进展中的作用的证据很少。本研究探讨了儿童 ADHD 患者的 5-羟色胺功能与成年早期 ASPD 发展之间的关系。我们假设儿童期药物刺激后 5-羟色胺反应低会预测成年后 ASPD 的发展。为此，我们将 40 名年龄在 23-26 岁（m-24.57，sd-2.33）的成年 ADHD 患者（M=37，F=3）分为两组：患有（n=21）和不患有（n=19）ASPD。我们使用逻辑回归来评估童年期通过催乳素和皮质醇对芬氟拉明反应的 5-羟色胺测量是否可以选择性地预测成年早期 ASPD 的发展。逻辑回归模型显示，儿童期皮质醇反应指标的中枢 5-羟色胺反应低下显著预测成年后 ASPD（Wald=4.427，p=.035），但不能预测成年后 ADHD 诊断。没有 ASPD 的成年人具有最高的 5-羟色胺反应，而患有青少年 ASPD（即早发性 ASPD）的成年人反应最低。因此，我们提供了新的证据表明儿童期 5-羟色胺功能低下与成年后 ASPD 的发展之间存在联系，特别是对于青春期前发病的男性。这些发现对于理解儿童神经生物学对以后发生 ASPD 的风险的贡献具有重要意义。
