Conduct disorder
Conduct disorder
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DOI：
10.1038/s41572-019-0095-y
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发表时间：
2019-06-27
影响因子：
81.5
通讯作者：
De Brito, Stephane A.
中科院分区：
文献类型：
--
作者：
Fairchild, Graeme;Hawes, David J.;De Brito, Stephane A.
品行障碍(CD)是一种常见的高度损害精神障碍，通常出现在儿童或青少年时期，以严重的反社会和攻击性行为为特征。它经常与注意力缺陷/多动障碍(ADHD)并存，并经常导致成年后的反社会人格障碍。CD对学龄儿童的影响类似于3%，男性的发病率是女性的两倍。这种障碍可以根据发病年龄(儿童期发病与青春期发病)以及是否存在冷酷无情的特征(同理心和内疚方面的缺陷)进行亚型划分。CD的病因学很复杂，既有遗传风险因素，也有环境风险因素，以及两者之间不同形式的相互作用(基因-环境相互作用和相关性)。此外，CD还与神经认知障碍有关；已有报道称，杏仁核、脑岛和眶前皮质等边缘区域的灰质体积较小，以及负责情绪处理、情绪调节和基于强化的决策的重叠大脑回路的功能异常。降低下丘脑-垂体-肾上腺轴和自主神经对应激的反应性也有报道。CD的管理主要包括以父母为基础或以家庭为基础的心理社会干预，尽管有时也会使用兴奋剂和非典型抗精神病药物，特别是在患有ADHD的个人。
Conduct disorder (CD) is a common and highly impairing psychiatric disorder that usually emerges in childhood or adolescence and is characterized by severe antisocial and aggressive behaviour. It frequently co-occurs with attention-deficit/hyperactivity disorder (ADHD) and often leads to antisocial personality disorder in adulthood. CD affects similar to 3% of school-aged children and is twice as prevalent in males than in females. This disorder can be subtyped according to age at onset (childhood-onset versus adolescent-onset) and the presence or absence of callous-unemotional traits (deficits in empathy and guilt). The aetiology of CD is complex, with contributions of both genetic and environmental risk factors and different forms of interplay among the two (gene-environment interaction and correlation). In addition, CD is associated with neurocognitive impairments; smaller grey matter volume in limbic regions such as the amygdala, insula and orbitofrontal cortex, and functional abnormalities in overlapping brain circuits responsible for emotion processing, emotion regulation and reinforcement-based decision-making have been reported. Lower hypothalamic-pituitary-adrenal axis and autonomic reactivity to stress has also been reported. Management of CD primarily involves parent-based or family-based psychosocial interventions, although stimulants and atypical antipsychotics are sometimes used, especially in individuals with comorbid ADHD.