Citation

Pisano S, Masi G. Expert Opin. Pharmacother. 2019; ePub(ePub): ePub.

Affiliation

IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Pisa, Italy.

Copyright

(Copyright © 2019, Informa - Taylor and Francis Group)

DOI

10.1080/14656566.2019.1685498

PMID

31663786

Abstract

Conduct Disorder (CD) is characterized by repetitive and persistent patterns of behavior, with violation of the rights of others and societal norms or rules. It is included in the new DSM-5 chapter of Disruptive, Impulse Control and Conduct Disorders, with problems in the self-control of both behavior and emotions. This chapter includes also the Oppositional Defiant Disorder (ODD), often developmentally related to a possible outcome to an early-onset CD. In this developmental pathway, the first disorder to appear is often Attention Deficit Hyperactivity Disorder (ADHD), which affects not only presentation and natural history, but also treatment strategies.

Irritability and/or aggression in CD define subgroups of patients with specific diagnostic and treatment needs. Irritability is a deficit in emotional regulation, and a low threshold to anger in response to frustration. Episodic and chronic irritability are separable presentations, and remain substantially stable over time. Severe irritability, irrespective of its episodicity or chronicity, was firstly considered a possible age-related phenotype of pre-pubertal mania. Subsequent research showed that episodic irritability is mainly related to bipolar disorder (BD), while chronic irritability is associated with ODD or Disruptive Mood Dysregulation Disorder (DMDD).

Oppositional Defiant Disorder presents distinct sub-dimensions, irritable, headstrong (rule violations, purposefully annoying others), and hurtful (being spiteful, vindictive behavior), which delineate differential pathways to different negative psychiatric outcomes. The irritable (or affective) sub-dimension is prospectively associated with internalizing problems, and only to a lesser extent, to CD, while the behavioral dimensions predict CD.

In order to limit the risk of an over-diagnosis of Bipolar Disorder (BD), based on prospective findings, children with chronic irritability, negative mood and temper outbursts were firstly included in a temporary diagnosis of ...

Language: en

Keywords

Aggression; antipsychotics; clonidine; conduct problems; mood stabilizers; stimulants