■行为障碍(CD)的特征是重复和持续的反社会行为,是青年中最常见的转诊原因之一。CD是一种高度异质性的疾病,根据发病年龄定义可能的说明符,有限的亲社会情绪(LPE),也称为冷酷无情(CU)特质,情绪失调(ED)和合并症的模式,每个人都有自己特定的发展轨迹。
■作者回顾了已发表的有关临床表现的文献中的证据,诊断程序,心理治疗和心理教育方法,以及RCT和青年自然主义研究的药物干预。来自研究的证据,包括具有LPE/CU特征的年轻人,ED和侵略也被审查,作为回应主持人。
■由于其临床异质性,应仔细鉴定CD的相关亚型,以获得有关预后和治疗的可靠信息.因此,作为诊断的第一步,在亚型中解开这大类至关重要。心理社会干预是第一选择,可能会改善LPE/CU特征和ED,特别是如果在开发早期实施。相反,信息有限,基于低质量的研究,支持药理学选择。第二代抗精神病药,情绪稳定剂,兴奋剂是一线药物,根据不同的目标症状,比如攻击性和情绪反应性。包括ADHD在内的发育途径表明了精神兴奋剂的特定作用。
Conduct disorder (CD) is characterized by repetitive and persistent antisocial behaviors, being among the most frequently reported reasons of referral in youth. CD is a highly heterogeneous disorder, with possible specifiers defined according to age at onset, Limited Prosocial Emotions (LPE) otherwise known as Callous-Unemotional (CU) traits, Emotional Dysregulation (ED), and patterns of comorbidity, each with its own specific developmental trajectories.
The authors review the evidence from published literature on the clinical presentations, diagnostic procedures, psychotherapeutic and psychoeducational approaches, and pharmacological interventions from RCT and naturalistic studies in youth. Evidence from studies including youths with LPE/CU traits, ED and aggression are also reviewed, as response moderators.
Due to its clinical heterogeneity, relevant subtypes of CD should be carefully characterized to gain reliable information on prognosis and treatments. Thus, disentangling this broad category in subtypes is crucial as a first step in diagnosis. Psychosocial interventions are the first option, possibly improving LPE/CU traits and ED, especially if implemented early during development. Instead, limited information, based on low-quality studies, supports pharmacological options. Second-generation antipsychotics, mood stabilizers, and stimulants are first-line medications, according to different target symptoms, such as aggression and emotional reactivity. Developmental pathways including ADHD suggest a specific role of psychostimulants.