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Neurobiology of Mental Illness > Lecture 5 - Conduct Disorder > Flashcards

Lecture 5 - Conduct Disorder Flashcards

1
Q

What is the label used to identify the group of life-course persistent male offenders?

A

Anti-social personality disorder

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2
Q

What does ASPD stand for?

A

Antisocial personality disorder

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3
Q

What is the unique feature of ASPD compared to all other personality disorders?

A

It is the only personality disorder which has a childhood antecedent in its diagnostic criteria.

To be diagnosed with ASPD by age 18, you need to have met criteria for conduct disorder by age 15.

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4
Q

What percentage of young people with conduct disorder will go on to develop a fully blown personality disorder as an adult?

A

50%

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5
Q

What percentage of male prisoners had conduct disorder when young, and have ASPD?

A

50-80% - ASPD is disproportionately represented in the male prison population.

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6
Q

Describe the subgroup within male prisoners with ASPD.

A

In addition to showing a high level of antisocial behavior, also have psychopathy.

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7
Q

What is psychopathy?

A

An extreme, severe form of ASPD.

Those with psychopathy, in addition to having ASPD, also show affective-interpersonal features (shallow affect, lack of empathy, pathological lying)

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8
Q

Describe the relationship between psychopathy and ASPD.

A

Asymmetric.

Very few men with ASPD will have psychopathy, but many, if not all, of those with psychopathy will have ASPD.

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9
Q

Describe the features of criminal behaviour by psychopaths?

A
  • greater numbers of crime
  • crimes are more violent
  • more likely to recidivate
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10
Q

What are the two domains of psychopathy?

A

Affective-interpersonal and antisocial-impulsive

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11
Q

What is used to diagnose psychopathy?

A

PCL-R

Psychopathy checklist revised.

Score of 30/40 in the US will mean you are considered psychopathic.

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12
Q

Name items of the affective-interpersonal domain

A

Taps the core features of the syndrome of psychopathy.

  • grandiose sense of self-worth
  • pathological lying
  • cunning/manipulative
  • lack of remorse/guilt
  • shallow affect
  • callous-lack of empathy
  • failure to accept responsibility for own actions
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13
Q

Name items of the antisocial-impulsive domain.

A
  • need for stimulation/proneness to boredom
  • parasitic lifestyle (constantly exploiting others)
  • poor behavioural control
  • early behavioural problems
  • lack of realistic long term goals
  • impulsivity
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14
Q

What is conduct disorder characterised as?

A

A repetitive and persistent pattern of behaviour in which the basic rights of other or major age-appropriate societal norms or rules are violated, resulting in a clinically significant impairment in functioning.

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15
Q

What are the 4 main categories of symptoms in conduct disorder?

A

Overt:

  • aggression to people and animals
  • destruction of property

Covert:

  • deceitfulness and theft
  • violation of rules
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16
Q

Why is there such heterogeneity between individuals with conduct disorder?

A

Because most of the symptoms are overt behaviours. There are 3 symptoms required for a diagnosis of conduct disorder.

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17
Q

How many different symptom combinations are possible in conduct disorder?

A

32,000

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18
Q

What is equifinality?

A

The same endpoint can be reached via different pathophysiological pathways

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19
Q

What is Multifinality?

A

Different endpoints can be reached via the same pathophysiological pathways

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20
Q

What is the age-distinction made by Tammy Moffatt in conduct disorder?

A
  • Childhood-onset (at least one problem with conduct before age 10)
  • Adolescent-onset (no problems with conduct before age 10)

The two groups are characterised by different neurobiological vulnerabilities and risk factors.

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21
Q

What is the more recent specifier to characterise those with child

A

(Children) With Limited Prosocial Emotions

  • lack of remorse or guilt
  • callous-lack of empathy
  • lack of concern about performance in important activities
  • shallow or deficient affect
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22
Q

What is the diagnostic criteria for children With Limited Prosocial Emotions?

A

Needs to have 2 of the features in the last 12 months in different relationships or settings.

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23
Q

What is the evidence for conduct disorder as a risk factor for mental health problems?

A

It is the single most common reason for referral to CAHMS

24
Q

What is the evidence for conduct disorder as a risk factor for legal problems?

A

Associated with a high level of crime and antisocial behaviour

25
Q

What is the evidence for conduct disorder as a risk factor for educational problems?

A

One of the main reasons for school dropout in young people.

In Europe, one of the main reasons for teacher burnout.

26
Q

What is the evidence for conduct disorder as a risk factor for social problems?

A

Those with conduct disorder are usually rejected in society.

27
Q

What is the evidence for conduct disorder as a risk factor for occupational problems?

A

Don’t sustain jobs or have difficulty getting training.

28
Q

What is the evidence for conduct disorder as a risk factor for physical health problems?

A

Engage in alcohol and fights - often have traumatic brain injuries. Substance abuse, accidental falls, etc.

29
Q

What did Scott et al, (2001) find about the costs of children with conduct disorder compared to children without problems?

A

Young people followed up for two decades:

By age 28, a child with conduct disorder will cost 10 times more than children without problems.

30
Q

What did Rivenbark et al., (2018) find about

A

Used administrative records to look at the costs associated with conduct problems:

Those with child conduct problems only made up 9% of the sample, but accounted for 50% of all criminal convictions, 15% of all hospital bed nights, 16% of all emergency department visits and 25% of all welfare benefits.

31
Q

Where does conduct disorder rank in the amount of funding received for research?

A

Nowhere. Doesn’t even appear on lists of average yearly spend, or funding from NIMH (national institute for mental health).

32
Q

What did Kim-Cohen et al., (2002) do and find to change the perception of conduct disorder?

A

Used a prospective longitudinal design to show that, a child with Cd by age 15, has an increased risk of developing a host of internalising and externalising symptoms in adulthood:

  • anxiety
  • depression
  • schizophrenia
  • substance misuse

Between 25 and 65% of all disorders in adulthood had CD at age 15.

Therefore, focus on conduct disorder could lead to prevention of development of associated conditions, leading to alleviation of burden on mental health services.

33
Q

Describe the comorbid disorders in children with CD.

A
  • ADHD: between 8% and 45% of boys and between 1% and 61% of girls with CD
  • ANXIETY: between 22% and 33% in community CD samples, while prevalence ranges between 60% and 75% in children with CD who have sought treatment.
  • DEPRESSIVE DISORDERS: between 12% and 17%
34
Q

List 7 dispositional risk factors for CD.

A
  • genetic
  • neurochemical
  • autonomic irregularities
  • neurocognitive deficits
  • deficits in the processing of social information
  • temperamental vulnerabilities
  • personality predispositions
35
Q

Describe genetics as a dispositional risk factor for CD.

A

There are no genes for CD, but it is highly heritable:

  • 50% of variance is due to genetics.
  • runs in families
36
Q

Describe neurochemicals as dispositional risk factors for CD.

A

Altered level of serotonin in the brain is associated with CD

37
Q

Describe autonomic irregularities in their risk for CD.

A

Low resting heart rate, skin conductance, fear response, eye blink response.

38
Q

Describe neurocognitive deficits as a dispositional risk factor for CD.

A

Poor executive functions, low IQ (studies show that those with CD tend to have at least one SD below the mean for IQ)

39
Q

List 4 contextual/environmental risk factors for CD.

A
  • prenatal
  • early child care and family
  • peer
  • neighbourhood
40
Q

What are the two affective-interpersonal subtypes of conduct disorder?

A

CD with high levels of callous-unemotional traits (lack of emotional responsiveness to negative emotional stimuli). Underpinned by genetic elements.

CD with low levels of callous-unemotional traits (greater emotional reactivity/poor emotion regulation) underpinned more by environmental factors.

41
Q

Describe features of childhood-onset CD and high CU traits.

A
  • severe, stable and aggressive pattern of behaviour
  • deficits in the processing of negative emotional stimuli
  • less sensitive to punishment cues
  • more positive outcome expectancies in aggressive situations with peers
  • fearless and thrill-seeking and lower levels of anxiety.
42
Q

What did Jones et al., (2009) & Marsh et al., (2008) find about brain responses to facial expressions in adolescents with CD?

A

Adolescents with CD showed decreased amygdala responses to fearful faces compared to healthy controls and to adolescents with ADHD.

43
Q

Why are young people with CD and high CU traits (and adults with psychopathy) more likely to use instrumental aggression?

A

The reason why young people with CD and high CU traits (and adults with psychopathy) use instrumental aggression is because social signals conveying ‘what you’re doing is wrong’ does not register in such individuals. Therefore at greater risk of using aggression in a proactive and instrumental way.

44
Q

What did Lozier et al., (2014) find about the relationship between CU traits and amygdala activity (3 points)?

A

When you show fearful facial expressions to children, the higher they are on CU traits, the lower the amygdala reactivity. The higher CU traits was also related to greater proactive aggression, and this was partially mediated by the lower amygdala reactivity to fearful facial expressions.

When you partial out CU traits: in those who only show antisocial, externalising behaviour, the greater the externalising behaviour, the greater the amygdala reactivity. Could be related to reactive aggression.

45
Q

Describe features of childhood-onset conduct disorder in those with low CU traits (/high emotional and behavioural dysregulation).

A
  • typically do not show problems with empathy and guilt
  • high rates of anxiety, and appear to be highly distressed by the effects of their behaviour on others.
  • show a hostile attribution bias in social situations
  • more likely to come from families with high rate of hostile and inconsistent parenting practices
  • less aggressive and more reactive aggression.
46
Q

What did Viding et al., (2012) study and find about reactions to fear in those with conduct problems?

A

Showed fearful or neutral faces for 17ms, presented before the neutral mask. Measures effect of the emotion on automatic implicit processing in controls, those with conduct problems and low CU traits, and those with CP and high CU traits.

Increased amygdala reactivity in response to fearful faces in those with CP and low CU traits, but decreased amygdala activity in those with CP and high CU traits, both compared to controls (and each other).

Across all those with conduct problems, the higher on CU traits, the lower the responses in amygdala.

Suggests the two groups of individuals with conduct disorder are characterised by different affective-interpersonal styles, and could have different neurobiological etiologies.

47
Q

What is conduct disorder now recognised as

A

Neurodevelopmental disorder - result of aberrant brain development

48
Q

What did Rogers and De Brito (2016) find about structural MRI differences in those with CD?

A

Found overall reductions in gray matter volume, and a reduction in specific cortical and subcortical brain regions, including the ventromedial and dorsolateral PFC, ACC and temporal lobes.

49
Q

What did Rogers and De Brito (2016) find about specific structural abnormalities in those with conduct problems?

A

Those with conduct problems show gray matter reductions in the left amygdala, left and right interior insular, right ventrolateral PFC, medial PFC, fusiform gyrus (important for face processing).

Level of CU traits were related to gray matter volume in the left amygdala and putamen.

50
Q

What is the medial PFC important for?

A

Social cognition, mentalising, ability to understand what others are thinking or feeling.

51
Q

What is the fusiform gyrus important for?

A

Face processing

52
Q

What is the putamen important for?

A

Decision making

53
Q

What are some of the main sex differences in conduct disorder?

A
  • Males are more likely to show childhood onset CD, whereas females are more likely to show adolescent-onset.
  • early onset of puberty is a strong risk factor for CD in females
  • boys tend to show higher level comorbidity with ADHD or ODD (externalising)
  • girls show greater comorbidity with internalising disorders, such as PTSD or depression.
54
Q

What should clinical interventions focus on if they are to try and improve the behaviour of those with CD and high CU traits?

A

Intervene in a way that appeals to the individual’s self-interests, rather than through interventions that focus primarily on punishment-oriented strategies, or attempts to induce empathy for the victims, as they just won’t care.

E.g. rewards for behaviours incompatible with bullying, and ensure that rewards for bullying behaviour is minimised.

Viding et al., (2011)

55
Q

What should clinical interventions focus on if they are to try and improve the behaviour of those with CD and low CU traits?

A

Intervention should focus on altering social information processing bias (hostile attributional bias) and on increasing emotional regulation abilities (anger control)

56
Q

What is hostile attributional bias?

A

The tendency to interpret others’ behaviour as having hostile intent, even when the behaviour is ambiguous or benign.

57
Q

What is the most effective intervention in conduct disorder, regardless of subgrouping?

A

Parent training - working with the child as early as possible, e.g. from age 4/5 when disruptive behaviour can be identified.

Neurobiology of Mental Illness (10 decks)

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