Davranım Bozukluğu: Güncel Bir Bakış

Yıl 2024, , 72 - 87, 31.03.2024

Ahmet Özbay , Osman Özçelik , Süleyman Kahraman

https://doi.org/10.18863/pgy.1331287

Öz

Davranım bozukluğu (DB) çocuk ve ergen psikiyatri kliniklerine bakıldığında toplumsal ve uluslararası farklılıklar olmakla beraber fazla rastlanan etiyolojisi oldukça heterojen olan ciddi bir ruhsal bozukluktur. DB, başkalarının temel haklarını, bulunduğu yaşa uygun sosyal norm ve değerleri ya da var olan kuralların istikrarlı olarak agresif davranış örüntüleriyle çiğnenmesi olarak tanımlanabilir. DSM-II’den beri çeşitli başlıklar altında tanımlanmıştır ve en son DSM-5’te “Yıkıcı Bozukluklar, Dürtü Denetim ve Davranım Bozuklukları” başlığı altında tanımlanmıştır. Etiyolojisinde genetik faktörler, bireysel faktörler ve psikososyal faktörler rol alarak geniş bir etiyolojiyi oluşturmaktadır. Başlangıcı çocukluğa dayansa da yardım aranmadığı takdirde daha ciddi daha başka ruhsal bozukluklara sebep olmaktadır. DB' nin birçok ruhsal bozuklukla da komorbiditesi vardır. Bu nedenle ayırıcı tanının iyi yapılması ve etkili bir tedavi seçeneği oluşturulması gerekmektedir. Tedavide kendine özgü bir ilacı yoktur. Farklı disiplinler bir araya gelerek uzun süre çalışarak başarılı sonuçlar elde edebilir. Bu yazıda genel olarak DB' nin tanımı, DSM-5 tanı kriterleri, epidemiyolojisi, etiyolojisi, eş tanı, ayırıcı tanı, prognoz ve tedavi yaklaşımları gözden geçirilmiştir.

Anahtar Kelimeler

davranım bozukluğu, çocuk-ergen, ruh sağlığı

Conduct Disorder: An Update

Öz

Conduct disorder is a serious mental disorder with a heterogeneous etiology that is frequently encountered in child and adolescent psychiatric clinics, although there are social and international differences. Conduct disorder can be defined as violating the basic rights of others, age-appropriate social norms and values, or existing rules with consistently aggressive behavioral patterns. It has been defined under various headings since DSM-II and most recently in DSM-5 under the heading "Disruptive Disorders, Impulse Control and Conduct Disorders". Genetic, individual, and psychosocial factors play a role in the etiology and constitute a broad etiology. Although its onset dates to childhood, if assistance is not sought, it can lead to more serious mental disorders. Conduct disorders are associated with several mental disorders. Therefore, a differential diagnosis should be made and an effective treatment option should be established. No specific medications were available for treatment. Different disciplines can collaborate for a long time to achieve successful results. In this article, the definition of conduct disorder, DSM-5 diagnostic criteria, epidemiology, etiology, comorbidity, differential diagnosis, prognosis, and treatment approaches are reviewed.

Anahtar Kelimeler

conduct disorder, child-adolescent, mental health

Kaynakça

• Abalı O, Onur M, Gürkan K, Çelik Ö, Tüzün ÜD (2006) İlköğretim çağı çocuklarındaki davranım bozukluğu semptomlarının sosyodemografik verilere göre değerlendirilmesi. Dusunen Adam, 19:14-19.
• Afifi TO, McMillan KA, Asmundson GJ, Pietrzak RH, Sareen J (2011) An examination of the relation between conduct disorder, childhood and adulthood traumatic events, and posttraumatic stress disorder in a nationally representative sample. J Psychiatr Res, 45:1564-1572.
• Anderson SL, Zheng Y, McMahon RJ (2018) Do callous-unemotional traits and conduct disorder symptoms predict the onset and development of adolescent substance use? Child Psychiatry Hum Dev, 49:688-698.
• APA (1968) Diagnostic and Statistical Manual of Mental Disorders, 2nd ed. Washington DC, American Psychiatric Association.
• APA (1980) Diagnostic and Statistical Manual of Mental Disorders, 3rd ed. Washington DC, American Psychiatric Association.
• APA (1987). Diagnostic and Statistical Manual of Mental Disorders, 3rd ed rev. Washington DC, American Psychiatric Association.
• APA (1994) Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington DC, American Psychiatric Association.
• APA (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th ed rev. Washington DC, American Psychiatric Association.
• APA (2013) Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Washington DC, American Psychiatric Association.
• Arkan B, Üstün B (2009) Davranım bozukluğu olan çocuklara psikiyatrik yaklaşımda anne-baba eğitim programları: iki örnek bağlamında değerlendirme. Psikiyatride Güncel Yaklaşımlar, 1:155-174.
• Ateş S (2014) Davranım bozukluğu tanısı alan ergenlerin ebeveynlerinde psikopatolojik özellikler ve cinsiyetlerine göre karşılaştırılması (Uzmanlık tezi). İstanbul, İstanbul Bakırköy Prof. Dr. Mazhar Osman Ruh Sağlığı ve Sinir Has. Eğitim ve Araştırma Hastanesi.
• Ayaz M, Ayaz AB, Başgül ŞZ, Karakaya I, Şişmanlar ŞG, Yar G ve ark. (2012) 3-5 yaş grubu kurum bakımındaki çocuklarda ruhsal hastalık sıklığı ve ilişkili etmenler. Turk Psikiyatri Derg, 23:82-88.
• Baker K (2013) Conduct disorders in children and adolescents. Paediatr Child Health, 23:24-29.
• Bakhshipour RA, Karimpour VA (2021) The role of ımpulsivity and sensitivity to reward in dropout of addiction treatment in heroin addicts. Addict Health, 13:45-51.
• Baumann S, Bernhard A, Martinelli A, Ackermann K, Herpetz DB, Freitag C ve ark. (2022) Perpetrators and victims of cyberbullying among youth with conduct disorder. Eur Child Adolesc Psychiatry, 32:1643-1653.
• Beaver KM, Wright, JP, DeLisi M, Walsh A, Vaughn MG, Boisvert D ve ark. (2007) A gene x gene interaction between DRD2 and DRD4 is associated with conduct disorder and antisocial behavior in males. Behav Brain Funct, 3:30.
• Berluti K, Ploe ML, Marsh AA (2023) Emotion processing in youths with conduct problems: an fMRI meta-analysis. Translational Psyc, 13:105 (online first)
• Blazei RW, Iacono WG, McGue M (2008) Father-child transmission of antisocial behavior: the moderating role of father's presence in the home. J Am Acad Child Adolesc Psychiatry, 47:406-415.
• Burke J, Loeber R, Birmaher B (2002) Oppositional defiant disorder and conduct disorder: a review of the past 10 years, part II. J Am Acad Child Adolesc Psychiatry, 41:1275-1293.
• Caserini C, Ferro M, Nobile M, Scaini S, Michelini G (2023) Shared genetic influences between depression and conduct disorder in children and adolescents: a systematic review. J Affect Disord, 322:31-38.
• Caspi A, McClay J, Moffitt TE, Mill J, Martin J, Craig IW ve ark. (2002) Role of genotype in the cycle of violence in maltreated children. Science, 297:851-854.
• Chan L, Simmons C, Tillem S, Conley M, Brazil IA, Baskin SA (2023) Classifying conduct disorder using a biopsychosocial model and machine learning method. Biol Psychiatry Cogn Neurosci Neuroimaging, 8:599-608.
• Conner BT, Lochman JE (2010) Comorbid conduct disorder and substance use disorders. Clin Psychol (New York), 17:337-349.
• Çakar FS (2017) Davranım bozukluğu. İçinde: S. Avşaroğlu, editör. Çocuk ve Ergenlerde Gelişimsel ve Davranışsal Bozukluklar:1-19. Ankara, Vize Yayıncılık.
• Çenteli K (2021) Davranım bozukluğu olan ergenlerin ailelerinde disiplin uygulamaları: Fenomenolojik bir çalışma (Yüksek lisans tezi). İzmir, Ege Üniversitesi.
• Çıkılı UM (2015) Dikkat eksikliği hiperaktivite bozukluğu ve davranım bozukluğu olan erkek çocuk ve ergenlerde nöropsikolojik test ve dinlenme hali fonksiyonel manyetik rezonans görüntüleme (rs-fMRG) profili (Uzmanlık tezi). Kayseri, Erciyes Üniversitesi.
• Dodge KA, Pettit GS (2003) A biopsychosocial model of the development of chronic conduct problems in adolescence. Dev Psychol, 39:349-371.
• Eapen V, Al-Gazali L, Bin-Othman S, Abou-Saleh M (1998) Mental health problems among school children in United Arab Emirates: prevalence and risk factors. J Am Acad Child Adolesc Psychiatry, 37:880-886.
• Edelbrock C, Rende R, Plomin R, Thompson LA (1995) A twin study of competence and problem behavior in childhood and early adolescence. J Child Psychol Psychiatry, 36:775-785.
• Ercan ES, Polanczyk G, Ardıç UA, Yüce D, Karaçetin G, Tufan AE ve ark. (2019) The prevalence of childhood psychopathology in Turkey: a cross-sectional multicenter nationwide study (EPICPAT-T). Nord J Psychiatry, 73:132-140.
• Erskine HE, Ferrari AJ, Nelson P, Polanczyk GV, Flaxman AD, Vos T ve ark. (2013) Research Review: epidemiological modelling ofattention-deficit/hyperactivity disorder and conductdisorder for the Global Burden of Disease Study 2010. J Child Psychol Psychiatry, 54:1263-1274.
• Eskander N (2020) The psychosocial outcome of conduct and oppositional defiant disorder in children with attention deficit hyperactivity disorder. Cureus, 12:8 (online first)
• Fahim C, He Y, Yoon U, Chen J, Evans A, Pérusse D (2011) Neuroanatomy of childhood disruptive behavior disorders. Aggress Behav, 37:326–337.
• Fairchild G, Passamonti L, Hurford G, Hagan CC, von dem Hagen EA, van Goozen SH ve ark. (2011) Brain structure abnormalities in early-onset and adolescent-onset conduct disorder. The Am J Psychiatry, 168: 624–633.
• Fairchild G, Toschi N, Hagan CC, Goodyer IM, Calder AJ, Passamonti L (2015) Cortical thickness, surface area, and folding alterations in male youths with conduct disorder and varying levels of callous-unemotional traits. Neuroimage Clin, 8:253–260.
• Fairchild G, Hawes DJ, Frick PJ, Copeland WE, Odgers CL, Franke B ve ark. (2019) Conduct disorder. Nat Rev Dis Primers, 5:1-25.
• Fleitlich-Bilyk B, Goodman R (2004) Prevalence of child and adolescent psychiatric disorders in southeast Brazil. J Am Acad Child Adolesc Psychiatry, 43:727-734.
• Ford T, Goodman R, Meltzer H (2003) The British child and adolescent mental health survey 1999:the prevalence of DSM-IV disorders. J Am Acad Child Adolesc Psychiatry, 42:1203-1211.
• Gau SS, Chong MY, Chen TH, Cheng AT (2005) A 3-year panel study of mental disorders among adolescents in Taiwan. Am J Psychiatry, 162:1344-1350.
• Greene RW, Biederman J, Zerwas S, Monuteaux MC, Goring JC, Faraone SV (2002) Psychiatric comorbidity, family dysfunction, and social impairment in referred youth with oppositional defiant disorder. Am J Psychiatry, 159:1214-1224.
• Gül N, Tiryaki A, Kültür SE, Topbaş M, Ak I (2010) Prevalence of attention deficit hyperactivity disorder and comorbid disruptive behavior disorders among school age children in Trabzon. Klinik Psikofarmakol Bülteni, 20:50-56.
• Haberstick BC, Lessem JM, Hopfer CJ, Smolen A, Ehringer MA, Timberlake D ve ark. (2005) Monoamine oxidase A (MAOA) and antisocial behaviors in the presence of childhood and adolescent maltreatment. American journal of medical genetics. Part B, Am J Med Genet B Neuropsychiatr Genet, 135:59–64.
• Hauschild S, Kasper L, Volkert J, Sobanski E, Taubner S (2022) Mentalization-based treatment for adolescents with conduct disorder (MBT-CD): A feasibility study. Eur Child Adolesc Psychiatry, (online first).
• Hawes DJ, Gardner, F, Dadds MR, Frick PJ, Kimonis ER, Burke JD ve ark. (2023) Oppositional defiant disorder. Nat Rev Dis Primers, 9:31.
• Holz NE, Zohsel K, Laucht M, Banaschewski T, Hohmann S, Brandeis D (2018). Gene x environment interactions in conduct disorder: Implications for future treatments. Neurosci Biobehav Rev, 91:239–258.
• Hopfer C, Salomonsen SS, Mikulich GS, Min SJ, McQueen M, Crowley T ve ark. (2013) Conduct disorder and initiation of substance use: A prospective longitudinal study. J Am Acad Child Adolesc Psychiatry, 52:511-518.
• Huebner T, Vloet TD, Marx I, Konrad K, Fink GR, Herpertz SC ve ark. (2008). Morphometric brain abnormalities in boys with conduct disorder. J Am Acad Child Adolesc Psychiatry, 47:540–547.
• Ilomäki E, Hakko H, Ilomäki R, Räsänen P (2012) STUDY-70 workgroup. Gender differences in comorbidity of conduct disorder among adolescents in Northern Finland. Int J Circumpolar Health, 71:17393.
• Kerekes N, Zouini B, Karlsson E, Cederholm E, Lichtenstein P, Anckarsäter H ve ark. (2020) Conduct disorder and somatic health in children: a nationwide genetically sensitive study. BMC Psychiatry, 20:595.
• Kohls G, Konrad K, Bauman S, Bernhard A, Martinelli A, Ackermann K ve ark. (2021) Sex differences in psychiatric comorbidity and clinical presentation in youths with conduct disorder. J Child Psychol Psychiatry, 63:218-228.
• Kring AM, Johnson SL, Davidson G, Neale J (2017) Anormal Psikoloji (Çeviri Ed. M. Şahin). Ankara, Nobel Yayınevi.
• Larkby CA, Goldschmidt L, Hanusa BH, Day NL (2011) Prenatal alcohol exposure is associated with conduct disorder in adolescence: findings from a birth cohort. J Am Acad Child Adolesc Psychiatry, 50:262-271.
• Lillig M (2018) Conduct disorder: recognition and management. Am Fam Physician, 98:584-592.
• Loeber R, Burke JD, Lahey BB, Winters A, Zera M (2000) Oppositional defiant and conduct disorder: A review of the past 10 years, part I. J Am Acad Child Adolesc Psychiatry, 39:1468 1484.
• Lynch F, Mills C, Daly I, Fitzpatrick C (2006) Challenging times: prevalence of psychiatric disorders and suicidal behaviours in Irish adolescents. J Adolesc, 29:555-573.
• Masroor A, Patel RS, Bhimanadham NN, Raveendran S, Ahmad N, Queeneth U ve ark. (2019) Conduct disorder-related hospitalization and substance use disorders in American Teens. Behav Sci (Basel), 9:73.
• Maughan B, Rowe R, Messer J, Goodman R, Meltzer H (2004) Conduct disorder and oppositional defiant disorder in a national sample: developmental epidemiology. J Child Psychol Psychiatry, 45:609-621.
• Mezquita L, Bravo AJ, Pilatti A, Ortet G, Ibáñez MI, Team CAS (2021) Preliminary validity and reliability evidence of the Brief Antisocial Behavior Scale (B-ABS) in young adults from four countries. Plos ONE, 16:2 (online first)
• Mohamed MS, Marzouk SA, Ahmed FA, Nashaat NAM, Thabet ORAE (2022) Cognitive behavioral program on aggression and self-concept among institutionalized children with conduct disorder. Arch Psychiatr Nurs, 39:84-90.
• Mohammadi MR, Salmanian M, Ghanizadeh A, Alavi A, Malek A, Fathzadeh H ve ark. (2014) Psychological problems of Iranian children and adolescents: parent report form of strengths and difficulties questionnaire. J Ment Health, 23:287-291.
• Murray J, Farrington DP (2010) Risk factors for conduct disorder and delinquency: Key findings from longitudinal studies. Can J Psychiatry, 55:633-642.
• Polanczyk GV, Salum GA, Sugaya LS, Caye A, Rohde LA (2015) Annual research review: A meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. J Child Psychol Psychiatry, 56:345-365.
• Ramklint M, Von Knorring AL, Von Knorring L, Ekselius L (2002) Personality disorders in former child psychiatric patients. Eur Child Adolesc Psychiatry, 11:289-295.
• Reebye P, Moretti M, Lessard J (1995) Conduct disorder and substance use disorder: Comorbidity in a clinical sample of preadolescents and adolescents. Can J Psychiatry, 40:313-319.
• Rodopman AA (2019) Karşıt olma karşıt gelme bozukluğu ve davranım bozukluğunda izlem ve süreç, prognostik faktörler ve erken tedavinin etkisi. Turkiye Klinikleri J Child Psychiatry-Special Topics, 5:76-81.
• Rogers JC, De Brito, SA (2016) Cortical and subcortical gray matter volume in youths with conduct problems: A meta-analysis. JAMA Psychiatry, 73:64–72.
• Rowe R, Costello EJ, Angold A, Copeland WE, Maughan B (2010) Developmental pathways in oppositional defiant disorder and conduct disorder. J Abnorm Psychol, 119:726-738.
• Rowe R, Maughan B, Pickles A, Costello EJ, Angold A (2002) The relationship between DSM-IV oppositional defiant disorder and conduct disorder: findings from the great smoky mountains study. J Child Psychol Psychiatry, 43:365-373.
• Sacco R, Camilleri N, Umla-Runge K (2021) The prevalence of conduct disorders among young people in europe: Asystematic review and meta-analysis. Eur Psychiatry, 64:637-638.
• Sagar R, Patra BN, Patil V (2019) Clinical practice guidelines for the management of conduct disorder. Indian J Psychiatry, 61:270-276.
• Sakai JT., Stallings MC, Crowley TJ, Gelhorn HL, McQueen MB, Ehringer MA (2010) Test of association between GABRA2 (SNP rs279871) and adolescent conduct/alcohol use disorders utilizing a sample of clinic referred youth with serious substance and conduct problems, controls and available first degree relatives. Drug Alcohol Depend, 106:199–203.
• Salmanian M, Mohammadi MR, Keshavarzi Z, Brand S (2018) An update on the global prevalence of conduct disorder (2011–2017): Study protocol for a systematic review and meta-analysis. J Forensic Leg Med, 59:1-3.
• Salmanian M, Mohammadi MR, Hooshyari Z, Mostafavi SA, Zarafshan H, Khaleghi A ve ark. (2020) Prevalence, comorbidities, and sociodemographic predictors of conduct disorder: The national epidemiology of Iranian children and adolescents psychiatric disorders (IRCAP). Eur Child Adolesc Psychiatry, 29:1385-1399.
• Salvatore JE, Dick DM (2018) Genetic influences on conduct disorder. Neurosci Biobehav Rev, 91:91–101.
• Searight HR, Rottnek F, Abby SL (2001) Conduct disorder: diagnosis and treatment in primary care. Am Fam Physician, 63:1579-1588.
• Shevidi S, Timmins MA, Coccaro EF (2023) Childhood and parental characteristics of adults with DSM-5 intermittent explosive disorder compared with healthy and psychiatric controls. Compr Psychiatry, 122:152367.
• Smaragdi A, Blackman A, Donato A, Walsh M, Augimeri L (2020) Sex differences in the classification of conduct problems: Implications for treatment. J Dev Life Course Criminol, 6:280-295.
• Sterzer P, Stadler C, Poustka F, Kleinschmidt A (2007) A structural neural deficit in adolescents with conduct disorder and its association with lack of empathy. NeuroImage, 37:335–342.
• Sung M, Erkanlı A, Angold A, Costello EJ (2004) Effects of age at first substance use and psychiatric comorbidity on the development of substance use disorders. Drug Alcohol Depend, 75:287-299.
• Tamam L, Döngel BD (2018) Yıkıcı bozukluklar, dürtü kontrol ve davranım bozuklukları. In Temel ve Klinik Psikiyatri (Ed O Karamustafalıoğlu):539-550. Ankara, Güneş Yayınevi..
• Tay A, Mohsin M, Rees S Silove D (2022) Prevalence and correlates of DSM-IV and DSM-5 ıntermittent explosive disorder amongst Myanmar refugees living in Malaysia: A population-based study. Epidemiol Psychiatr Sci, 31
• Thabrew H, McDowell H, Given KS, Murrell K (2017). Systematic review of screening instruments for psychosocial problems in children and adolescents with long-term physical conditions. Global Pediatric H, 4 (online first)
• Tonyalı A, Göker Z, Üneri ÜŞ (2019) Çocuk ve ergen davranım bozukluğu tedavisinde psikososyal müdahaleler. Psikiyatride Güncel Yaklaşımlar, 11:284-303.
• Torry ZD, Billick S (2011) Implications of antisocial parents. Psychiatr Q, 82:275–285.
• Uysal T (2012) İzmir ili Konak merkez ilçede ilköğretim 1.sınıf, 2.sınıf, 3.sınıf, 4.sınıf ve 5.sınıf öğrencilerinde dikkat eksikliği ve hiperaktivite bozukluğu, karşıt olma karşıt gelme bozukluğu ve davranım bozukluğu prevalansı (Uzmanlık tezi). İzmir, Ege Üniversitesi
• Veroude K, Zhang-James Y, Fernàndez-Castillo N, Bakker MJ, Cormand B, Faraone, SV (2016) Genetics of aggressive behavior: An overview. Am J Med Genet B Neuropsychiatr Genet, 171B: 3–43.
• Young SE, Smolen A, Hewitt JK, Haberstick BC, Stallings MC, Corley R ve ark. (2006) Interaction between MAO-A genotype and maltreatment in the risk for conduct disorder: Failure to confirm in adolescent patients. Am J Psychiatry, 163:1019–1025.
• Zhang J, Liu W, Zhang J, Wu Q, Gao Y, Jiang Y ve ark. (2018) Distinguishing adolescents with conduct disorder from typically developing youngsters based on pattern classification of brain structural MRI. Front Hum Neurosci, 12:152.
• Wallace GL, White SF, Robustelli B, Sinclair S, Hwang S, Martin A ve ark. (2014) Cortical and subcortical abnormalities in youths with conduct disorder and elevated callous-unemotional traits. J Am Acad Child Adolesc Psychiatry, 53:456–65.
• Wesseldijk LW, Bartels M, Vink JM, Van Beijsterveldt CEM, Ligthart L, Boomsma DI ve ark. (2018) Genetic and environmental influences on conduct and antisocial personality problems in childhood, adolescence and adulthood. Eur Child Adolesc Psychiatry, 27:1123-1132.
• WHO (2019) International Statistical Classification of Diseases and Related Health Problems 10th version (ICD-10). Geneva, World Health Organisation.
• WHO (2022) International Statistical Classification of Diseases and Related Health Problems 11th version (ICD-11). Geneva, World Health Organisation
• Woodward D, Wilens TE, Yule AM, Di Salvo M, Taubin D, Berger A ve ark. (2023) Examining the clinical correlates of conduct disorder in youth with bipolar disorder. J Affect Disord, 329:300-306.
• Yücel Y (2020) Davranım bozukluğu temel belirtileri gözlenen ön ergenlere yönelik hazırlanan müdahale programının etkililiğinin değerlendirilmesi (Doktora tezi). İstanbul, İstanbul Arel Üniversitesi.
• Zohdi Y, Mohammadkhani P, Karipour VA (2022) The role of anhedonia and low arousal in substance use disorder among adolescents with conduct disorder symptoms. Pract Clin Psychol, 10:111-120