Dual neurocircuitry dysfunctions in disruptive behavior disorders: emotional responding and response inhibition

Abstract

Background To determine the functional integrity of the neural systems involved in emotional responding, regulation and response control/inhibition in youths (age 10–18) with Disruptive Behavioral Disorder (DBD: Conduct Disorder and/or Oppositional Defiant Disorder) as a function of callous-unemotional (CU) traits. Method 28 healthy youths and 35 youths with DBD (N=18 High CU, N=17 Low CU) performed the fMRI Affective Stroop task. Participants viewed positive, neutral, and negative images under varying levels of cognitive load. A 3-way ANOVA (group by emotion by task) was conducted on the BOLD response data. Results Youths with DBD-HCU showed significantly less activation of ventromedial prefrontal cortex (vmPFC) and amygdala in response to negative stimuli, compared to healthy youths and youths with DBD-LCU. VMPFC responsiveness was inversely related to CU symptoms in DBD. Youths with DBD-LCU showed decreased functional connectivity between amygdala and regions including inferior frontal gyrus in response to emotional stimuli. Youths with DBD (LCU and HCU) additionally showed decreased insula responsiveness to high load (incongruent trials) compared to healthy youths. Insula responsiveness was inversely related to ADHD symptoms in DBD. Conclusion These data reveal two forms of pathophysiology in DBD. One associated with reduced amygdala and vmPFC responses to negative stimuli and related to increased CU traits. Another associated with reduced insula responses during high load task trails and related to ADHD symptoms. Appropriate treatment will need to be individualized according to the patient’s specific pathophysiology.

Imaging decision about whether to benefit self by harming others: Adolescents with conduct and substance problems, with or without callous-unemotionality, or developing typically

“…The anterior insula is an agranular heteromodal association cortex involved in multiple processes, including self-related and empathetic feelings, bodily awareness, response inhibition, salience (both interoceptive and exteroceptive), and assessment of risk and uncertainty (Hwang et al, 2016; Singer et al, 2009; Uddin, 2015). Mounting work has examined the anterior insula’s role in decision-making, especially risky decision-making.…”

“…However, the LPE specifier is a relatively new construct and therefore most published work to date has used a related but distinct phenotype, high levels of callous-unemotional traits (i.e. a dimensional severity score (e.g.,(Sebastian et al, 2012)) or a median split to categorize individuals with high and low levels of callous-unemotional traits (e.g., (Hwang et al, 2016)). High levels of callous-unemotional traits are stable through adolescence, predict persistent antisocial behavior problems, are associated with greater violence and aggression, and predict poorer outcomes to standard treatment (Frick et al, 2014).…”

“…Thus, excluding co-morbidity would bias results towards atypical, less severely affected samples (Krueger, 1999). An alternate strategy is to utilize other conduct-problem youths (i.e., with serious antisocial behavior problems but scoring at about average levels for callous-unemotional traits) as a control (Hwang et al, 2016). We have previously demonstrated that patients with conduct disorder with and without LPE have similar patterns of co-morbidity in terms of prevalence of depression, ADHD, and specific substance use disorders when recruited in the same manner as done in this study (Sakai et al, 2016b).…”

“…A small set of work in detained adolescents has shown similar results (Colins and Vermeiren, 2013; Van Damme et al, 2016). Therefore, including both typically-developing adolescents and youth with serious conduct problems without high levels of callous-unemotional traits as comparison groups, as in prior important work (Viding et al, 2012; White et al, 2016b; Hwang et al, 2016), may provide a useful strategy to reduce confounds driven by some co-morbid disorders. But such an approach will not control for all confounds.…”

Envolvimento do núcleo accumbens e da amígdala na neurobiologia dos transtornos do comportamento disruptivo e do transtorno de déficit de atenção/hiperatividade: um estudo de conectividade funcional de repouso em crianças

“…TDAH: ↓CC entre amígdala E e COF E; ↑CC entre amígdala E e giro pré-central D Correlação negativa entre CC amígdala-giro pré-central e sintomas de desatenção ROI = região de interesse; RMcf-r = ressonância magnética de conectividade funcional de repouso; RMf = ressonância magnética funcional; E = esquerdo(a); D = direito(a); TDAH = transtorno de déficit de atenção/hiperatividade; ↑LE = alta pontuação de labilidade emocional; ↓LE = baixa pontuação de labilidade emocional; TDC = transtorno do desenvolvimento da coordenação; DT = desenvolvimento típico; CC = conectividade; CPFm = córtex pré-frontal medial; GTS = giro temporal superior; GOM = giro occipital médio; CPF = córtex pré-frontal; COF = córtex orbitofrontal TCD/↓TEPSL: ↓CC da amígdala com giro frontal inferior E, CCP E, caudado E e ínsula E, em resposta a estímulo emocional TCD/↑TEPSL: ↑CC da amígdala com o caudado em resposta a estímulo positivo ROI = região de interesse; RMcf-r = ressonância magnética de conectividade funcional de repouso; RMf = ressonância funcional; E = esquerdo(a); D = direito(a); TC = transtorno de conduta; TOD = transtorno de oposição desafiante; TP = traços psicopáticos; DT = desenvolvimento típico; TCD = transtornos do comportamento disruptivo; TEPSL = traços de emoção prossocial limitada; TDAH = transtorno de déficit de atenção/hiperatividade; DE = desregulação emocional; CC = conectividade; CPF = córtex préfrontal; GTS = giro temporal superior; CPFvm = córtex pré-frontal ventromedial; CCP = córtex cigulado porterior Considerando os TCD, estudos avaliaram a conectividade funcional da amígdala usando RMf de repouso (60,64) ou RMf tradicional (com tarefas) (44,(61)(62)(63). Os estudos encontraram redução da conectividade entre amígdala e: CPFvm/COF, córtex temporal superior, córtex parietal inferior, córtex cingulado posterior e insula (44,(60)(61)(62)(63) O recrutamento na comunidade permitiu a inclusão de uma amostra com maior representatividade da população afetada pelos transtornos e menos sujeita à influência de multi-morbidade, gravidade dos transtornos e uso de medicação, comuns em amostras clínicas. A inclusão de crianças com TDAH e com TCD no mesmo estudo permitiu comparar os transtornos e avaliar alterações da conectividade funcional do NAcc e da amígdala potencialmente específicas de cada transtorno.…”