Associations of observed callous-unemotional behaviors in early childhood with conduct problems and substance use over 14 years.

Callous-unemotional (CU) behaviors (i.e., low concern and active disregard for others) uniquely predict severe conduct problems and substance use when present by late childhood. Less is known about the predictive utility of CU behaviors displayed in early childhood, when morality is developing and interventions may be more effective. Children aged 4-7 years (N = 246; 47.6% girls) completed an observational task wherein they were encouraged to tear an experimenter's valued photograph, and blind raters coded children's displayed CU behaviors. During the next 14 years, children's conduct problems (i.e., oppositional defiant and conduct symptoms) and age of onset of substance use were assessed. Compared to children displaying fewer CU behaviors, children displaying greater CU behaviors were 7.61 times more likely to meet criteria for a conduct disorder (n = 52) into early adulthood (95% CI, 2.96-19.59; p = <.0001), and their conduct problems were significantly more severe. Greater CU behaviors were associated with earlier onset of substance use (B = -.69, SE = .32, t = -2.14, p = .036). An ecologically valid observed indicator of early CU behavior was associated with substantially heightened risk for conduct problems and earlier onset substance use into adulthood. Early CU behavior is a powerful risk marker identifiable using a simple behavioral task which could be used to target children for early intervention.

Examining the clinical correlates of conduct disorder in youth with bipolar disorder.

BACKGROUND: Conduct Disorder (CD) is highly comorbid with Bipolar Disorder (BP) and this comorbidity is associated with high morbidity and dysfunction. We sought to better understand the clinical characteristics and familiality of comorbid BP + CD by examining children with BP with and without co-morbid CD. METHODS: 357 subjects with BP were derived from two independent datasets of youth with and without BP. All subjects were evaluated with structured diagnostic interviews, the Child Behavior Checklist (CBCL), and neuropsychological testing. We stratified the sample of subjects with BP by the presence or absence of CD and compared the two groups on measures of psychopathology, school functioning, and neurocognitive functioning. First-degree relatives of subjects with BP +/- CD were compared on rates of psychopathology in relatives. RESULTS: Subjects with BP + CD compared to BP without CD had significantly more impaired scores on the CBCL Aggressive Behavior (p < 0.001), Attention Problems (p = 0.002), Rule-Breaking Behavior (p < 0.001), Social Problems (p < 0.001), Withdrawn/Depressed clinical scales (p = 0.005), the Externalizing Problems (p < 0.001), and Total Problems composite scales(p < 0.001). Subjects with BP + CD had significantly higher rates of oppositional defiant disorder (ODD) (p = 0.002), any SUD (p < 0.001), and cigarette smoking (p = 0.001). First-degree relatives of subjects with BP + CD had significantly higher rates of CD/ODD/ASPD and cigarette smoking compared to first-degree relatives of subjects without CD. LIMITATIONS: The generalization of our findings was limited due to a largely homogeneous sample and no CD only comparison group. CONCLUSIONS: Given the deleterious outcomes associated with comorbid BP + CD, further efforts in identification and treatment are necessary.

Pharmacological strategies for the management of the antisocial personality disorder.

INTRODUCTION: Antisocial personality disorder (AsPD) is a pervasive pattern of violation of others' rights, related to the concept of psychopathy. AsPD is stable over time from adolescence, with evidence of conduct disorder (CD) before 15 years. DSM-5 included a specifier 'with limited prosocial emotions' (LPE), which characterizes adolescents with higher developmental vulnerability to develop AsPD. Despite being relatively frequent with considerable societal impact, AsPD is a difficult-to-treat condition with high comorbidity rates and poor evidence for effective pharmacological interventions. AREAS COVERED: We conducted a narrative review and searched PubMed up to September 2022. We included RCTs and naturalistic studies evaluating pharmacological interventions on AsPD in adults, including those with comorbid substance use disorder or psychopathic traits. Evidence in youths with CD, callous-unemotional (CU) traits and aggression were also reviewed, exploring the role of CU traits as moderators of response. EXPERT OPINION: Psychosocial interventions are the first option, with possible improvement of CU traits, beyond behavioral and affective symptoms, particularly if implemented early during development. Limited information, based on low-quality studies, supports the pharmacological options. Second-generation antipsychotics, lithium, anti-epileptic drugs, and stimulants are first-line medications, according to different target symptoms. Developmental pathways including ADHD suggest a specific role of psychostimulants.

Parental drug use disorders and youth psychopathology: Meta-analytic review.

Parental drug use disorders (PDUDs) represent a highly prevalent risk factor for youth's development of psychological and substance misuse. However, most research on associations between parental substance use and child mental health focuses on composites of parental drug, alcohol, and tobacco use. PDUDs are associated with a range of legal, health, and environmental risks that make them substantially distinct from tobacco and alcohol misuse, yet associations between PDUDs and youth psychopathology symptoms have yet to be assessed quantitatively using meta-analytic techniques. Accordingly, the present meta-analysis assessed the association between PDUDs and youth's internalizing, externalizing, substance use, and total psychological problems across 30 studies (N = 8433). Meta-analytic findings showed that PDUDs were associated with greater substance use and total psychological problems in youth. Across studies, PDUDs were not associated with broad dimensions of youth internalizing and externalizing symptoms but demonstrated a positive relation with youth ADHD and conduct disorder symptoms. There were significant moderation effects for study quality, symptom informant, and child age, where the association between PDUDs and child symptoms of psychopathology was stronger for older youth, in higher quality studies, and studies using joint parent-child symptom informants. Taken together, the meta-analytic findings suggest that PDUDs present a significant risk factor for youth. Future research targeting the relation between parental drug use and youth psychopathology is warranted for prevention and intervention efforts. Implication of findings, mechanisms of interest, and an agenda for future research are discussed.

The association between callous-unemotional traits and suicide ideation among youth: A conditional process analysis.

BACKGROUND: The relationship between callous-unemotional (CU) traits (the affective facet of psychopathy and the psychopathy that occurs during childhood and adolescence) and suicide ideation (SI) remains unclear. The mechanisms underlying this association still have a gap in the literature. The aims of this study were to determine whether and how callous-unemotional traits were associated with suicide ideation, and to evaluate the mediating effect of negative affect (includes irritability, depression, and anxiety) and the moderating effect of future orientation on the association. METHODS: Data were extracted from a longitudinal study involving middle and high school students, with 1,913 students (55.3% girls) aged 11 to 19 years (14.9 ± 1.6 years) completing a self-reported online survey. The conditional process analysis was examined using Mplus 8.3. RESULTS: We found that callous-unemotional traits positively predicted youths' current suicide ideation, with the observed positive relationship partly mediated by negative affect. However, callous-unemotional traits did not predict the worst-point suicide ideation, which indicated the connection fully mediated by negative affect. Furthermore, future orientation moderated these indirect effects. LIMITATIONS: Use of self-report measures and cross-sectional design. CONCLUSIONS: These findings provided evidence for current debates and conflicting conclusions, and set the foundation for future research, as well as implied the important intervention goals for reducing suicide ideation in youth.

Validation of the inventory of Callous-Unemotional Traits among school-going adolescents in Malaysia.

A key component in the study of antisocial behaviour among adolescents is the presence of callous-unemotional (CU) traits. Among the established tools available to measure CU traits is the Inventory of Callous-Unemotional traits (ICU). To date, there is no validated questionnaire to assess CU traits for the local population. Therefore, there is a need to validate the Malay version of the ICU (M-ICU) so that research can be conducted to explore CU traits among adolescents in Malaysia. The aim of the study is to validate the M-ICU. Two phases of cross-sectional study involving 409 (phase 1 -exploratory factor analysis (EFA), n = 180; phase 2-confirmatory factor analysis (CFA), n = 229) adolescents aged between 13 to 18 years old were conducted from July until October 2020 at six secondary schools in Kuantan district. Participants were selected via multistage random sampling. The ICU was initially translated into Malay language using forward-backward translation procedure by a group of bilingual researchers. Study participants completed the final version of the M-ICU questionnaire and socio-demographic questionnaire. Data was analysed using SPSS version 26 and MPlus software for factor structure validity by performing EFA and CFA. Initial EFA revealed three factors with two items deleted. A further EFA with two factors resulted in the deletion of unemotional factor items. Cronbach's alpha for overall scale improved from 0.70 to 0.74. CFA supported a two-factor solution with 17 items compared to the original English version that has three factors with 24 items. The findings revealed acceptable fit indices (RMSEA = 0.057, CFI = 0.941, TLI = 0.932, WRMR = 0.968). The study revealed that a two-factor model with 17 items of the M-ICU has good psychometric properties. The scale is valid and reliable to measure CU traits among adolescents in Malaysia.

Anxiety as a differentiating variable in emotional recognition in juvenile offenders with high callous-unemotional traits.

BACKGROUND: The presence of so-called callous-unemotional (CU) traits-lack of remorse/empathy, callous use of others and shallow/deficient affect-defines an important subgroup of children and adolescents with more severe and stable antisocial behaviours over time and may be a precursor to so-called psychopathy in adults. There are two main hypotheses to account for such traits, one emphasising deficits in recognition of specific emotions-the distress specific-and the other in aspects of facial recognition-the attention to the eyes hypothesis, but it may be that the manifestation of deficits is affected by the person's own emotional state. AIMS: To test the effect of anxiety scores on emotion recognition among young people high scoring for CU traits. METHODS: 14- to 21-year-olds serving sentences in youth justice institutions across Spain were invited to participate. Only those scoring above the cut-off on the Kimonis Inventory of Callous and Unemotional Traits were included. Anxiety was measured using the State-Trait Anxiety Inventory. Emotion recognition was assessed using the Emotional Face and Emotional Gaze Tasks. RESULTS: Of 91 (90% male) eligible participants, 53 had above threshold anxiety scores. The latter group recognised the emotional expressions of sadness, anger and fear earlier than their non-anxious peers, both when only the eye region was presented and when full faces were presented. There was less difference between groups in the case of the emotions of disgust and happiness, with both groups recognising these emotions earlier and more accurately when a full face was presented. CONCLUSIONS: Our findings suggest that 14- to 21-year old who struggle with callous emotional traits should not be treated as a homogenous group but that testing for other relevant problems, including anxiety, may inform optimal routes to the emotion recognition training that is likely to help them relate to others more prosocially.

Co-Occurring Conduct Problems and Anxiety: Implications for the Functioning and Treatment of Youth with Oppositional Defiant Disorder.

Conduct problems and anxiety symptoms commonly co-occur among youths with oppositional defiant disorder (ODD); however, how these symptoms influence functioning and treatment outcomes remains unclear. This study examined subtypes based on these co-occurring symptoms in a clinical sample of 134 youths (Mage = 9.67, 36.6% female, 83.6% white) with ODD and the predictive power of these subgroups for youth functioning and psychosocial treatment outcomes. The latent profile analysis (LPA) was used to identify subgroups based on parent- and self-reported conduct problems and anxiety symptoms. Differences among the subgroups in clinician-, parent-, and/or self-reported accounts of symptom severity, school performance, underlying processing known to be impaired across ODD, conduct and anxiety disorders, self-concept, and psychosocial treatment outcomes were examined. Four distinct profiles were identified: (1) Low Anxiety/Moderate Conduct Problems (n = 42); (2) High Anxiety/Moderate Conduct Problems (n = 33); (3) Moderate Anxiety/Moderate Conduct Problems (n = 40); and (4) Moderate Anxiety/High Conduct Problems (n = 19). The Moderate Anxiety/High Conduct Problems group exhibited more severe behavioral problems, greater difficulties with negative emotionality, emotional self-control, and executive functioning; they also demonstrated worse long-term treatment outcomes than the other subgroups. These findings suggest more homogeneous subgroups within and across diagnostic categories may result in a deeper understanding of ODD and could inform nosological systems and intervention efforts.

Callous-Unemotional Traits and Social Adjustment among Chinese Preschoolers: The Moderating Role of Teacher-Child Relationship.

Callous-unemotional (CU) traits are associated with social adjustment difficulties, but few studies have examined the underlying mechanisms in Chinese preschoolers. This study examined the relationship between CU traits and social adjustment among Chinese preschoolers as well as the moderating role of the teacher-child relationship in the association. Participants were 484 preschool children aged 3-6 years old from Shanghai, China (Mage = 5.56 years, SD = 0.96 years). Parents reported children's CU traits and teachers reported their relationship with children and rated children's social adjustment as well. The results revealed that (1) children with higher CU traits positively related to aggressive and asocial behavior with peers, but negatively related to prosocial behavior; (2) the teacher-child relationship moderated the relationship between CU traits and social adjustment in children. Specifically, teacher-child conflict exacerbated the aggressive and asocial behavior of children with CU traits and reduced the prosocial behavior of children with CU traits. These findings extended the current research on CU traits and had important implications for early interventions targeted at children with CU traits.

Different executive function impairments in medication-naïve children with attention-deficit/hyperactivity disorder comorbid with oppositional defiant disorder and conduct disorder.

The impairment of executive functions (EFs) in attention-deficit/hyperactivity disorder (ADHD) might vary from one individual to another, indicating high heterogeneity. Comorbidity may contribute to this heterogeneity. Disruptive behavior disorders (DBD), including oppositional defiant disorder (ODD) and conduct disorder (CD), is the most common comorbidity in ADHD. Although many studies suggest that ADHD with CD (ADHDCD+) and ADHD with ODD (ADHDODD+) should be treated differently, little research has attempted to separate these two disorders when studying the EFs and brain imaging of ADHD with DBD (ADHDDBD+). Thus, based on our ongoing research in ADHD, we have now recruited a large sample size of medication-naïve children to obtain estimates of neurocognitive function and functional brain networks. We found no EF impairment in ADHDCD+ patients compared with healthy controls (HCs). Correlation analysis showed that more severe CD symptoms were associated with better EFs. The mediation analysis revealed that the relationship between CD symptoms and inhibition function was mediated by the functional connectivity (FC) of SMN(L) - DMN(R) in the younger group. The study suggested that ADHDCD+ and ADHDODD+ are different in their EF impairment. The comorbidity of CD may not worsen the impairments and might even improve EF performance within ADHD individuals.

Association between childhood maltreatment and callous-unemotional traits in youth: A meta-analysis.

Callous-unemotional (CU) traits (i.e., lack of remorse or guilt, callous lack of empathy, deficient concern for the feelings of others) in youth with conduct problems confer risk for a particularly severe and persistent form of antisocial behaviour. Previous research has linked childhood maltreatment as a potential risk factor for CU traits, both primary (i.e., genetically underpinned) and secondary (i.e., environmentally influenced) variants, but findings have been inconsistent, and the association has not yet been tested in a meta-analysis. To address this gap, we conducted a meta-analysis to assess the nature and strength of the associations between childhood maltreatment and its subtypes with CU traits and potential variants (i.e., primary and secondary CU traits). A systematic search identified 29 eligible studies including 9,894 participants (42% female) between the ages of 3 and 18 years (Mage=14.22 years, SD = 1.07). Results revealed a significant moderate positive association between childhood maltreatment and CU traits. All subtypes of maltreatment bar sexual abuse were significantly associated with CU traits. However, it was not possible to compare primary and secondary CU traits directly due to inconsistencies in how they are defined. The limitations posed by current research signal the need for clinical and operational guidelines on how to define primary and secondary CU traits. Additionally, prospective longitudinal, genetically informed research is needed to clarify if maltreatment is a causal risk factor for CU traits.

The body keeps the score: The neurobiological profile of traumatized adolescents.

Trauma-related disorders are debilitating psychiatric conditions that affect people who have directly or indirectly witnessed adversities. Experiencing multiple types of traumas appears to be common during childhood, and even more so during adolescence. Dramatic brain/body transformations occurring during adolescence may provide a highly responsive substrate to external stimuli and lead to trauma-related vulnerability conditions, such as internalizing (anxiety, depression, anhedonia, withdrawal) and externalizing (aggression, delinquency, conduct disorders) problems. Analyzing relations among neuronal, endocrine, immune, and biochemical signatures of trauma and internalizing and externalizing behaviors, including the role of personality traits in shaping these conducts, this review highlights that the marked effects of traumatic experience on the brain/body involve changes at nearly every level of analysis, from brain structure, function and connectivity to endocrine and immune systems, from gene expression (including in the gut) to the development of personality.

Psychosis and conduct disorder in Greek forensic patients found not guilty by reason of insanity: Differences between patients with and those without a history of conduct disorder in childhood or adolescence.

Much epidemiological evidence converges in identifying distinct types of individuals suffering from schizophrenia who exhibit aggressive behavior: those with and those without a history of conduct disorder (CD) in childhood or adolescence. In this study a sample of Greek forensic patients suffering from psychotic disorders was examined regarding demographic, clinical, legal and psychometric characteristics. All patients had committed a crime and were found not guilty by reason of insanity (NGRIs) in a court of law. This study aims to clarify whether history of conduct disorder leads to greater violence or shapes the index offense in some way. It also aims to examine new parameters, such as psychopathology, personality traits, substance abuse and risk assessment, not included in the relevant literature so far, and whether they are relevant and why in this specific group of patients. The sample was divided in two groups depending on the history of CD or not, and subsequently statistically significant differences were explored between the groups. The research aimed to highlight specific characteristics of both groups with the ultimate goal of making more accurate prognosis regarding risk assessment, as well as determining different needs for treatment in each group (e.g. drug abuse). Overall, 78 forensic psychiatric records of NGRI offenders were identified throughout a five-year period in the Psychiatric Hospital of Thessaloniki (January 2015 to January 2020), who were divided into two groups depending on the history of conduct disorder in childhood or adolescence (N = 30) or not (N = 48). The two groups were compared regarding hostility and aggression (with the Hostility and Direction of Hostility Questionnaire-HDHQ and the Aggression Questionnaire), personality traits (with the Zuckerman- Kuhlman Personality Questionnaire-ZKPQ), dangerousness (with the Historical, Clinical and Risk Management 20- HCR-20 scale), addiction (with the Addiction Severity Index-ASI), previous violent behavior or convictions (with a semi-structured tool), and psychopathology current and at the time of the index (with the Positive And Negative Syndrome Scale-PANSS). Comparing the two groups (with CD history vs. without CD history) we found that patients with a history of conduct disorder had significantly higher compulsory hospitalization rates up to the time of the perpetration of the offense and a significantly higher rate of illicit drug use. While they were more likely to exhibit violent behavior before the index offense, it was noted that they committed fewer crimes against life. They were younger at the index offense and they presented with more severe positive symptomatology at the time of the research and a steadily high risk assessment score. Our findings underline the importance of diagnosing CD in early life and subsequently raising awareness when this individual develops schizophrenic disorder, thus emphasizing the need for appropriately targeted interventions in each case. Our research also illustrates that forensic patients with both schizophrenia and a history of conduct disorder before the age of 15 exhibit more severe psychopathology after the index crime even after long hospitalization and treatment. Our findings illustrate that the diagnosis of CD in psychotic offenders found not guilty by reason of insanity affects their dangerousness in general, but not the severity of the crimes committed.

Investigating Direct and Indirect Genetic Effects in Attention-Deficit/Hyperactivity Disorder Using Parent-Offspring Trios.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is highly heritable, but little is known about the relative effects of transmitted (i.e., direct) and nontransmitted (i.e., indirect) common variant risks. Using parent-offspring trios, we tested whether polygenic liability for neurodevelopmental and psychiatric disorders and lower cognitive ability is overtransmitted to ADHD probands. We also tested for indirect or genetic nurture effects by examining whether nontransmitted ADHD polygenic liability is elevated. Finally, we examined whether complete trios are representative of the clinical ADHD population. METHODS: Polygenic risk scores (PRSs) for ADHD, anxiety, autism, bipolar disorder, depression, obsessive-compulsive disorder, schizophrenia, Tourette syndrome, and cognitive ability were calculated in UK control subjects (n = 5081), UK probands with ADHD (n = 857), their biological parents (n = 328 trios), and also a replication sample of 844 ADHD trios. RESULTS: ADHD PRSs were overtransmitted and cognitive ability and obsessive-compulsive disorder PRSs were undertransmitted. These results were independently replicated. Overtransmission of polygenic liability was not observed for other disorders. Nontransmitted alleles were not enriched for ADHD liability compared with control subjects. Probands from incomplete trios had more hyperactive-impulsive and conduct disorder symptoms, lower IQ, and lower socioeconomic status than complete trios. PRS did not vary by trio status. CONCLUSIONS: The results support direct transmission of polygenic liability for ADHD and cognitive ability from parents to offspring, but not for other neurodevelopmental/psychiatric disorders. They also suggest that nontransmitted neurodevelopmental/psychiatric parental alleles do not contribute indirectly to ADHD via genetic nurture. Furthermore, ascertainment of complete ADHD trios may be nonrandom, in terms of demographic and clinical factors.

Proposed Specifiers for Conduct Disorder (PSCD): Factor Structure and Validation of the Self-Report Version in Community and Forensic Samples of Portuguese Youth.

The Proposed Specifiers for Conduct Disorder (PSCD) was developed as a measure to assess the multifaceted model of psychopathic traits in children/youth (i.e., grandiose-manipulative [GM], callous-unemotional [CU], and daring-impulsive [DI] traits) in addition to Conduct Disorder (CD) symptoms. This study aims to test the psychometric properties of the PSCD-self-report version across community (n = 648; 52.9% female) and forensic male youth (n = 258) from the Portuguese population. Results supported a general factor and four specific factors (GM, CU, DI, CD), which was invariant across gender and sample type. Evidence for reliability, construct, and temporal validity were also found. Overall, the PSCD appears to be a promising measure for assessing psychopathic traits in youth from both community and forensic settings, which may contribute to the discussion around the conceptualization, assessment, predictive value, and clinical usefulness of the multifaceted model of psychopathy in youthful populations, particularly in its association with CD.

A Comparison of Parent, Teacher, and Youth Ratings on the Inventory of Callous-Unemotional Traits.

The current study compared the validity of self-, parent-, and teacher-report versions of the Inventory of Callous-Unemotional Traits (ICU), a widely used measure of callous-unemotional (CU) traits, at several different ages. Participants (N = 236, 60.6% girls) were children in Grades 3, 6, and 8 (Mage = 11.55, SD = 2.23) from a public school system in the southern United States. We tested the association of all three ICU versions with several validators: parent- and teacher-reported conduct problems, peer nominations of characteristics associated with CU traits, and sociometric peer nominations of social preference. Results revealed an interaction between the ICU version and grade in the overall level of CU traits reported, with teacher-report leading to the highest ratings in sixth grade and being higher than parent-report in third grade. Furthermore, the validity of the different versions of the ICU varied somewhat across grades. Specifically, findings support the validity of both teacher- and self-report in third grade, but self-report was the only version to show strong validity in the eighth grade.

The computational psychiatry of antisocial behaviour and psychopathy.

Antisocial behaviours such as disobedience, lying, stealing, destruction of property, and aggression towards others are common to multiple disorders of childhood and adulthood, including conduct disorder, oppositional defiant disorder, psychopathy, and antisocial personality disorder. These disorders have a significant negative impact for individuals and for society, but whether they represent clinically different phenomena, or simply different approaches to diagnosing the same underlying psychopathology is highly debated. Computational psychiatry, with its dual focus on identifying different classes of disorder and health (data-driven) and latent cognitive and neurobiological mechanisms (theory-driven), is well placed to address these questions. The elucidation of mechanisms that might characterise latent processes across different disorders of antisocial behaviour can also provide important advances. In this review, we critically discuss the contribution of computational research to our understanding of various antisocial behaviour disorders, and highlight suggestions for how computational psychiatry can address important clinical and scientific questions about these disorders in the future.

Shared genetic influences between depression and conduct disorder in children and adolescents: A systematic review.

INTRODUCTION: The co-occurrence between major depression disorder (MDD) and conduct disorder (CD) is common across development and represents a significant risk factor for future psychiatric problems and long-term impairment. Large-scale quantitative genetic studies suggest that the MDD-CD co-occurrence may be partly explained by shared genetic vulnerability factors, in line with transdiagnostic models of psychopathology, but no systematic synthesis of the literature is currently available. METHODS: We therefore conducted a systematic review of the available genetic literature on the co-occurrence between MDD and CD in children and adolescents. We identified 10 eligible studies, including 5 cross-sectional bivariate/multivariate twin studies, 3 longitudinal bivariate/multivariate twin studies, and 2 latent profile/trajectory twin studies. RESULTS: Most of the reviewed studies found a strong contribution of shared genetic factors on the covariation between depression and conduct problems, in line with the prominent effect of a common genetic liability across development. LIMITATIONS: The scientific literature on this psychiatric comorbidity is still limited, as it solely consists of twin studies from high income countries. CONCLUSION: Considering the joint burden of MDD and CD on youth, families and society worldwide, future studies are needed to better investigate the shared risk processes of these frequently co-occurring conditions, in order to inform new treatments through personalized medicine.

[New challenge for services for people with a first episode of psychosis: To integrate interventions to prevent and reduce physical aggression]. / Le nouveau défi des services destinés aux personnes présentant un premier épisode de psychose : intégrer des interventions pour prévenir et réduire les agressions physiques.

Objective Mental health services for persons presenting a first episode of psychosis include specialized interventions that are effective in treating psychosis, but they do not include treatments that prevent aggressive behaviour (AB). This article presents the results of studies in an effort to incite these services to evaluate the risk of AB and to intervene rapidly to prevent these behaviours as well as treating the psychotic disorder. Method This article presents a narrative review of the scientific studies. We have reviewed publications in French and English reporting studies, reviews, and meta-analyses focused on the antecedents, correlates, and effective treatments for AB and criminality of persons described as presenting severe mental disorder, schizophrenia, or a first episode of psychosis. Results The review of scientific studies confirms that persons developing or presenting schizophrenia are at increased risk to engage in AB, crime, and homicide relative to the general population. Before a first episode of psychosis approximately one third of patients display AB. One subgroup of these persons, those who present the highest risk of AB and criminality, have a history of conduct disorder since childhood. Another subgroup who also begin engaging in AB before a first episode of psychosis display AB as anxiety and positive symptoms increase. The association between positive psychotic symptoms and AB varies according to the phase of illness and the age of onset of AB. Further, other factors such as substance misuse (especially cannabis use), difficulty in recognizing emotions in the faces of others, impulsivity, and physical victimization are related to AB. In addition to effective treatments for psychosis and social skill training, treatment programs aimed at preventing AB and antisocial behaviours, and the associated factors are needed, as well as interventions that aim to reduce victimization. Conclusion The extant literature identifies different profiles of patients and factors associated with AB that can be identified at a first episode of psychosis. Consequently, first episode services could play an important role in preventing AB. To do this, they would need to simultaneously treat the psychosis and the AB. The implementation of such treatments would involve challenges such as convincing treatment teams of the benefits of such an approach and convincing patients needing these treatments to comply. Increasing patients' motivation and compliance remains an important challenge.

Some critical comments on the paper titled "Some critical considerations in applying the construct of psychopathy to research and classification of childhood disruptive behavior disorders".

Frick (2022) presented a narrative review of some literature and made several critical comments regarding the extension of the full psychopathy construct to research and classification of childhood disruptive behavior disorders (DBDs). His arguments cautioned against the use of the multicomponent concept of psychopathy for specification of DBDs for several reasons including definitional issues, symptom sequencing, specifier versus risk factor considerations, potential overlap with other disorders and criteria (e.g., ADHD), and concerns regarding harm. While I agree with Frick (2022) that we need to be cautious when extending personality constructs to the DBDs, the remaining arguments in his paper fall short of calling for the exclusion of psychopathy components in the examination of DBDs. Rather, the counterpoints in this paper further convince that the multidimensional model of psychopathy, when applied to the DBDs, could better facilitate understanding of the etiology and mechanisms for Conduct Disorder (CD), and, it may help us to predict the prognosis and treatment outcomes of children with various forms of DBDs such as CD and Oppositional Defiant Disorder (ODD). To have the most informative designs, future research should examine the broad construct to glean a better understanding of psychopathy and the DBDs. Further, research should continue to examine sequencing and external correlates at the component level and to test the incremental value of the multicomponent model of psychopathy to help us better comprehend how each component may facilitate our understanding of the types and severity of conduct problems exhibited by youth with DBDs (i.e., CD, ODD).