Die Bedeutung von Ängstlichkeit für die Phänotypisierung dissozialer Störungen des Kindes- und Jugendalters
Ein Weg zu konsistenteren neurobiologischen Befunden?
Abstract
In den letzten Jahren wurden vermehrt neurobiologische Marker dissozialen Verhaltens bei Kindern mit hohem Risiko für einen ungünstigen Verlauf (so genannter early-starter Subtyp der Conduct disorder, CD nach DSM-IV) identifiziert. Trotz einer Fokussierung auf diese Subpopulation innerhalb eines sehr heterogenen Störungsbildes liegen bisher widersprüchliche Befunde vor. Es deutet sich an, dass die zunehmenden methodischen Möglichkeiten der Untersuchung biologischer Marker eine detaillierte Phänotypisierung der untersuchten Stichproben notwendig macht. Die vorliegende Übersichtsarbeit betont die Berücksichtigung komorbider Ängstlichkeit als ein potenziell wichtiges Differenzierungsmerkmal, welches zu einer konsistenteren Befundlage vor allem im Bereich neuroendokriner Studien beitragen könnte. Möglicherweise bestehen darüber hinaus auch Assoziationen zu neurostrukturellen und neurofunktionellen Veränderungen des Gehirns. Es wird weiter der Einfluss des Merkmals Ängstlichkeit auf aggressives Verhalten sowie auf die Prognose der Betroffenen aufgezeigt. Eine detaillierte psychometrische und neurobiologische Charakterisierung könnte dazu beitragen, die an dissozialen Entwicklungen beteiligten neurobiologischen Mechanismen besser zu verstehen und die Effektivität derzeitiger therapeutische Optionen zu steigern.
In recent years, neurobiological markers of antisocial behavior have frequently been identified in children of the early-starter subtype of conduct disorder (CD, according DSM-IV). Some studies, however, produced inconsistent findings. The present review argues that, given the existing methodological opportunities, we need a more detailed phenotyping of children with CD. In particular, establishing comorbid anxiety in neuroendocrinological studies might constitute an important factor. There also seem to be associations between trait anxiety and alterations of brain function and brain structure. Finally, the impact of trait anxiety on different subtypes of aggressive behavior as well as on prognosis is emphasized. In sum, a more detailed characterization of children with CD might help to improve our understanding of antisocial development and enhance therapeutic options.
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