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

Published online by Cambridge University Press:  15 February 2016

S. Hwang ,
Z. T. Nolan ,
S. F. White ,
W. C. Williams ,
S. Sinclair  and
R. J. R. Blair
S. Hwang*
Affiliation:
University of Nebraska Medical Center, Omaha, NE, USA
Z. T. Nolan
Affiliation:
Penn State College of Medicine, MD/PhD Program, Hershey, PA, USA
S. F. White
Affiliation:
Boystown National Research Hospital, Boystown, NE, USA
W. C. Williams
Affiliation:
Department of Psychology, Stanford University, Stanford, CA, USA
S. Sinclair
Affiliation:
Department of Health and Human Services, Section on Affective Cognitive Neuroscience, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
R. J. R. Blair
Affiliation:
Department of Health and Human Services, Section on Affective Cognitive Neuroscience, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
*
*Address for correspondence: S. Hwang, M.D., Department of Psychiatry, University of Nebraska Medical Center, 987830 Nebraska Medical Center, Omaha, NE 68198, USA. (Email: [email protected])
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Abstract

Background

To determine the functional integrity of the neural systems involved in emotional responding/regulation and response control/inhibition in youth (age 10–18 years) with disruptive behavioral disorders (DBDs: conduct disorder and/or oppositional defiant disorder) as a function of callous-unemotional (CU) traits.

Method

Twenty-eight healthy youths and 35 youths with DBD [high CU (HCU), n = 18; low CU (LCU), n = 17] performed the fMRI Affective Stroop task. Participants viewed positive, neutral, and negative images under varying levels of cognitive load. A 3-way ANOVA (group×emotion by task) was conducted on the BOLD response data.

Results

Youth with DBD-HCU showed significantly less activation of ventromedial prefrontal cortex (vmPFC) and amygdala in response to negative stimuli, compared to healthy youth and youth with DBD-LCU. vmPFC responsiveness was inversely related to CU symptoms in DBD. Youth with DBD-LCU showed decreased functional connectivity between amygdala and regions including inferior frontal gyrus in response to emotional stimuli. Youth with DBD (LCU and HCU) additionally showed decreased insula responsiveness to high load (incongruent trials) compared to healthy youth. Insula responsiveness was inversely related to ADHD symptoms in DBD.

Conclusions

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 trials and related to ADHD symptoms. Appropriate treatment will need to be individualized according to the patient's specific pathophysiology.

Keywords

Amygdalacallous-unemotional traitdisruptive behavior disorderemotional respondingresponse inhibition
Type
Original Articles
Information
Psychological Medicine , Volume 46 , Issue 7 , May 2016 , pp. 1485 - 1496
Copyright
Copyright © Cambridge University Press 2016 

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