Background

Although impulsive aggression (IA) and dysfunctional response inhibition (RI) are hallmarks of attention-deficit/hyperactivity disorder (ADHD) and disrupted behavioral disorders (DBDs), little is known about their shared and distinct deviant neural mechanisms.

Aims and Methods

Here, we selectively reviewed s/fMRI ADHD and DBD studies to identify disorder-specific and shared IA and RI aberrant neural mechanisms.

Results

In ADHD, deviant prefrontal and cingulate functional activity was associated with increased IA. Structural alterations were most pronounced in the cingulate cortex. Subjects with DBDs showed marked cortico-subcortical dysfunctions. ADHD and DBDs share similar cortico-limbic structural and functional alterations. RI deficits in ADHD highlighted hypoactivity in the dorso/ventro-lateral PFC, insula, and striatum, while the paralimbic system was primarily dysfunctional in DBDs. Across disorders, extensively altered cortico-limbic dysfunctions underlie IA, while RI was mostly associated with aberrant prefrontal activity.

Conclusion

Control network deficits were evidenced across clinical phenotypes in IA and RI. Dysfunctions at any level within these cortico-subcortical projections lead to deficient cognitive-affective control by ascribing emotional salience to otherwise irrelevant stimuli. The clinical implications of these findings are discussed.

中文翻译：

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注意缺陷/多动障碍和破坏性行为障碍的冲动攻击和反应抑制：系统评价的结果

背景

尽管冲动攻击（IA）和功能障碍抑制（RI）是注意缺陷/多动障碍（ADHD）和行为紊乱（DBD）的标志，但对它们共有和独特的异常神经机制知之甚少。

目的与方法

在这里，我们选择性地回顾了s / fMRI ADHD和DBD研究，以识别特定于疾病的和共享的IA和RI异常神经机制。

结果

在ADHD中，异常的前额叶和扣带回功能活动与IA增加有关。在扣带回皮层中，结构改变最为明显。患有DBD的受试者表现出明显的皮质下皮质功能障碍。ADHD和DBD具有相似的皮质-边缘结构和功能改变。注意力缺陷多动障碍中的RI缺乏突出了背侧/腹侧PFC，岛状和纹状体的活动不足，而准肢系统主要在DBD中功能失调。在各种疾病中，IA构成了皮质-边缘功能障碍的广泛改变，而RI主要与异常的额叶前活动有关。

结论

IA和RI的临床表型之间均存在控制网络缺陷。这些皮质-皮层下投射的任何水平的功能障碍都会通过将情绪上的显着性归因于其他无关紧要的刺激而导致缺乏认知情感控制。讨论了这些发现的临床意义。