对立反抗性障碍的双因素模型的外部验证。,Molecular Psychiatry

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对立反抗性障碍的双因素模型的外部验证。
Molecular Psychiatry ( IF 11.0 ) Pub Date : 2018-Dec-11 , DOI: 10.1038/s41380-018-0294-z
Irwin D Waldman ₁ , Richard Rowe ₂ , Khrista Boylan ₃ , Jeffrey D Burke ₄

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易怒和反抗行为的维度虽然与ODD的结构相关，但通过青春期和成年期传达了可分离的发展风险。易怒预示着抑郁和焦虑，反抗行为是反社会结果的先兆。先前，我们证明了包括易怒性和违抗行为维度以及一般因素在内的双因素模型在五个大型数据集中提供了ODD症状的最佳拟合结构。在这里，我们通过使用多元回归和多元行为遗传分析从外部验证ODD的双因子模型来扩展我们以前的工作。我们使用了父母对DSM IV ODD症状的评分，以及对ADHD的症状范围（即注意力不集中和多动冲动），行为障碍（CD），抑郁/心律失常，和来自846名6-18岁双胞胎对的广泛性焦虑症（GAD）。我们发现，ODD易怒因素仅与抑郁/心律失常和GAD相关，而ODD违抗行为因素仅与注意力不集中，多动冲动和CD相关，而ODD一般因素与所有五个症状维度相关。多元行为遗传分析发现，所有五个症状维度均与ODD的一般性，易怒性和挑衅行为因素共有遗传影响。相反，挑衅行为因子与注意力不集中和多动性冲动独特地共享遗传影响，而烦躁因子与抑郁/心境障碍和GAD独特地共享遗传影响，反之则不然。这表明，影响儿童早期易怒性的基因也易患青春期和成年期的抑郁症和焦虑症。这些多变量的遗传学发现也支持病原学水平上三个ODD维度的外部有效性。我们的研究为基于这些症状维度的ODD分型提供了额外的支持，如ICD-11的修订版，并提出了从ODD演变为行为或情感障碍的潜在机制。

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External validation of a bifactor model of oppositional defiant disorder.

Dimensions of irritability and defiant behavior, though correlated within the structure of ODD, convey separable developmental risks through adolescence and adulthood. Irritability predicts depression and anxiety, whereas defiant behavior is a precursor to antisocial outcomes. Previously we demonstrated that a bifactor model comprising irritability and defiant behavior dimensions, in addition to a general factor, provided the best-fitting structure of ODD symptoms in five large datasets. Herein we extend our previous work by externally validating the bifactor model of ODD using multiple regression and multivariate behavior genetic analyses. We used parent ratings of DSM IV ODD symptoms, and symptom dimensions for ADHD (i.e., inattention and hyperactivity-impulsivity), conduct disorder (CD), depression/dysthymia, and generalized anxiety disorder (GAD) from 846 6-18-year-old twin pairs. We found that the ODD irritability factor was associated only with depression/dysthymia and GAD and the ODD defiant behavior factor was associated only with inattention, hyperactivity-impulsivity, and CD, whereas the ODD general factor was associated with all five symptom dimensions. Multivariate behavior genetic analyses found all five symptom dimensions shared genetic influences in common with the ODD general, irritability, and defiant behavior factors. In contrast, the defiant behavior factor shared genetic influences uniquely with inattention and hyperactivity-impulsivity, whereas the irritability factor shared genetic influences uniquely with depression/dysthymia and GAD, but not vice versa. This suggests that genes that influence irritability in early childhood also predispose to depression and anxiety in adolescence and adulthood. These multivariate genetic findings also support the external validity of the three ODD dimensions at the etiological level. Our study provides additional support for subtyping ODD based on these symptom dimensions, as in the revisions in the ICD-11, and suggests potential mechanisms underlying the development from ODD to behavioral or affective disorders.

更新日期：2019-01-26

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