import json

data = {
 "topic": "Conduct Disorder",
 "slug": "conduct-disorder",
 "category_id": 15493,
 "summary": "Conduct disorder is a persistent pattern of behavior violating the rights of others and major societal norms - aggression, destruction, deceit, and serious rule-breaking - with childhood-onset type carrying the highest risk of progression to antisocial personality disorder.",
 "written_by": "claude-sonnet",
 "references": [
  {"title": "MedStudy Pediatrics Core 11th Edition 2024-2025", "author": None, "pages": [221]},
  {"title": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024", "author": None, "pages": [322, 324]},
  {"title": "AAP Developmental and Behavioral Pediatrics", "author": "AAP Section on Developmental and Behavioral Pediatrics,Robert G. Voigt,Michelle M. Macias ,Scott M. Myers ,Carl D Tapia", "pages": [516, 517, 670]},
  {"title": "Pediatric ICD-10-CM 2023", "author": "American Academy of Pediatrics Committee on Coding and Nomenclature;", "pages": [206]},
  {"title": "CURRENT Diagnosis and Treatment Pediatrics, Twenty-Fourth Edition", "author": "Hay, William W., Levin, Myron J., Deterding, Robin R., Abzug, Mark J.", "pages": [233, 238]},
  {"title": "Cover", "author": "Vitalsource Download", "pages": [1392]},
  {"title": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub", "author": None, "pages": []},
  {"title": "Signs and Symptoms in Pediatrics", "author": "Henry M. Adam,Jane Meschan Foy", "pages": [190, 229]}
 ],
 "short": [
  {"title": "In short", "content": (
   "- Conduct disorder (CD) is a repetitive, persistent (DSM-5 requires at least 6 months) pattern of behavior violating the basic rights of others or major age-appropriate societal norms/rules\n"
   "- DSM-5 requires at least 3 of 15 criteria in the past 12 months, with at least 1 present in the past 6 months, across 4 categories: aggression to people/animals, destruction of property, deceitfulness/theft, and serious rule violations\n"
   "- Unlike oppositional defiant disorder (ODD), children with CD are deliberately aggressive and deceitful, commit serious rule violations, and often show a lack of remorse or guilt\n"
   "- Two DSM-5 subtypes by onset: childhood-onset type (before age 10) is particularly pernicious with higher risk of delinquency and progression to antisocial personality disorder in adulthood; adolescent-onset type is more peer-influenced, time-limited, and has a more favorable prognosis\n"
   "- Behaviors span aggression (bullying, threatening, initiating fights, weapon use, physical cruelty to people/animals, robbery, rape), destructiveness (deliberate property destruction including fire-setting), deceitfulness (breaking and entering, lying for gain, theft), and rule violations (truancy and staying out past curfew before age 13, running away from home)\n"
   "- The typical child with CD is a boy from a turbulent home with academic difficulties; symptoms often progress with age - defiance/fighting/tantrums early, then fire-setting/theft, then truancy/vandalism/substance abuse and, in adolescence, sexual promiscuity and other criminal behavior\n"
   "- Preschool/early-school hyperactive, aggressive, uncooperative behavior patterns predict later adolescent conduct disorder with high accuracy, especially when comorbid ADHD goes untreated; a history of reactive attachment disorder is an additional risk factor\n"
   "- Risk factors include inconsistent/severe parental discipline, parental alcoholism, and parental antisocial behavior\n"
   "- Children with more violent CD histories have an increased incidence of neurologic signs/symptoms, psychomotor seizures, psychotic symptoms, mood disorders, ADHD, and learning disabilities - these comorbidities should be actively screened for since they may need their own targeted treatment\n"
   "- CD is associated with increased suicide risk; because children with CD rarely seek help themselves, parental recognition and help-seeking behavior are critical to getting treatment started"
  )}
 ],
 "long": [
  {"title": "Definition", "content": (
   "Conduct disorder (CD) is defined by DSM-5 as a repetitive and persistent pattern of behavior in which the basic rights of others, or major age-appropriate societal norms or rules, are violated. Diagnosis requires at least 3 of 15 specified criteria to have been present in the past 12 months, with at least one criterion present in the past 6 months, drawn from four categories: aggression to people and animals, destruction of property, deceitfulness or theft, and serious violations of rules. The behavior must cause clinically significant impairment in academic, social, or occupational functioning, and the criteria for antisocial personality disorder must not be met. CD sits within the broader DSM-5 category of disruptive, impulse-control, and conduct disorders, alongside oppositional defiant disorder (ODD), intermittent explosive disorder, pyromania, and kleptomania - all sharing a core deficit in self-regulation of anger, aggression, defiance, and antisocial behavior, but differing in the relative balance of emotional dysregulation (as in intermittent explosive disorder) versus behavioral dysregulation (as in CD and ODD). Unlike ODD, CD involves deliberate aggression and deceit with serious rule violations, and children with CD often show little remorse or guilt for their actions. DSM-5 recognizes childhood-onset type (onset before age 10, unsocialized/solitary aggressive pattern) and adolescent-onset type (socialized/group type), which differ meaningfully in prognosis."
  )},
  {"title": "Epidemiology", "content": (
   "Conduct disorder typically first appears in early or middle childhood. Childhood-onset type (before age 10) carries a particularly poor prognosis, with higher risk of delinquency and conversion to antisocial personality disorder in adulthood, while adolescent-onset type is more strongly shaped by peer influence, tends to be time-limited, and carries a more favorable prognosis."
  )},
  {"title": "Etiology", "content": (
   "CD is best conceptualized as a final common behavioral pathway that can emerge from a variety of underlying psychosocial, genetic, environmental, and neuropsychiatric contributors, rather than a single cause. Preschool and early-school-age patterns of hyperactive, aggressive, and uncooperative behavior predict later adolescent CD with a high degree of accuracy - especially when comorbid ADHD is left untreated. A history of reactive attachment disorder is an additional childhood risk factor. Family and environmental risk factors that increase the likelihood of developing CD include inconsistent and overly severe parental disciplinary techniques, parental alcoholism, and parental antisocial behavior."
  )},
  {"title": "Clinical features", "content": (
   "The typical presentation is a boy with a turbulent home life and academic difficulties, showing defiance of authority, fighting, tantrums, running away, school failure, and destruction of property; with increasing age, fire-setting and theft may emerge, followed in adolescence by truancy, vandalism, and substance abuse, and in some cases sexual promiscuity, sexual perpetration, or other criminal behavior. Specific behaviors span four DSM-5 categories: aggression to people and animals (bullying, threatening or intimidating others, initiating physical fights, use of a weapon capable of serious harm, physical cruelty to people or animals, robbery, forced sexual activity); destruction of property (including deliberate fire-setting); deceitfulness or theft (breaking and entering, lying to obtain goods or avoid obligations, shoplifting/theft without confrontation); and serious rule violations (staying out past curfew before age 13, truancy before age 13, running away from home overnight at least twice). CD is associated with chronic conflict with parents, teachers, and sometimes peers, often resulting in property damage and physical injury to the patient or others. Notably, children with conduct problems are at higher risk for suicide, and oppositional/conduct-disordered children may also manifest depressive symptoms that require separate attention."
  )},
  {"title": "Diagnostics", "content": (
   "Diagnosis is clinical, based on DSM-5 criteria requiring at least 3 of the 15 specific behaviors in the past year (at least 1 in the past 6 months) causing significant functional impairment, with antisocial personality disorder criteria not met. Because children with CD themselves will not typically seek help, parental recognition of the problem and help-seeking behavior are essential to getting the child evaluated. Distinguishing CD from ADHD and bipolar disorder is clinically important, since school and behavior problems occur in all three: in CD, defiant attitude is constant and anger expression takes the form of planned revenge (versus short-lived anger in ADHD or intense, episodic rages in bipolar disorder); motor restlessness, impulsivity, and distractibility, which are constant in ADHD, may only be present or absent in CD; thought content in CD is characterized by blaming others rather than the immature thought content of ADHD or the morbid/grandiose ideas of bipolar disorder; and hallucinations, if present, are diagnostic for bipolar disorder but do not occur in CD or straightforward ADHD. Given the association with increased neurologic and psychiatric comorbidity, evaluation - particularly in children with more violent histories - should screen for neurologic signs/symptoms, psychomotor seizures, psychotic symptoms, mood disorders, ADHD, and learning disabilities, since these may require their own specific interventions."
  )},
  {"title": "Differential diagnosis", "content": (
   "Oppositional defiant disorder (ODD) is the key differential and often a precursor - CD, unlike ODD, involves deliberate aggression/deceit and serious rule violations rather than only defiance and irritability. Intermittent explosive disorder focuses on poorly controlled emotional outbursts rather than the sustained pattern of rule- and rights-violating behavior seen in CD. ADHD and bipolar disorder can overlap symptomatically with CD (school and behavior problems occur in all three) but are distinguished by the pattern of anger expression, impulsivity/distractibility, thought content, and presence or absence of hallucinations, as detailed above. Substance use disorders, mood disorders, and psychotic disorders should also be considered and screened for as potential comorbidities or alternative explanations for aggressive or antisocial behavior."
  )},
  {"title": "Treatment", "content": (
   "Because CD reflects a convergence of multiple underlying psychosocial, genetic, environmental, and neuropsychiatric contributors, effective management requires identifying and specifically treating any associated conditions (ADHD, mood disorders, learning disabilities, psychotic symptoms) alongside behavioral interventions targeting the conduct symptoms themselves. Parental engagement is essential, since children with CD rarely seek help on their own; family-focused interventions addressing parental disciplinary consistency are an important part of treatment given the association between CD risk and inconsistent/severe discipline."
  )}
 ],
 "clinical": [
  {"title": "Approach at the bedside", "content": (
   "When evaluating a child or adolescent for possible conduct disorder, systematically screen the four DSM-5 behavior categories - aggression to people/animals, property destruction, deceitfulness/theft, and serious rule violations - and confirm at least 3 criteria within the past 12 months with at least 1 in the past 6 months, plus meaningful functional impairment. Distinguish CD from ODD by looking specifically for deliberate aggression, deceit, and serious rule-breaking with little remorse, rather than only oppositional defiance and irritability. Note the age of onset: onset before age 10 (childhood-onset type) carries a substantially worse prognosis and should prompt more assertive intervention, while adolescent-onset (peer-influenced) type is generally more time-limited.\n\nActively screen for comorbidities that can drive presentation and require their own treatment - ADHD, mood disorders (including depression, given increased suicide risk in CD), learning disabilities, and, in more violent presentations, psychomotor seizures or psychotic symptoms. Use the ADHD/CD/bipolar disorder comparison to sharpen the differential when the picture is ambiguous: constant defiance with planned revenge points to CD, constant impulsivity/distractibility/motor restlessness points to ADHD, and episodic intense rages with morbid or grandiose thought content (or hallucinations) point to bipolar disorder. Engage parents directly in both diagnosis and treatment planning, since children with CD do not typically seek help themselves, and address any inconsistent or overly harsh disciplinary patterns in the home as part of the overall management plan, alongside referral for behavioral/family therapy and treatment of identified comorbidities."
  )}
 ]
}

with open("/tmp/conduct-disorder.article.json", "w") as f:
    json.dump(data, f, indent=1)
print("written")