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Diagnostic instruments for the assessment of disruptive mood dysregulation disorder: a systematic review of the literature. Eur Child Adolesc Psychiatry 2023; 32:17-39. [PMID: 34232390 PMCID: PMC9908712 DOI: 10.1007/s00787-021-01840-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Abstract
Disruptive mood dysregulation disorder (DMDD) involves non-episodic irritability and frequent severe temper outbursts in children. Since the inclusion of the diagnosis in the DSM-5, there is no established gold-standard in the assessment of DMDD. In this systematic review of the literature, we provide a synopsis of existing diagnostic instruments for DMDD. Bibliographic databases were searched for any studies assessing DMDD. The systematic search of the literature yielded K = 1167 hits, of which n = 110 studies were included. The most frequently used measure was the Kiddie Schedule for Affective Disorders and Schizophrenia DMDD module (25%). Other studies derived diagnostic criteria from interviews not specifically designed to measure DMDD (47%), chart review (7%), clinical diagnosis without any specific instrument (6%) or did not provide information about the assessment (9%). Three structured interviews designed to diagnose DMDD were used in six studies (6%). Interrater reliability was reported in 36% of studies (ranging from κ = 0.6-1) while other psychometric properties were rarely reported. This systematic review points to a variety of existing diagnostic measures for DMDD with good reliability. Consistent reporting of psychometric properties of recently developed DMDD interviews, as well as their further refinement, may help to ascertain the validity of the diagnosis.
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Topal Z, Demir N, Tufan E, Tuman TC, Semerci B. Emotional and cognitive conflict resolution and disruptive mood dysregulation disorder in adolescent offspring of parents diagnosed with major depressive disorder, bipolar disorder, and matched healthy controls. Nord J Psychiatry 2021; 75:427-436. [PMID: 33591219 DOI: 10.1080/08039488.2021.1880635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIMS Children of parents with mood disorders have an elevated risk for various psychopathologies. In this study rate of psychopathologies among adolescent offspring of parents with major depressive (MDDoff) and bipolar disorder (BDoff), including disruptive mood dysregulation disorder (DMDD) along with the offspring ability to resolve cognitive and emotional conflicts were evaluated. METHOD 12-16 years old children of parents with MDD (n = 31, children= 36), BP (n = 20, children = 26) and controls (n = 25, children = 28) were enrolled. Children and parents were evaluated by using the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID); respectively. The parents completed the Child Behavior Checklist (CBCL)-dysregulation profile. The Stroop test-TBAG form and emotional Stroop test were given out to evaluate conflict resolution ability. RESULTS The most common diagnoses among the whole sample were attention deficit and hyperactivity, separation anxiety and oppositional defiant disorders. Five cases (5.5%) of lifetime DMDD were found (three from MDDoff, the rest from BDoff). Completion times for the Stroop test-TBAG form were ranked as: BDoff > MDDoff > Hoff. In the emotional Stroop test, the BDoff responded significantly later and had significantly reduced correct responses. CONCLUSION Rates of lifetime DMDD were similar in the MDDoff and BDoff groups. BDoff may experience greater difficulties in resolving cognitive and emotional conflicts.
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Affiliation(s)
- Zehra Topal
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Gaziantep University, Osmangazi, Turkey
| | - Nuran Demir
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Yıldırım Bayezit University, Ankara, Turkey
| | - Evren Tufan
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey
| | - Taha Can Tuman
- Department of Psychiatry, Health Practice and Researching Center, Istanbul Medipol University, İstanbul, Turkey
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Abstract
Based on its course over time, irritability is linked to depression cross-sectionally and longitudinally. Cross-sectionally, irritability takes an episodic form as a symptom in pediatric depression; yet, irritability in the absence of depressed mood or anhedonia is rare. Longitudinally, chronic irritability has been shown to predict depression rather than bipolar disorder or externalizing disorders. Evidence suggests that the link between irritability and depression is explained mostly by shared genetic risk. Both conditions are also associated with higher rates of family history of depression, childhood temperaments and personality styles, and negative parenting styles. The treatment implications are discussed.
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Affiliation(s)
- Pablo Vidal-Ribas
- Social and Behavioral Science Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 6710 Rockledge Drive, Building 6710B, Room 3153A, Bethesda, MD 20892, USA.
| | - Argyris Stringaris
- Section of Clinical and Computational Psychiatry, National Institute of Mental Health, National Institutes of Health, 9000 Rockville Pike, Building 15k, Room 208, Bethesda, MD 20892, USA. https://twitter.com/argStringaris
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Lin YJ, Tseng WL, Gau SSF. Psychiatric comorbidity and social adjustment difficulties in children with disruptive mood dysregulation disorder: A national epidemiological study. J Affect Disord 2021; 281:485-492. [PMID: 33383391 PMCID: PMC8142276 DOI: 10.1016/j.jad.2020.12.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/09/2020] [Accepted: 12/11/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND We examined correlates, psychiatric comorbidities, and social adjustment difficulties in children with disruptive mood dysregulation disorder (DMDD) from a national epidemiological study in Taiwan. METHODS The sample consisted of 4816 children, who were 3rd, 5th, and 7th graders from schools randomly chosen based on the urbanization level in a recent national survey of childhood mental disorders. Among the 4816 children (2520 boys, 52.3%) interviewed using the Kiddie epidemiologic version of the Schedule for Affective Disorders and Schizophrenia (K-SADS-E) for the DSM-5, 30 children were diagnosed as DMDD (23 boys, 76.7%). They and their parents also reported on the Social Adjustment Inventory for Children and Adolescents (SAICA). We conducted regressions for survey data that controlled for stratification and clustering. RESULTS The weighted prevalence of DMDD was 0.3~0.76% in Taiwanese children. Lower parental educational levels, male predominance, higher psychiatric comorbidities, and worse self-report school functions (e.g., more behavioral problems with peers) were observed in children with DMDD than those without. Additional analyses revealed that oppositional defiant disorder (ODD) but not DMDD was related to conduct disorder. Children with ODD with or without DMDD had more problems regarding attitudes toward school, academic performance, and parent-child interaction at home than those with DMDD-only. LIMITATIONS Small sample size of DMDD. CONCLUSIONS DMDD is a rare disorder in the community. Children with DMDD had more psychiatric comorbidities, and subjectively experienced more difficulties than those without. DMDD and ODD both resulted in severe impairment yet in different domains.
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Affiliation(s)
- Yu-Ju Lin
- Department of Psychiatry, National Taiwan University and College of Medicine, Taiwan,Department of Psychiatry, Far Eastern Memorial Hospital, Taiwan
| | - Wan-Ling Tseng
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Susan Shur-Fen Gau
- Department of Psychiatry, National Taiwan University and College of Medicine, Taiwan; Graduate Institute of Brain and Mind Sciences, and Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taiwan.
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Sahu S, Saldanha D, Chaudhury S, Menon P, Marella S, Kalkat VS. Demographic and psychosocial profile of disruptive mood dysregulation disorder in Indian settings. Ind Psychiatry J 2020; 29:228-236. [PMID: 34158706 PMCID: PMC8188932 DOI: 10.4103/ipj.ipj_226_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/06/2020] [Accepted: 01/19/2021] [Indexed: 11/24/2022] Open
Abstract
AIMS The aim of this study was to assess the demographic and psychosocial profile of the children with and without disruptive mood dysregulation disorder (DMDD) attending psychiatric and pediatric OPD and evaluation of the phenomenology of children diagnosed with DMDD. MATERIALS AND METHODS Children of 6-16 years attending the psychiatric outpatient department were screened by self-made peer-reviewed questionnaire and further underwent diagnostic evaluation using DSM 5 diagnostic criteria. Socioeconomic status (SES) was assessed using the Kuppuswamy scale. Affective Reactivity Index (ARI) was used to measure the severity of irritability. Overall behavioral problems were assessed on Conner's parent rating scale and impairment in functioning on the Children's Global Assessment of Functioning Scale. RESULTS A total of nine subjects were diagnosed with DMDD out of 500. The mean age of children with DMDD was higher than other children. DMDD children had better SES. Multiple psychosocial factors such as broken family, family history of psychiatric illness, and childhood adversities including sexual abuse were found to be a contributory factor. Those diagnosed with DMDD had significant conduct and learning problem along with moderate to severe irritability and a mean CGAS value of 50.66 which implies that children with DMDD had moderate impairment in functioning. CONCLUSIONS DMDD cases have male preponderance, urban background, and belong to upper and middle socioeconomic strata. Conduct problems, academic decline, hyperactivity, impulsivity, and mild degree of impairment in anxiety, along with moderate to severe irritability produce impairment in their overall functioning of these children.
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Affiliation(s)
- Samiksha Sahu
- Department of Psychiatry, Gandhi Medical College and Hamidia Hospital, Bhopal, Madhya Pradesh, India
| | - Daniel Saldanha
- Department of Psychiatry, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pune, Maharashtra, India
| | - Suprakash Chaudhury
- Department of Psychiatry, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pune, Maharashtra, India
| | - Preethi Menon
- Department of Psychiatry, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pune, Maharashtra, India
| | - Shivaji Marella
- Department of Psychiatry, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pune, Maharashtra, India
| | - Vasdev Singh Kalkat
- Department of Psychiatry, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pune, Maharashtra, India
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Zwicker A, Drobinin V, MacKenzie LE, Howes Vallis E, Patterson VC, Cumby J, Propper L, Abidi S, Bagnell A, Pavlova B, Alda M, Uher R. Affective lability in offspring of parents with major depressive disorder, bipolar disorder and schizophrenia. Eur Child Adolesc Psychiatry 2020; 29:445-451. [PMID: 31172297 DOI: 10.1007/s00787-019-01355-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 05/16/2019] [Indexed: 12/19/2022]
Abstract
Affective lability, defined as the propensity to experience excessive and unpredictable changes in mood, has been proposed as a potential transdiagnostic predictor of major mood and psychotic disorders. A parental diagnosis of bipolar disorder has been associated with increased affective lability in offspring. However, the association between affective lability and family history of other mood and psychotic disorders has not been examined. We measured affective lability using the self- and parent-reported Children's Affective Lability Scale in a cohort of 320 youth aged 6-17 years, including 137 offspring of a parent with major depressive disorder, 68 offspring of a parent with bipolar disorder, 24 offspring of a parent with schizophrenia, and 91 offspring of control parents. We tested differences in affective lability between groups using mixed-effects linear regression. Offspring of a parent with major depressive disorder (β = 0.46, 95% CI 0.17-0.76, p = 0.002) or bipolar disorder (β = 0.47, 95% CI 0.12-0.81, p = 0.008) had significantly higher affective lability scores than control offspring. Affective lability did not differ significantly between offspring of a parent with schizophrenia and offspring of control parents. Our results suggest that elevated affective lability during childhood is a marker of familial risk for mood disorders.
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Affiliation(s)
- Alyson Zwicker
- Nova Scotia Health Authority, Halifax, NS, Canada
- Department of Pathology, Dalhousie University, Halifax, NS, Canada
| | - Vladislav Drobinin
- Nova Scotia Health Authority, Halifax, NS, Canada
- Department of Medical Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Lynn E MacKenzie
- Nova Scotia Health Authority, Halifax, NS, Canada
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Emily Howes Vallis
- Nova Scotia Health Authority, Halifax, NS, Canada
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Victoria C Patterson
- Nova Scotia Health Authority, Halifax, NS, Canada
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Jill Cumby
- Nova Scotia Health Authority, Halifax, NS, Canada
| | - Lukas Propper
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- IWK Health Centre, Halifax, NS, Canada
| | - Sabina Abidi
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- IWK Health Centre, Halifax, NS, Canada
| | - Alexa Bagnell
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- IWK Health Centre, Halifax, NS, Canada
| | - Barbara Pavlova
- Nova Scotia Health Authority, Halifax, NS, Canada
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Martin Alda
- Nova Scotia Health Authority, Halifax, NS, Canada
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Rudolf Uher
- Nova Scotia Health Authority, Halifax, NS, Canada.
- Department of Pathology, Dalhousie University, Halifax, NS, Canada.
- Department of Medical Neuroscience, Dalhousie University, Halifax, NS, Canada.
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada.
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.
- IWK Health Centre, Halifax, NS, Canada.
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
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Benarous X, Renaud J, Breton JJ, Cohen D, Labelle R, Guilé JM. Are youths with disruptive mood dysregulation disorder different from youths with major depressive disorder or persistent depressive disorder? J Affect Disord 2020; 265:207-215. [PMID: 32090743 DOI: 10.1016/j.jad.2020.01.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 11/27/2019] [Accepted: 01/05/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Although the disruptive mood dysregulation disorder (DMDD) was included in the depressive disorders (DD) section of the DSM-5, common and distinctive features between DMDD and the pre-existing DD (i.e., major depressive disorder, MDD, and persistent depressive disorder, PDD) received little scrutiny. METHODS Youths consecutively assessed as outpatients at two Canadian mood clinics over four years were included in the study (n = 163; mean age:13.4 ± 0.3; range:7-17). After controlling for inter-rater agreement, data were extracted from medical charts, using previously validated chart-review instruments. RESULTS Twenty-two percent of youths were diagnosed with DMDD (compared to 36% for MDD and 25% for PDD), with substantial overlap between the three disorders. Youths with DMDD were more likely to have a comorbid non-depressive psychiatric disorder - particularly attention deficit hyperactivity disorder, odds ratio (OR=3.9), disruptive, impulse-control and conduct disorder (OR=3.0) or trauma- and stressor-related disorder (OR=2.5). Youths with DMDD did not differ with regard to the level of global functioning, but reported more school and peer-relationship difficulties compared to MDD and/or PDD. The vulnerability factors associated with mood disorders (i.e., history of parental depression and adverse life events) were found at a comparable frequency across the three groups. LIMITATIONS The retrospective design and the selection bias for mood disordered patients restricted the generalizability of the results. CONCLUSIONS Youths with DMDD share several clinical features with youths with MDD and PDD. Further studies are required to determine the developmental trajectories and the benefits of expanding pharmacotherapy for DD to DMDD.
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Affiliation(s)
- Xavier Benarous
- Child and Adolescent Psychopathology Services, Amiens University Hospital, Amiens, France; INSERM Unit U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardy Jules Verne (UPJV), Amiens, France; Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Johanne Renaud
- Manulife Centre for Breakthroughs in Teen Depression and Suicide Prevention, Douglas Mental Health University Institute, McGill University, Montreal, Canada; Department of psychiatry, McGill University, Montreal, Canada
| | | | - David Cohen
- Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France; CNRS UMR 7222, Institute for Intelligent Systems and Robotics, Sorbonne Universités, UPMC, Paris, France
| | - Réal Labelle
- Department of psychiatry, University of Montreal, Montreal, Canada; Département de psychologie, Université du Québec à Montréal, Montréal, Canada; Centre de recherche, Hôpital en santé mentale Rivière-des-Prairies, CIUSSS du Nord-de-l'Île-de-Montréal, Canada; Centre for Research and Intervention on Suicide, Ethical Issues and End-of-life practices, (CRISE), Montreal, Canada
| | - Jean-Marc Guilé
- Child and Adolescent Psychopathology Services, Amiens University Hospital, Amiens, France; INSERM Unit U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardy Jules Verne (UPJV), Amiens, France; Department of psychiatry, McGill University, Montreal, Canada.
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Bruno A, Celebre L, Torre G, Pandolfo G, Mento C, Cedro C, Zoccali RA, Muscatello MRA. Focus on Disruptive Mood Dysregulation Disorder: A review of the literature. Psychiatry Res 2019; 279:323-330. [PMID: 31164249 DOI: 10.1016/j.psychres.2019.05.043] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 12/28/2022]
Abstract
The inclusion of the Disruptive Mood Dysregulation Disorder (DMDD) in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), under the category of depressive disorders, provides a diagnosis for those children and adolescents with severe persistent irritability and temper outbursts, once misdiagnosed as Bipolar Disorders. The main and constantly present features of DMDD are chronic, non-episodic and persistent irritability, and temper tantrums disproportionate with the trigger. DMDD is characterized by high rates of comorbidity with other psychiatric disorders. Its main clinical manifestations overlap with Oppositional Defiant Disorder, Conduct Disorder, and Attention-Deficit/Hyperactivity Disorder. For this diagnostic overlap and the increasing use of pharmacological treatments in children and adolescents, the inclusion of DMDD diagnosis has been subjected to many criticisms. Since it is a new diagnostic entity, literature on DMDD prevalence, epidemiology, risk factors, and treatment guidelines, is still sparse and unclear. The aim of this review is to collect and analyze the literature on DMDD diagnostic criteria and main hallmarks, with particular attention to comorbidities and treatment options.
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Affiliation(s)
- Antonio Bruno
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 1, 98125 Messina, Italy.
| | - Laura Celebre
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 1, 98125 Messina, Italy
| | - Giovanna Torre
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 1, 98125 Messina, Italy
| | - Gianluca Pandolfo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 1, 98125 Messina, Italy
| | - Carmela Mento
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 1, 98125 Messina, Italy
| | - Clemente Cedro
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 1, 98125 Messina, Italy
| | - Rocco A Zoccali
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 1, 98125 Messina, Italy
| | - Maria Rosaria Anna Muscatello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 1, 98125 Messina, Italy
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Vidal-Ribas P, Brotman MA, Salum GA, Kaiser A, Meffert L, Pine DS, Leibenluft E, Stringaris A. Deficits in emotion recognition are associated with depressive symptoms in youth with disruptive mood dysregulation disorder. Depress Anxiety 2018; 35:1207-1217. [PMID: 30004611 PMCID: PMC9719110 DOI: 10.1002/da.22810] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 06/06/2018] [Accepted: 06/13/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Although severe irritability is a predictor of future depression according to recent meta-analytic evidence, other mechanisms for this developmental transition remain unclear. In this study, we test whether deficits in emotion recognition may partially explain this specific association in youth with severe irritability, defined as disruptive mood dysregulation disorder (DMDD). METHODS Participants aged 8-20 years (M = 13.3, SD = 2.8) included youth with DMDD, split by low depressive (DMDD/LD; n = 52) and high depressive (DMDD/HD; n = 25) symptoms, and healthy controls (HC; n = 39). A standardized computer task assessed emotion recognition of faces and voices of adults and children expressing happiness, fear, sadness, and anger. A Group (3) × Emotion (4) × Actor (2) × Modality (2) repeated measures analysis of covariance examined the number of errors and misidentification of emotions. Linear regression was then used to assess whether deficits in emotion recognition were predictive of depressive symptoms at a 1 year follow-up. RESULTS DMDD/HD youth were more likely to interpret happy stimuli as angry and fearful compared to DMDD/LD (happy as angry: p = 0.018; happy as fearful: p = 0.008) and HC (happy as angry: p = 0.014; happy as fearful: p = 0.024). In youth with DMDD, the misidentification of happy stimuli as fearful was associated with higher depressive symptoms at follow-up (β = 0.43, p = 0.017), independent of baseline depressive and irritability symptoms. CONCLUSIONS Deficits in emotion recognition are associated, cross-sectionally and longitudinally, with depressive symptoms in youth with severe irritability. Future studies should examine the neural correlates that contribute to these associations.
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Affiliation(s)
- Pablo Vidal-Ribas
- Department of Health and Human Services, Mood Brain and Development Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland,Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Melissa A. Brotman
- Department of Health and Human Services, Section on Mood Dysregulation and Neuroscience, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Giovanni A. Salum
- National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil,Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ariela Kaiser
- Department of Health and Human Services, Mood Brain and Development Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Liana Meffert
- Department of Health and Human Services, Mood Brain and Development Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Daniel S. Pine
- Department of Health and Human Services, Section on Development and Affective Neuroscience, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Ellen Leibenluft
- Department of Health and Human Services, Section on Mood Dysregulation and Neuroscience, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Argyris Stringaris
- Department of Health and Human Services, Mood Brain and Development Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
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10
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Stringaris A, Vidal-Ribas P, Brotman MA, Leibenluft E. Practitioner Review: Definition, recognition, and treatment challenges of irritability in young people. J Child Psychol Psychiatry 2018; 59:721-739. [PMID: 29083031 DOI: 10.1111/jcpp.12823] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Irritability is one of the most common reasons for referral to child and adolescent mental health services and is the main characteristic of the new diagnosis of disruptive mood dysregulation disorder (DMDD). However, the recognition and management of irritability presents a major challenge in clinical practice and may be partly responsible for the dramatic increase in antipsychotic prescribing in recent years. METHODS In this review, we provide up-to-date information on the definition and mechanisms underlying irritability, and its assessment in clinical practice. We aim to discuss the latest research on DMDD, and the presence of severe irritability in the context of other disorders, as well as to recommend a treatment algorithm. RESULTS Severe irritability is associated with aberrant reward processing and bias toward threatening stimuli. Several measures are available to easily assess irritability. The recent diagnosis of DMDD captures children whose main problem is severe irritability and differ from those with bipolar disorder in longitudinal outcomes, family history, and behavioral and neural correlates. Treatment of irritability might depend on the context it appears. Indirect evidence suggests that parent management training (PMT) and cognitive behavioral therapy (CBT) are the most supported psychological treatments for irritability. CONCLUSIONS Irritability, recognized as a mood problem rather than a purely behavioral manifestation, is a common condition for young people. Practitioners should not ignore irritability as it is associated with substantial morbidity and impairment. Although there are no trials with irritability as main outcome, clinicians can apply several existing pharmacological and psychological interventions for its treatment. Also, new promising approaches relying on pathophysiological findings, such as exposure-based cognitive behavioral therapy techniques and interpretation bias training (IBT), are being currently investigated.
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Affiliation(s)
- Argyris Stringaris
- Mood Brain and Development Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Pablo Vidal-Ribas
- Mood Brain and Development Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA.,Institute of Psychiatry, Psychology and Neuroscience, Department of Child and Adolescent Psychiatry, King's College London, London, UK
| | - Melissa A Brotman
- Section on Mood Dysregulation and Neuroscience, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Ellen Leibenluft
- Section on Mood Dysregulation and Neuroscience, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
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Ogasawara K, Nakamura Y, Kimura H, Aleksic B, Ozaki N. Issues on the diagnosis and etiopathogenesis of mood disorders: reconsidering DSM-5. J Neural Transm (Vienna) 2017; 125:211-222. [PMID: 29275445 DOI: 10.1007/s00702-017-1828-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 12/12/2017] [Indexed: 10/18/2022]
Abstract
The authors present a narrative review from the diagnostic and nosologic viewpoints of mood disorders (bipolar and depressive ones) by revisiting the revision from the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, Text Revision to DSM-5, including the following: the separation of the bipolar and depressive sections; the addition of increased energy and continuation of symptoms to the hypo/manic criteria; the elimination of mixed episodes; the creation of new categories and specifiers ("other specified bipolar and related disorder", "disruptive mood dysregulation disorder", "with anxious distress", "with mixed features", "with peripartum onset"); the categorization of hypo/manic episodes during antidepressant treatment into bipolar disorder; the elimination of the "bereavement exclusion"; the ambiguous separation between bipolar I and II; the insufficient distinction between "other specified bipolar and related disorders" and major depressive disorder; the differentiation regarding borderline personality disorder; agitation; premenstrual dysphoric disorder; and society and psychiatry. Through this analysis, we point out both the achievements and limitations of DSM-5. In addition, to examine the future direction of psychiatry, we introduce our cohort study regarding maternal depression and an outline of the National Institute of Mental Health's Research Domain Criteria project in the US. Finally, we advocate the importance of elucidating etiopathogeneses by starting from or going beyond the DSM operational diagnostic system, which has shown great efficacy.
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Affiliation(s)
- Kazuyoshi Ogasawara
- Bioethics Research Center, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan. .,Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Yukako Nakamura
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Hiroyuki Kimura
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Branko Aleksic
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Norio Ozaki
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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