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Jha MK, Minhajuddin A, Chin Fatt C, Kircanski K, Stringaris A, Leibenluft E, Trivedi MH. Association between irritability and suicidal ideation in three clinical trials of adults with major depressive disorder. Neuropsychopharmacology 2020; 45:2147-2154. [PMID: 32663842 PMCID: PMC7784964 DOI: 10.1038/s41386-020-0769-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/19/2020] [Accepted: 07/08/2020] [Indexed: 12/19/2022]
Abstract
Irritability in pediatric samples is associated with higher rates of subsequent suicide-related outcomes. No study, to date, has evaluated the longitudinal association between irritability and suicidal ideation (SI) in adults with major depressive disorder (MDD). This report evaluated whether irritability is associated with SI at the same visit (i.e., concurrently) and whether early changes in irritability with antidepressant treatment predict subsequent levels of SI. Participants of Combining Medications to Enhance Depression Outcomes (CO-MED, n = 665), Establishing Moderators and Biosignatures of Antidepressant Response in Clinical Care (EMBARC, n = 296), and Suicide Assessment Methodology Study (SAMS, n = 266) were included. Repeated-measures mixed model analyses evaluated concurrent association throughout the trial between irritability (five-item irritability domain of Concise Associated Symptom Tracking scale) and SI (three-item suicidal thoughts factor of Concise Health Risk Tracking scale) after controlling for overall depression (excluding suicidality-related item), and predicted subsequent levels of SI (repeated observations from week-2-to-week-8) based on early (baseline-to-week-2) changes in irritability after controlling for early changes in overall depression. Higher irritability was associated with higher SI concurrently; estimates (standard error) were 0.18 (0.02, p < 0.0001), 0.64 (0.02, p < 0.0001), and 0.26 (0.04, p < 0.0001) in CO-MED, EMBARC, and SAMS respectively. Greater baseline-to-week-2 reductions in irritability predicted lower levels of subsequent SI; estimates (standard errors) were -0.08 (0.03, p = 0.023), -0.50 (0.05, p < 0.0001), and -0.12 (0.05, p = 0.024) in CO-MED, EMBARC, and SAMS, respectively. Controlling for anxiety or insomnia produced similar results. In conclusion, irritability and SI were consistently linked in adults with MDD. These findings support careful assessment of irritability in suicide risk assessment.
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Affiliation(s)
- Manish K Jha
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY, 10029, USA
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9119, USA
| | - Abu Minhajuddin
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9119, USA
| | - Cherise Chin Fatt
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9119, USA
| | | | - Argyris Stringaris
- National Institute of Mental Health, 10 Center Dr, Bethesda, MD, 20814, USA
| | - Ellen Leibenluft
- National Institute of Mental Health, 10 Center Dr, Bethesda, MD, 20814, USA
| | - Madhukar H Trivedi
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9119, USA.
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102
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ZHANG L, YAO B, ZHANG X, XU H. Effects of Irritability of the Youth on Subjective Well-Being: Mediating Effect of Coping Styles. IRANIAN JOURNAL OF PUBLIC HEALTH 2020; 49:1848-1856. [PMID: 33346241 PMCID: PMC7719647 DOI: 10.18502/ijph.v49i10.4685] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/21/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND The global COVID-19 pandemic caused great impacts and influences to human psychology. As a result, youths who are kept at home for a long time easily develop irritability and problematic behaviors. However, relatively little attention has been paid to the relations among irritability, coping style, and subjective well-being of the youth. METHODS Overall, 1,033 youth respondents (aged 18-30 yr) from seven provinces in China were investigated in 2020 using the irritability, depression, and anxiety scale, coping style scale, and well-being index scale. RESULTS Among the dimensions of irritability of the youth, anxiety received the highest score, followed by introversion irritability, extroversion irritability, and depression. Irritability had significant regional differences. The total score of irritability among rural youth was significantly higher than that of urban youth (P<0.05). The irritability level of youths with parents' emotional status was harmonious and good relations with family members and peers was far lower than those of youths who have poor relations between parents, family members, and peers (P<0.05). The irritability level of youths with a lower monthly household income was higher (P<0.05). Irritability of the youth had significantly negative correlations with positive response and SWB, and it had a significantly positive correlative with negative response. Coping style can mediate the relationship between irritability and SWB of the youth to some extent. CONCLUSION Significant correlations exist among irritability, coping style, and SWB of the youth. Irritability can be used to predict SWB indirectly through positive response.
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Affiliation(s)
- Ling ZHANG
- Center for Mental Health, Shaoxing University, Shaoxing, China
| | - Benxian YAO
- College of Educational Science, Anhui Normal University, Wuhu, China
| | - Xiaodan ZHANG
- College of Teacher Education, Hefei Normal University, Hefei, China
| | - Hao XU
- Center for Mental Health, Shaoxing University, Shaoxing, China
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103
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Beltrán-Velasco AI, Mendoza-Castejón D, Fuentes-García JP, Clemente-Suárez VJ. Behavioural, psychological, and physiological stress markers and academic performance in immigrant and non-immigrant preschool and school students. Physiol Behav 2020; 225:113081. [DOI: 10.1016/j.physbeh.2020.113081] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/11/2020] [Accepted: 07/15/2020] [Indexed: 11/27/2022]
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Drechsler R, Brem S, Brandeis D, Grünblatt E, Berger G, Walitza S. ADHD: Current Concepts and Treatments in Children and Adolescents. Neuropediatrics 2020; 51:315-335. [PMID: 32559806 PMCID: PMC7508636 DOI: 10.1055/s-0040-1701658] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 11/28/2019] [Indexed: 12/17/2022]
Abstract
Attention deficit hyperactivity disorder (ADHD) is among the most frequent disorders within child and adolescent psychiatry, with a prevalence of over 5%. Nosological systems, such as the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) and the International Classification of Diseases, editions 10 and 11 (ICD-10/11) continue to define ADHD according to behavioral criteria, based on observation and on informant reports. Despite an overwhelming body of research on ADHD over the last 10 to 20 years, valid neurobiological markers or other objective criteria that may lead to unequivocal diagnostic classification are still lacking. On the contrary, the concept of ADHD seems to have become broader and more heterogeneous. Thus, the diagnosis and treatment of ADHD are still challenging for clinicians, necessitating increased reliance on their expertise and experience. The first part of this review presents an overview of the current definitions of the disorder (DSM-5, ICD-10/11). Furthermore, it discusses more controversial aspects of the construct of ADHD, including the dimensional versus categorical approach, alternative ADHD constructs, and aspects pertaining to epidemiology and prevalence. The second part focuses on comorbidities, on the difficulty of distinguishing between "primary" and "secondary" ADHD for purposes of differential diagnosis, and on clinical diagnostic procedures. In the third and most prominent part, an overview of current neurobiological concepts of ADHD is given, including neuropsychological and neurophysiological researches and summaries of current neuroimaging and genetic studies. Finally, treatment options are reviewed, including a discussion of multimodal, pharmacological, and nonpharmacological interventions and their evidence base.
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Affiliation(s)
- Renate Drechsler
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Silvia Brem
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, Swiss Federal Institute of Technology and University of Zurich, Zurich, Switzerland
| | - Daniel Brandeis
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, Swiss Federal Institute of Technology and University of Zurich, Zurich, Switzerland
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Edna Grünblatt
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, Swiss Federal Institute of Technology and University of Zurich, Zurich, Switzerland
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Gregor Berger
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, Swiss Federal Institute of Technology and University of Zurich, Zurich, Switzerland
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
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Liuzzi MT, Kryza-Lacombe M, Christian IR, Palumbo D, Amir N, Wiggins JL. Neural and behavioral correlates of inhibitory control in youths with varying levels of irritability. J Affect Disord 2020; 273:567-575. [PMID: 32560955 PMCID: PMC7945044 DOI: 10.1016/j.jad.2020.04.049] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Irritability, a relatively lowered threshold for anger, is prevalent in typically and atypically developing youths. Inhibitory control, the ability to suppress behaviors counter to goals, is essential for regulating emotions, including anger. Understanding how irritability relates to behavioral and neural markers of inhibitory control may inform interventions. METHODS Youths (N=52; mean age=13.78) completed a Flanker task on an iPad to measure behavioral correlates of inhibitory control; a subsample (n=19; mean age=13.21) additionally completed a similar task while undergoing fMRI acquisition to evaluate inhibitory control on a neural level. Irritability was measured using the Affective Reactivity Index. Associations between irritability and inhibitory control were evaluated behaviorally (via Pearson correlations), and neurally (via ANCOVAs with whole-brain activation and amygdala connectivity). RESULTS fMRI results indicated that higher levels of irritability were associated with aberrant activation (in middle frontal gyrus, amygdala/parahippocampal gyrus, anterior cingulate, lentiform nucleus/striatum) and left amygdala connectivity (with middle temporal gyrus, parahippocampal gyrus, posterior cingulate, fusiform gyrus, and thalamus). Behavioral results were mixed. LIMITATIONS Longitudinal studies are needed to characterize changes in neural circuitry and delineate whether the brain profiles precede or are a consequence of symptoms. Larger samples powered to examine multiple irritability-related symptom dimensions will be necessary to elucidate shared vs. disorder-specific irritability mechanisms. CONCLUSIONS Findings suggest that pediatric irritability may be related to neural processes involving inhibitory control. Further, findings underscore the importance of neuroimaging in investigating symptom dimensions such as irritability, as neuroimaging may be more sensitive in detecting underlying abnormalities compared to behavioral data alone.
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Affiliation(s)
- Michael T. Liuzzi
- San Diego State University, Department of Psychology, San Diego, CA, U.S.A
| | - Maria Kryza-Lacombe
- San Diego State University/University of California, San Diego, Joint Doctoral Program in Clinical Psychology, San Diego, CA, U.S.A
| | | | - Danielle Palumbo
- San Diego State University, Department of Psychology, San Diego, CA, U.S.A
| | - Nader Amir
- San Diego State University, Department of Psychology, San Diego, CA, U.S.A.,San Diego State University/University of California, San Diego, Joint Doctoral Program in Clinical Psychology, San Diego, CA, U.S.A
| | - Jillian Lee Wiggins
- San Diego State University, Department of Psychology, San Diego, CA, U.S.A.,San Diego State University/University of California, San Diego, Joint Doctoral Program in Clinical Psychology, San Diego, CA, U.S.A
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106
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Deveney CM, Grasso D, Hsu A, Pine DS, Estabrook CR, Zobel E, Burns JL, Wakschlag LS, Briggs-Gowan MJ. Multi-method assessment of irritability and differential linkages to neurophysiological indicators of attention allocation to emotional faces in young children. Dev Psychobiol 2020; 62:600-616. [PMID: 31631345 PMCID: PMC7328764 DOI: 10.1002/dev.21930] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 08/25/2019] [Accepted: 09/09/2019] [Indexed: 01/31/2023]
Abstract
Facilitated attention toward angry stimuli (attention bias) may contribute to anger proneness and temper outbursts exhibited by children with high irritability. However, most studies linking attention bias and irritability rely on behavioral measures with limited precision and no studies have explored these associations in young children. The present study explores irritability-related attention biases toward anger in young children (N = 128; ages 4-7 years) engaged in a dot-probe task with emotional faces, as assessed with event-related brain potential (ERP) indices of early selective attention and multi-method assessment of irritability. Irritability assessed via semi-structured clinical interview predicted larger anterior N1 amplitudes to all faces. In contrast, irritability assessed via a laboratory observation paradigm predicted reduced P1 amplitudes to angry relative to neutral faces. These findings suggest that altered early attentional processing occurs in young children with high irritability; however, the nature of these patterns may vary with methodological features of the irritability assessments. Future investigations using different assessment tools may provide greater clarity regarding the underlying neurocognitive correlates of irritability. Such studies may also contribute to the ongoing debates about how to best define and measure irritability across the developmental spectrum in a manner that is most informative for linkage to neural processes.
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Affiliation(s)
| | - Damion Grasso
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Amy Hsu
- Department of Psychology, Wellesley College, Wellesley, MA, USA
| | - Daniel S. Pine
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Christopher R. Estabrook
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA
| | - Elvira Zobel
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - James L. Burns
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Lauren S. Wakschlag
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA
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Abstract
Research into irritability has focused largely on its developmental and child-adolescent manifestations. Although irritability appears to be as elemental an experience as anxiety or depression, diagnoses highlighting irritability as the focal ingredient have yet to be delineated for adults. Instead, irritability-related diagnoses in adults have largely emphasized externalizing behaviors, depressed mood, and personality. Consequently, patients complaining of irritability are sometimes shoehorned into diagnostic categories that they do not experience as authentic representations of their lived experiences. This article proposes that the symptom of irritability might be productively reenvisioned as a focal point, analogous to anxiety and depression, around which irritability-related syndromes and disorders in adults might coalesce. If anxiety, depressive, insomnia, and pain disorders, why not irritability disorders? Both state and trait characteristics of irritability can lend themselves to DSM diagnostic frames. Based on clinical observations, specific irritability disorders in adults can be envisioned, modeled as Irritability Disorder of Adulthood, Irritability Disorder Secondary to Another Medical Condition, Substance-Induced Irritability Disorder, Adjustment Disorder With Irritable Mood, and the like. Further delineation of irritability phenomena, syndromes, and possible disorders in adults is warranted to advance investigation, guide assessment, and improve treatment.
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Affiliation(s)
- Joel Yager
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado
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108
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Zentner M. Identifying child temperament risk factors from 2 to 8 years of age: validation of a brief temperament screening tool in the US, Europe, and China. Eur Child Adolesc Psychiatry 2020; 29:665-678. [PMID: 31414220 PMCID: PMC7250798 DOI: 10.1007/s00787-019-01379-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/22/2019] [Indexed: 11/26/2022]
Abstract
Despite ample evidence linking particular child temperament characteristics to behavior disorders later in life, there is currently a lack of temperament measures that can be used early, easily, and widely for screening purposes. To redress this gap, the current research aimed at developing a very brief scale of child temperament characteristics that have been found to predict behavior problems over the long term, are represented across models of temperament, and have the potential to exhibit measurement invariance over different countries and childhood periods. The new scale was derived from the Integrative Child Temperament Inventory, a 30-item measure to assess five well-established temperament dimensions, and examined in three studies with samples of children aged between 2 and 8 years across five countries: The United States, the United Kingdom, China, Germany, and Spain (N = 13,425; boys 55.96%). The studies included tests of measurements invariance, of convergent validity with established measures of temperament, and of criterion validity with measures of behavior problems. The scale exhibited full metric invariance and partial scalar invariance across age groups (toddlerhood, preschool, school age) and countries. Test-retest reliability, interrater reliability across teachers, and convergent and criterion validity were adequate. Preliminary data on the measure's clinical utility suggest a favorable balance between brevity and screening accuracy. Altogether, this study suggests that early childhood temperament characteristics placing children at risk for developing behavior problems much later in life can be quickly, effectively, and commensurably assessed across different countries and age groups.
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Affiliation(s)
- Marcel Zentner
- Department of Psychology, University of Innsbruck, Innrain 52, 6020, Innsbruck, Austria.
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109
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Trait irritability and social cue identification and interpretation in young adult females. PERSONALITY AND INDIVIDUAL DIFFERENCES 2020. [DOI: 10.1016/j.paid.2019.109751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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110
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Uçar HN, Tekin U, Tekin E. Irritability and its relationships with psychological symptoms in adolescents with migraine: a case-control study. Neurol Sci 2020; 41:2461-2470. [PMID: 32212010 DOI: 10.1007/s10072-020-04331-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 03/05/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to investigate self- and parent-reported irritability in adolescents with migraine and to evaluate the relationship between self- and parent-reported irritability and psychological symptoms in adolescents with migraine. METHODS The sample of this single-center cross-sectional case-control study consisted of 71 adolescents with migraine (who were followed in a pediatric neurology clinic) and their parents. The control group consisted of 41 age- and sex-matched healthy adolescents and their parents. RESULTS It was observed that there were significant differences in both self- (p < 0.001) and parent-reported (p < 0.001) irritability scores between the migraine and control groups. When the two groups were compared in terms of psychological symptoms, adolescents with migraine had significantly higher levels of anxiety (p < 0.001) and emotional problems (p < 0.001) than their healthy peers. This significant difference persisted even after controlling for confounding factors such as age, gender, family income, and maternal and paternal educational level. Our results revealed a moderate positive correlation between irritability scores and anxiety scores (r = 0.522, p < 0.001) and between irritability scores and emotional/behavioral problem scores (r = 0.487, p < 0.001) in the migraine group. In addition to these results, the odds ratios of self-reported irritability scores and emotional problem scores for migraine were 1.31 and 1.41, respectively. CONCLUSION The levels of anxiety, emotional/behavioral, and attention deficit/hyperactivity problems increased as the levels of irritability increased in the migraine group, suggesting that the psychosocial functionality of these adolescents may be impaired. Therefore, all adolescents with migraine (especially those with irritability) may have need of psychosocial support.
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Affiliation(s)
- Halit Necmi Uçar
- Department of Child and Adolescent Psychiatry, Selçuk University Medical School, Konya, Turkey.
| | - Uğur Tekin
- Department of Child and Adolescent Psychiatry, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Emine Tekin
- Department of Child Neurology, Giresun University Medical School, Giresun, Turkey
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111
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Levy T, Kronenberg S, Crosbie J, Schachar RJ. Attention-deficit/hyperactivity disorder (ADHD) symptoms and suicidality in children: The mediating role of depression, irritability and anxiety symptoms. J Affect Disord 2020; 265:200-206. [PMID: 32090742 DOI: 10.1016/j.jad.2020.01.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 11/22/2019] [Accepted: 01/05/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is associated with increased suicidality risk. Yet, potential mechanisms transmitting the effect of ADHD to suicidality remain unclear. We investigated whether depression, irritability and anxiety symptoms mediate between ADHD symptoms and suicidality. METHODS ADHD, depression, irritability and anxiety symptoms as well as suicidality (composited of suicidal ideation, attempts or self-harm) were measured in an outpatient clinic for ADHD (N = 1,516, 6-17 years old, 61.1% diagnosed with ADHD) using parent and teacher questionnaires. Multiple mediator models adjusted for age, sex and psychosocial adversities were constructed separately for parent- and teacher-report. RESULTS Parents reported higher rates of suicidality than did teachers (12.1% and 3.8%, p < .001). Suicidality was associated with parent (OR = 1.10, 95%CI: 1.07-1.14) and teacher (OR = 1.08, 95%CI: 1.03-1.15) reported ADHD symptoms. The association between ADHD symptoms and suicidality was mediated by both parent- and teacher-reported depression (39.1% and 45.3% of total effect, respectively) and irritability symptoms (36.8% and 38.4% of total effect, respectively). Anxiety symptoms mediated between ADHD and suicidality for parent- but not teacher-report (19.0% of total effect). No direct effect of ADHD symptoms was found once depression, irritability and anxiety were controlled. LIMITATIONS The cross-sectional design limits the ability to determine causal order between mediators and outcome. CONCLUSIONS Our results confirmed the association between ADHD symptoms and suicidality. However, this association was indirect and fully mediated by symptoms of depression, irritability and anxiety. Assessing these symptoms may enable an estimate of suicidality and help managing suicidal risk in ADHD.
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Affiliation(s)
- Tomer Levy
- Department of Psychiatry, The Hospital for Sick Children, Toronto M5G 1X8, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Sefi Kronenberg
- Department of Psychiatry, The Hospital for Sick Children, Toronto M5G 1X8, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jennifer Crosbie
- Department of Psychiatry, The Hospital for Sick Children, Toronto M5G 1X8, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Russell James Schachar
- Department of Psychiatry, The Hospital for Sick Children, Toronto M5G 1X8, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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112
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Seymour KE, Rosch KS, Tiedemann A, Mostofsky SH. The Validity of a Frustration Paradigm to Assess the Effect of Frustration on Cognitive Control in School-Age Children. Behav Ther 2020; 51:268-282. [PMID: 32138937 PMCID: PMC7523008 DOI: 10.1016/j.beth.2019.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 02/03/2023]
Abstract
Irritability refers to a proneness for anger, and is a symptom of internalizing and externalizing psychopathology. Since irritability is associated with significant cross-sectional and longitudinal impairments, research on the behavioral and neural correlates of pediatric irritability in populations at risk for significant irritability is of paramount importance. Irritability can be assessed in the laboratory using behavioral paradigms that elicit frustration. Few behavioral frustration paradigms have been designed to measure the effects of frustration on cognitive control. Therefore, the goal of the present study was to validate a behavioral frustration paradigm for use in school-age children which addressed some of the limitations of prior research. Participants included children, ages 8-12 years, who were either typically developing (TD; n = 38) or diagnosed with attention-deficit/hyperactivity disorder (ADHD; n = 67), which provided a sample of children with a range of baseline irritability. All participants completed the Frustration Go/No-Go (GNG) task, and self-reported irritability was assessed using the Affective Reactivity Index. Results showed that across participants, self-reported frustration, commission error rate, and tau all increased with the addition of frustration, with similar effect sizes in ADHD and TD groups. Further, self-reported irritability, moreso than ADHD symptoms, predicted changes in self-reported frustration during the task. Together, these results support the construct validity of the Frustration GNG task as a means of assessing the effect of frustration on cognitive control. Clinical applications and future directions are discussed.
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Affiliation(s)
- Karen E. Seymour
- Johns Hopkins University School of Medicine, Johns Hopkins University Bloomberg School of Public Health, Kennedy Krieger Institute
| | - Keri S. Rosch
- Johns Hopkins University School of Medicine, Kennedy Krieger Institute
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Haller SP, Kircanski K, Stringaris A, Clayton M, Bui H, Agorsor C, Cardenas SI, Towbin KE, Pine DS, Leibenluft E, Brotman MA. The Clinician Affective Reactivity Index: Validity and Reliability of a Clinician-Rated Assessment of Irritability. Behav Ther 2020; 51:283-293. [PMID: 32138938 PMCID: PMC7060970 DOI: 10.1016/j.beth.2019.10.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 09/22/2019] [Accepted: 10/11/2019] [Indexed: 10/25/2022]
Abstract
Irritability is impairing in youth and is the core feature of disruptive mood dysregulation disorder (DMDD). Currently, there are no established clinician-rated instruments to assess irritability in pediatric research and clinical settings. Clinician-rated measures ensure consistency of assessment across patients and are important specifically for treatment research. Here, we present data on the psychometric properties of the Clinician Affective Reactivity Index (CL-ARI), the first semistructured interview focused on pediatric irritability. The CL-ARI was administered to a transdiagnostic sample of 98 youth (M age = 12.66, SD = 2.47; 41% female). With respect to convergent validity, CL-ARI scores were (a) significantly higher for youth with DMDD than for any other diagnostic group, and (b) showed uniquely strong associations with other clinician-, parent-, and youth-report measures of irritability compared to measures of related constructs, such as anxiety. The three subscales of the CL-ARI (temper outbursts, irritable mood, impairment) showed excellent internal consistency. Test-retest reliability of the CL-ARI was adequate. These data support that irritability can be feasibly, validly, and reliably assessed by clinicians using the CL-ARI. A validated, gold-standard assessment of pediatric irritability is critical in advancing research and treatment efforts.
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Shimshoni Y, Lebowitz ER, Brotman MA, Pine DS, Leibenluft E, Silverman WK. Anxious-Irritable Children: A Distinct Subtype of Childhood Anxiety? Behav Ther 2020; 51:211-222. [PMID: 32138933 PMCID: PMC7080292 DOI: 10.1016/j.beth.2019.06.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 12/18/2022]
Abstract
Children with anxiety disorders often present with other co-occurring symptom clusters, of which irritability is among the most highly co-occurring. Despite compelling clinical and pathophysiological evidence linking anxiety and irritability, little is known regarding the clinical presentation and associated impairment of children with both anxiety and irritability. In this study, our aims were to confirm the preponderance of irritability in clinically anxious children and compare clinically anxious children with irritability to those without irritability across sociodemographic, clinical, psychosocial, and family domains. Participants were 230 children with anxiety disorders (ages 6-14 years) and their mothers, and 91 healthy controls (ages 6-17 years) and their mothers. Of the clinically anxious children, 121 were anxious and irritable; 109 were anxious but not irritable. Irritability levels were significantly higher in the clinically anxious children compared with the healthy controls. Children with anxiety disorders and irritability presented with greater severity and impairment across clinical phenomenology, psychosocial, and family domains relative to anxious children without irritability. Regression analysis findings were convergent in that greater severity and impairment across these same domains predicted higher irritability levels in the children with anxiety disorders. Results support the meaningful distinction between anxious children with and without irritability. Implications of the findings are discussed particularly in regard to assessment and treatment and future research directions are delineated.
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Affiliation(s)
| | - Eli R. Lebowitz
- Yale University Child Study Center, 230 S. Frontage Rd. New Haven, CT, USA
| | - Melissa A. Brotman
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Daniel S. Pine
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Ellen Leibenluft
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Wendy K. Silverman
- Yale University Child Study Center, 230 S. Frontage Rd. New Haven, CT, USA
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115
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Waschbusch DA, Baweja R, Babinski DE, Mayes SD, Waxmonsky JG. Irritability and Limited Prosocial Emotions/Callous-Unemotional Traits in Elementary-School-Age Children. Behav Ther 2020; 51:223-237. [PMID: 32138934 DOI: 10.1016/j.beth.2019.06.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 06/13/2019] [Accepted: 06/17/2019] [Indexed: 01/06/2023]
Abstract
Affective traits, including irritability and limited prosocial emotions/callous-unemotional traits (LPE/CU), each explain significant variance in youth conduct problems but few studies have examined these constructs simultaneously. This study examined whether irritability, LPE/CU, or their combination explained significant variance in measures of internalizing or externalizing psychopathology, aggression, peer problems, impairment, or parenting. Participants were 219 elementary-school-age children, including 178 with attention-deficit/hyperactivity disorder, oppositional defiant disorder, and/or conduct disorder and 41 typically developing children. Results of analyses showed that irritability and LPE/CU had significant and sometimes unique associations with measures of child behavior, impairment, and parenting. There was also evidence that the interaction between irritability and LPE/CU was significantly associated with aggression and impairment. These findings suggest that irritability and LPE/CU should be examined together when assessing and treating conduct problems in youth.
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Affiliation(s)
- Daniel A Waschbusch
- Penn State College of Medicine and Penn State Milton S. Hershey Medical Center.
| | - Raman Baweja
- Penn State College of Medicine and Penn State Milton S. Hershey Medical Center
| | - Dara E Babinski
- Penn State College of Medicine and Penn State Milton S. Hershey Medical Center
| | - Susan D Mayes
- Penn State College of Medicine and Penn State Milton S. Hershey Medical Center
| | - James G Waxmonsky
- Penn State College of Medicine and Penn State Milton S. Hershey Medical Center
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116
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Beauchaine TP, Tackett JL. Irritability as a Transdiagnostic Vulnerability Trait:Current Issues and Future Directions. Behav Ther 2020; 51:350-364. [PMID: 32138943 DOI: 10.1016/j.beth.2019.10.009] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 10/21/2019] [Accepted: 10/21/2019] [Indexed: 12/13/2022]
Abstract
In recent years, irritability has received increasing attention among mental health professionals given its transdiagnostic associations with diverse forms of psychopathology. In contrast to other emotional states and traits, however, literature addressing associations between irritability and related temperament and personality constructs is limited. In addition, those who study irritability have diverse perspectives on its neurobiological substrates. In this comment, we situate irritability in the literatures on child temperament and adult personality, and describe a model in which irritability derives from low tonic dopamine (DA) levels and low phasic DA reactivity in subcortical neural structures implicated in appetitive responding. We note that different findings often emerge in neuroimaging studies when irritability is assessed in circumscribed diagnostic groups versus representative samples. We conclude with directions for future research, and propose that more authors use hierarchical Bayesian modeling, which captures functional dependencies between irritability and other dispositional traits (e.g., trait anxiety) that standard regression models are insensitive too. Treatment implications are also considered.
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117
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Evans SC, Blossom JB, Fite PJ. Exploring Longitudinal Mechanisms of Irritability in Children: Implications for Cognitive-Behavioral Intervention. Behav Ther 2020; 51:238-252. [PMID: 32138935 DOI: 10.1016/j.beth.2019.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 03/30/2019] [Accepted: 05/10/2019] [Indexed: 12/19/2022]
Abstract
Severe irritability is a common and clinically important problem longitudinally associated with internalizing and externalizing problems in children. To better understand these mechanisms and to inform treatment research, we tested cognitive-behavioral processes as candidate mediators in the paths from irritability to later problems. Methods: A school sample (N = 238, 48% female, ages 8-10) was assessed at ~6-month intervals in fall (T1) and spring (T2) of third to fourth grade, and again the following fall (T3). Measures assessed irritability (T1/predictor); anger and sadness coping, intolerance of uncertainty, and rumination; (T1-T2/mediators); and anxiety, depressive symptoms, reactive aggression, and oppositionality (T1-T3/outcomes). Focused cross-lagged panel models, controlling for gender and grade, were specified to examine full (XT1 ➔ MT2 ➔ YT3) and half (XT1 ➔ MT2; MT1 ➔ YT2) longitudinal mediation. Across one or more intervals, irritability predicted higher depressive symptoms, anxiety, reactive aggression, oppositionality, intolerance of uncertainty, and poor emotion coping. From T1 irritability to T2/T3 outcomes, mediation was found for poor sadness coping leading to reactive aggression and oppositionality; poor anger coping to anxiety, depressive symptoms, and oppositionality; and intolerance of uncertainty to anxiety. Results offer further evidence for internalizing and externalizing outcomes of youth irritability and new evidence suggesting underlying mechanisms. Irritability may confer risk for externalizing problems via poor sadness/anger coping, and for internalizing problems via poor anger coping and intolerance of uncertainty. Theoretical models and psychosocial treatment should consider addressing regulation of various unpleasant emotions as well as psychological flexibility and tolerating uncertainty.
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Affiliation(s)
| | - Jennifer B Blossom
- Seattle Children's Hospital and University of Washington School of Medicine
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118
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Loring DW, Meador KJ, Shinnar S, Gaillard WD, Wheless JW, Kessler SK, Conry JA, Berl MM, Burns TG, Glauser TA, Kinkead B, Cnaan A. Differential antiseizure medication sensitivity of the Affective Reactivity Index: A randomized controlled trial in new-onset pediatric focal epilepsy. Epilepsy Behav 2020; 102:106687. [PMID: 31816478 PMCID: PMC7232830 DOI: 10.1016/j.yebeh.2019.106687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/04/2019] [Accepted: 11/04/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Irritability is a adverse effect of many antiseizure medications (ASMs), but there are no validated measures currently available to characterize this behavioral risk. We examined both child and parent/guardian versions of the Affective Reactivity Index (ARI), a validated measure developed for application in adolescent psychiatry, to determine its sensitivity to ASM-related irritability. We hypothesized irritability increases associated with levetiracetam (LEV) but not lamotrigine (LTG) or oxcarbazepine (OXC). METHOD The ARI was administered to 71 child and parent/guardian pairs randomized to one of three common ASMs (LEV, LTG, OXC) used to treat new-onset focal (localization-related) epilepsy. Subjects were recruited as part of a prospective multicenter, randomized, open-label, parallel group design. The ARI was administered at baseline prior to treatment initiation and again at 3 months after ASM initiation. RESULTS There was a significant increase in ARI ratings for both child and parent/guardian ratings for LEV but not LTG or OXC when assessed 3 months after treatment initiation. When examined on the individual subject level using a criterion of at least a 3-point ARI increase, there was an increase associated with LEV for child ratings but not parent/guardian scores. CONCLUSION Both child and parent/guardian versions of the ARI appear sensitive to medication-induced irritability associated with LEV on both the group and individual levels. The findings extend the applicability of ARI from characterizing the presence of clinical irritability as a psychiatric diagnostic feature to a more modifiable aspect of behavior change related to medication management and support its use in clinical trial applications.
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Affiliation(s)
- David W. Loring
- Departments of Neurology and Pediatrics, Emory University,
Atlanta, GA, United States of America,Corresponding author at: Emory University Brain
Health Center, 12 Executive Park, Atlanta, GA 30329, United States of America.
(D.W. Loring)
| | - Kimford J. Meador
- Department of Neurology & Neurological Sciences,
Stanford University, Palo Alto, CA, United States of America
| | - Shlomo Shinnar
- Departments of Neurology, Pediatrics, Epidemiology &
Population Health, Montefiore Medical Center, Albert Einstein College of Medicine,
Bronx, NY, United States of America
| | - William Davis Gaillard
- Department of Neurology, Children’s National Health
System, Washington, DC, United States of America
| | - James W. Wheless
- Department of Pediatrics, Division of Neurology, University
of Tennessee Health Science Center, Le Bonheur Children’s Hospital, Memphis,
TN, United States of America
| | - Sudha K. Kessler
- Division of Neurology, Children’s Hospital of
Philadelphia, Departments of Neurology and Pediatrics, University of Pennsylvania,
Philadelphia, PA, United States of America
| | - Joan A. Conry
- Department of Neurology, Children’s National Health
System, Washington, DC, United States of America
| | - Madison M. Berl
- Department of Neuropsychology, Children’s National
Health System, Washington, DC, United States of America
| | - Thomas G. Burns
- Department of Neuropsychology, Children’s Healthcare
of Atlanta, Atlanta, GA, United States of America
| | - Tracy A. Glauser
- Division of Neurology, Cincinnati Children’s
Hospital Medical Center and Department of Pediatrics, University of Cincinnati
College of Medicine, Cincinnati, OH, United States of America
| | - Becky Kinkead
- Department of Psychiatry and Behavioral Science, Emory
University, Atlanta, GA, United States of America
| | - Avital Cnaan
- Department of Pediatrics, George Washington University,
Washington, DC, United States of America
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119
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Moore AA, Lapato DM, Brotman MA, Leibenluft E, Aggen SH, Hettema JM, York TP, Silberg JL, Roberson-Nay R. Heritability, stability, and prevalence of tonic and phasic irritability as indicators of disruptive mood dysregulation disorder. J Child Psychol Psychiatry 2019; 60:1032-1041. [PMID: 30994196 PMCID: PMC6692198 DOI: 10.1111/jcpp.13062] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/12/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Little is known about genetic and environmental influences on the components of disruptive mood dysregulation disorder (DMDD), tonic irritability (i.e., irritable mood) and phasic irritability (i.e., temper outbursts). This study examined prevalence, stability, and heritability of tonic irritability, phasic irritability, and a DMDD proxy (pDMDD) based on DSM-5 criteria. METHODS pDMDD was derived using data from clinical interviews of parents and their twins (N = 1,431 twin pairs), ages 8-17, participating in Waves 1 and 2 of the Virginia Twin Study of Adolescent Behavioral Development. Biometrical modeling was used to compare a common pathway model (CPM) and an independent pathway model (IPM), and heritability estimates were obtained for pDMDD using the symptoms of irritable mood (tonic irritability; DMDD Criterion D), intense temper outbursts (phasic irritability; DMDD Criterion A), and frequent temper outbursts (phasic irritability; DMDD Criterion C). RESULTS Lifetime prevalence of pDMDD was 7.46%. The stability of DMDD symptoms and the pDMDD phenotype across approximately one year were moderate (.30-.69). A CPM was a better fit to the data than an IPM. Phasic irritability loaded strongly onto the pDMDD latent factor (.89-.96) whereas tonic irritability did not (.28). Genetic influences accounted for approximately 59% of the variance in the latent pDMDD phenotype, with the remaining 41% of the variance due to unique environmental effects. The heritability of tonic irritability (54%) was slightly lower than that of frequent and intense temper (components of phasic irritability; 61% and 63%, respectively). CONCLUSIONS Compared to tonic irritability, phasic irritability appears to be slightly more stable and heritable, as well as a stronger indicator of the latent factor. Furthermore, environmental experiences appear to play a substantial role in the development of irritability and DMDD, and researchers should seek to elucidate these mechanisms in future work.
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Affiliation(s)
- Ashlee A. Moore
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA
- Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, VA
| | - Dana M. Lapato
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA
- Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, VA
| | - Melissa A. Brotman
- Emotion and Development Branch, National Institutes of Mental Health, National Institutes of Health Department of Health and Human Services, Bethesda, MD
| | - Ellen Leibenluft
- Emotion and Development Branch, National Institutes of Mental Health, National Institutes of Health Department of Health and Human Services, Bethesda, MD
| | - Steven H. Aggen
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - John M. Hettema
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - Timothy P. York
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA
- Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, VA
| | - Judy L. Silberg
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA
- Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, VA
| | - Roxann Roberson-Nay
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
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120
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Vogel AC, Jackson JJ, Barch DM, Tillman R, Luby JL. Excitability and irritability in preschoolers predicts later psychopathology: The importance of positive and negative emotion dysregulation. Dev Psychopathol 2019; 31:1067-1083. [PMID: 31109387 PMCID: PMC7059859 DOI: 10.1017/s0954579419000609] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Emotion dysregulation is a risk factor for the development of a variety of psychopathologic outcomes. In children, irritability, or dysregulated negative affect, has been the primary focus, as it predicts later negative outcomes even in very young children. However, dysregulation of positive emotion is increasingly recognized as a contributor to psychopathology. Here we used an exploratory factor analysis and defined four factors of emotion dysregulation: irritability, excitability, sadness, and anhedonia, in the preschool-age psychiatric assessment collected in a sample of 302 children ages 3-5 years enriched for early onset depression. The irritability and excitability factor scores defined in preschoolers predicted later diagnosis of mood and externalizing disorders when controlling for other factor scores, social adversity, maternal history of mood disorders, and externalizing diagnoses at baseline. The preschool excitability factor score predicted emotion lability in late childhood and early adolescence when controlling for other factor scores, social adversity, and maternal history. Both excitability and irritability factor scores in preschoolers predicted global functioning into the teen years and early adolescence, respectively. These findings underscore the importance of positive, as well as negative, affect dysregulation as early as the preschool years in predicting later psychopathology, which deserves both further study and clinical consideration.
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Affiliation(s)
- Alecia C. Vogel
- Department of Psychiatry, Washington University in St. Louis School of Medicine
| | - Joshua J. Jackson
- Department of Psychological and Brain Sciences, Washington University in St. Louis
| | - Deanna M. Barch
- Department of Psychiatry, Washington University in St. Louis School of Medicine
- Department of Psychological and Brain Sciences, Washington University in St. Louis
| | - Rebecca Tillman
- Department of Psychiatry, Washington University in St. Louis School of Medicine
| | - Joan L. Luby
- Department of Psychiatry, Washington University in St. Louis School of Medicine
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121
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Evans SC, Bonadio FT, Bearman SK, Ugueto AM, Chorpita BF, Weisz JR. Assessing the Irritable and Defiant Dimensions of Youth Oppositional Behavior Using CBCL and YSR Items. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2019; 49:804-819. [PMID: 31276433 DOI: 10.1080/15374416.2019.1622119] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Research suggests that irritability and defiance are distinct dimensions of youth oppositionality that are differentially associated with internalizing and conduct problems, respectively. Because much of this evidence has emerged with limited psychometric evaluation, we conducted the first multi-informant examination of selected Child Behavior Checklist (CBCL) and Youth Self Report (YSR) items for measuring irritability and defiance in a large clinical sample. Clinically referred youths (N = 1,030; ages 6-15; 43% female, 42% ethnic minority) were assessed prior to treatment using multi-informant rating scales and diagnostic interviews. Analyses examined factor structure, invariance, internal consistency, multi-informant patterns, and convergent, discriminant, and criterion validity with internalizing and externalizing problems/disorders. A correlated 2-factor model of irritability (stubborn/sullen/irritable, mood, temper) and defiance (argues, disobeys-home, disobeys-school) fit well for both informants. Adequate measurement invariance and scale consistency was consistently found for parent-report but not youth-report. With both informants, all hypothesized convergent and discriminant validity associations were supported: irritability and defiance with internalizing and conduct scales, respectively. However, hypothesized criterion validity associations were largely found only by parent-report: irritability with anxiety and depressive disorders, defiance with conduct disorder, and both with oppositional defiant disorder. Results consistently supported the reliability and validity of the CBCL irritability and defiance scales, with somewhat less consistent support for the YSR scales. Thus, CBCL items may provide psychometrically sound assessment of irritability and defiance, whereas further research is needed to advance youth-report and multi-informant strategies. Results also provide further support for a two subdimension model of oppositional defiant disorder symptoms that includes irritability and defiance.
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Affiliation(s)
| | - F Tony Bonadio
- Department of Psychology, Harvard University.,Institute for Innovation and Implementation, School of Social Work , University of Maryland, Baltimore
| | | | - Ana M Ugueto
- Department of Psychiatry, McGovern Medical School, UT Health Science Center at Houston
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122
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Zhang P, Mo L, Torres J, Huang X. Effects of cognitive behavioral therapy on psychological adjustment in Chinese pediatric cancer patients receiving chemotherapy: A randomized trial. Medicine (Baltimore) 2019; 98:e16319. [PMID: 31277176 PMCID: PMC6635241 DOI: 10.1097/md.0000000000016319] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Cognitive behavioral therapy (CBT) has been widely used in pediatric cancer patients to promote psychological adjustment (PA). Considering the diversity of region and culture in China, its effect in Chinese population is not well defined. Therefore, our study is to explore the effect of CBT on improving PA in Chinese pediatric cancer patients receiving chemotherapy. METHODS One hundred four Chinese pediatric cancer patients receiving chemotherapy were divided into CBT group and control group randomly and equally. The resilience and negative mood were applied to evaluate the ability of psychological adjustment (PA). The Conner-Davidson Resilience Scale (CD-RISC) and depression anxiety stress scale (DASS) were employed to measure resilience and negative mood before and after intervention. The SPSS 22.0 software was used to analyze data. RESULTS Prior to the intervention, the ability of psychological adjustment between 2 groups showed no significant difference (P > .05 for all). After intervention, the total CD-RISC score was significantly higher (56.09 ± 7.29 vs 44.75 ± 5.40), whereas the scores of depression (4.57 ± 2.94 vs 7.25 ± 4.25), anxiety (5.83 ± 3.07 vs 8.66 ± 4.92), stress (7.51 ± 4.33 vs 11.17 ± 4.25) were obviously lower in CBT group than those in the control group (P < .05 for all). Moreover, the decline of negative mood score in Yolk sac tumor children was the most evident in CBT group. While the resilience changes of cancer children in stage III was most obvious. CONCLUSIONS CBT can effectively help Chinese pediatric cancer patients modify distorted cognition to have a positive attitude towards cancer and chemotherapy. This treatment enhances resilience and relieves negative mood, which results in good psychological adjustment ability, especially in Yolk sac tumor and stage III. It has a beneficial effect on better treatment cooperation and high long-term quality of life.
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Affiliation(s)
- Ping Zhang
- The Academy of Pediatrics of Chongqing Medical University, Chongqing, China
- Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing
- China International Science and Technology Cooperation base of Child Development and Critical Disorders
- Chongqing Key Laboratory of Pediatrics, Chongqing
| | - Lin Mo
- VIP Outpatient in Children's Hospital of Chongqing Medical University, Chongqing, China
- Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing
- China International Science and Technology Cooperation base of Child Development and Critical Disorders
- Chongqing Key Laboratory of Pediatrics, Chongqing
| | - Joseph Torres
- University Hospital “General Calixto Garcia”; Department of Plastic Surgery and Burns Care, Havana University of Health Sciences, Havana
| | - Xiaoyan Huang
- Department of Oncology, Children's Hospital Affiliated to Chongqing Medical University; Chongqing, China
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123
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Abstract
While emotional dysregulation is a broad construct, the current paper adopts a narrow approach to facilitate translational neuroscience research on pediatric anxiety. The paper first presents data on an adapted version of the antisaccade task and then integrates these data into a research framework. Data on an adapted version of the antisaccade task were collected in 57 youth, including 35 seeking treatment for an anxiety disorder. Associations were examined between performance on the antisaccade task and (a) age, (b) performance on other cognitive-control tasks (i.e., the stop-signal delay and flanker tasks), and (c) level of anxiety symptoms. Better performance on the antisaccade task occurred in older relative to younger subjects and correlated with better performance on the flanker task. Across the 57 youth, higher levels of anxiety correlated with shorter latency for correct antisaccades. These data can be placed within a three-step framework for translational neuroscience research. In the first step, a narrow index of emotion dysregulation is targeted. In the second step, this narrow index is linked to other correlated indicators of the same underlying narrow latent construct. In the third and final step, associations are examined with clinical outcomes and response to treatment.
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124
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Attention-deficit/hyperactivity disorder: An integrated developmental psychopathology and Research Domain Criteria (RDoC) approach. Compr Psychiatry 2019; 90:65-72. [PMID: 30743139 PMCID: PMC6913174 DOI: 10.1016/j.comppsych.2018.12.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 12/22/2018] [Accepted: 12/24/2018] [Indexed: 12/12/2022] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is characterized by heterogeneous behaviors and symptoms, developmental trajectories, and treatment response. Isolating intermediate phenotypes that are superior to current DSM-based nosology in order to explain such heterogeneity is integral to enhancing etiological theory, improving clinical assessment, predicting treatment response, and developing tailored treatments. To this end, this review provides an integrated developmental psychopathology and National Institute of Mental Health Research Domain Criteria (RDoC) approach to ADHD. In particular, associations between ADHD and RDoC domains of cognition (specifically working memory) and positive valence (reward anticipation/delay/receipt) are discussed. These domains are examined across behavioral and neurocircuitry levels of analysis and placed within a developmental context via examining associations among RDoC domains, relevant features of ADHD, and environmental correlates implicated across development. Limitations of the existing literature and proposed future directions are explored. Importantly, future work should focus on novel approaches that account for developmental shifts in functioning of relevant RDoC domains over time, as well as further examination of the interaction across RDoC domains and levels of analysis.
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125
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Deveney CM. Reward processing and irritability in young adults. Biol Psychol 2019; 143:1-9. [DOI: 10.1016/j.biopsycho.2019.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 02/07/2019] [Accepted: 02/08/2019] [Indexed: 11/25/2022]
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126
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Faraone SV, Rostain AL, Blader J, Busch B, Childress AC, Connor DF, Newcorn JH. Practitioner Review: Emotional dysregulation in attention-deficit/hyperactivity disorder - implications for clinical recognition and intervention. J Child Psychol Psychiatry 2019; 60:133-150. [PMID: 29624671 DOI: 10.1111/jcpp.12899] [Citation(s) in RCA: 170] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Because emotional symptoms are common in attention-deficit/hyperactivity disorder (ADHD) patients and associate with much morbidity, some consider it to be a core feature rather than an associated trait. Others argue that emotional symptoms are too nonspecific for use as diagnostic criteria. This debate has been difficult to resolve due, in part, to the many terms used to describe emotional symptoms in ADHD and to concerns about overlap with mood disorders. METHODS We sought to clarify the nature of emotional symptoms in ADHD by reviewing conceptual and measurement issues and by examining the evidence base regarding specificity of such symptoms for ADHD. We reviewed the various terms used to define emotional symptoms in ADHD, clarify how these symptoms are demarcated from mood disorders, and assess the possibility that symptoms of emotional impulsivity and deficient emotional self-regulation should be considered as core symptoms. We addressed psychiatric comorbidities, the effects of ADHD treatments on associated emotional dysregulation, and the utility of current rating scales to assess emotional symptoms associated with ADHD. RESULTS Emotional symptoms are common and persistent in youth and adults with ADHD. Although emotional symptoms are common in other psychiatric disorders, emotional impulsivity (EI), and deficient emotional self-regulation (DESR) may be sufficiently specific for ADHD to function as diagnostic criteria. CONCLUSIONS Emotional symptoms in ADHD cause clinically significant impairments. Although there is a solid theoretical rationale for considering EI and DESR to be core symptoms of ADHD, there is no consensus about how to define these constructs sin a manner that would be specific to the disorder. An instrument to measure EI and DESR which demarcates them from irritability and other emotional symptoms could improve the accuracy of diagnostic criteria for ADHD.
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Affiliation(s)
- Stephen V Faraone
- Departments of Psychiatry, Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Anthony L Rostain
- Departments of Psychiatry and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Joseph Blader
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Betsy Busch
- Developmental-Behavioral Pediatrics, Chestnut Hill, MA, USA
| | - Ann C Childress
- Center for Psychiatry and Behavioral Medicine, Las Vegas, NV, USA
| | - Daniel F Connor
- Department of Psychiatry, University of Connecticut School of Medicine and Health Care, Farmington, CT, USA
| | - Jeffrey H Newcorn
- Department of Psychiatry and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Rappaport LM, Carney DM, Verhulst B, Neale MC, Blair J, Brotman MA, Pine DS, Leibenluft E, Hettema JM, Roberson-Nay R. A Developmental Twin Study of Emotion Recognition and Its Negative Affective Clinical Correlates. J Am Acad Child Adolesc Psychiatry 2018; 57:925-933.e3. [PMID: 30522738 PMCID: PMC7036262 DOI: 10.1016/j.jaac.2018.05.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 05/16/2018] [Accepted: 06/14/2018] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Youth with psychiatric disorders distinguished by irritability, including depression and associated trait neuroticism, show deficits in the ability to recognize facial expressions of emotion, particularly happiness. However, the contribution of genetic and environmental factors to this ability remains unknown. The present study examined this trait in twins to assess the genetic and environmental influences on face-emotion recognition abilities and their association with irritability, neuroticism, and depression. METHOD Child and adolescent twins (N = 957 from 496 families) 9 to 17 years old rated their irritability (on the Affective Reactivity Index), neuroticism (on the Junior Eysenck Personality Questionnaire), and depression (on the Short Mood and Feelings Questionnaire) and completed a face-emotion labeling task. Faces depicting anger, disgust, fear, happiness, sadness, and surprise were morphed with a neutral face, yielding 10 levels of increasing emotional expressivity. Biometrical twin analyses evaluated contributions of genetic and environmental factors to the etiology of face-emotion recognition and its association with irritability, neuroticism, and depression. RESULTS Recognition of each emotion was heritable; common and specific sets of genetic factors influenced all emotions and individual emotions, respectively. Irritability, neuroticism, and depression were modestly and negatively correlated with emotion recognition, particularly the recognition of happiness. For irritability and neuroticism, this correlation appeared largely due to genetic factors. CONCLUSION This study maps genetic and environmental contributions to face-emotion recognition and its association with irritability, neuroticism, and depression. Findings implicate common genetic factors in deficits regarding the recognition of happiness associated with irritability and neuroticism in childhood and adolescence.
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Affiliation(s)
| | | | | | | | - James Blair
- National Institute of Mental Health, Bethesda, MD
| | | | | | | | - John M Hettema
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond
| | - Roxann Roberson-Nay
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond
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128
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Haller SP, Stoddard J, MacGillivray C, Stiles K, Perhamus G, Penton-Voak IS, Bar-Haim Y, Munafò MR, Brotman MA. A double-blind, randomized, placebo-controlled trial of a computer-based Interpretation Bias Training for youth with severe irritability: a study protocol. Trials 2018; 19:626. [PMID: 30428909 PMCID: PMC6237001 DOI: 10.1186/s13063-018-2960-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 10/03/2018] [Indexed: 12/03/2022] Open
Abstract
Background Severe, chronic, and impairing irritability is a common presenting clinical problem in youth. Indeed, it was recently operationalized as disruptive mood dysregulation disorder (DMDD) in the DSM-5. However, to date, there are no evidence-based treatments that were specifically developed for DMDD. The current randomized controlled trial assesses the efficacy of a computer-based cognitive training intervention (Interpretation Bias Training; IBT) in youth with DMDD. IBT aims to reduce irritability by altering judgments of ambiguous face-emotions through computerized feedback. IBT is based on previous findings that youth with irritability-related psychopathology rate ambiguous faces as more hostile and fear producing. Methods/design This is a double-blind, randomized controlled trial of IBT in 40 youth with DMDD. Participants will be randomized to receive four IBT sessions (Active vs. Sham training) over 4 days. Active IBT provides computerized feedback to change ambiguous face-emotion interpretations towards happy interpretations. Face-emotion judgments are performed pre and post training, and for 2 weeks following training. Blinded clinicians will conduct weekly clinical ratings. Primary outcome measures assess changes in irritability using the clinician-rated Affective Reactivity Index (ARI) and Clinical Global Impressions-Improvement (CGI-I) scale for DMDD, as well as parent and child reports of irritability using the ARI. Secondary outcome measures include clinician ratings of depression, anxiety, and overall impairment. In addition, parent and child self-report measures of depression, anxiety, anger, social status, and aggression will be collected. Discussion The study described in this protocol will perform the first RCT testing the efficacy of IBT in reducing irritability in youth with DMDD. Developing non-pharmacological treatment options for youth suffering from severe, chronic irritability is important to potentially augment existing treatments. Trial registration ClinicalTrials.gov, ID: NCT02531893. Registered on 25 August 2015. Electronic supplementary material The online version of this article (10.1186/s13063-018-2960-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Simone P Haller
- Section on Mood Dysregulation and Neuroscience, Emotion and Development Branch, National Institute of Mental Health, 9000 Rockville Pike, Building 15K, Bethesda, MD, 20892, USA.
| | - Joel Stoddard
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, USA
| | | | - Kelsey Stiles
- Department of Psychology, University of California, Los Angeles, USA
| | - Gretchen Perhamus
- Section on Mood Dysregulation and Neuroscience, Emotion and Development Branch, National Institute of Mental Health, 9000 Rockville Pike, Building 15K, Bethesda, MD, 20892, USA
| | - Ian S Penton-Voak
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Yair Bar-Haim
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Marcus R Munafò
- School of Experimental Psychology, University of Bristol, Bristol, UK.,MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.,UK Centre for Tobacco and Alcohol Studies, University of Bristol, Bristol, UK
| | - Melissa A Brotman
- Section on Mood Dysregulation and Neuroscience, Emotion and Development Branch, National Institute of Mental Health, 9000 Rockville Pike, Building 15K, Bethesda, MD, 20892, USA
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129
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Orri M, Perret LC, Turecki G, Geoffroy MC. Association between irritability and suicide-related outcomes across the life-course. Systematic review of both community and clinical studies. J Affect Disord 2018; 239:220-233. [PMID: 30025311 DOI: 10.1016/j.jad.2018.07.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 05/25/2018] [Accepted: 07/03/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Irritability is gaining considerable attention as a risk factor for suicide-related outcomes (suicide mortality, attempt, and ideation). However, the evidence of this association is scant. We conducted a systematic review of the evidence regarding the associations between irritability and suicide-related outcomes across the life-course. METHODS We conducted a systematic search on Medline and PsycINFO (up to January 2018) for original articles published in English investigating the association between irritability and suicide-related outcomes. Two researchers independently screened the articles, assessed the quality of the evidence (New-Castle-Ottawa Scale) and extracted study characteristics. RESULTS Thirty-nine studies were retrieved, most were of low/medium quality. Twelve assessed irritability in childhood/adolescence (6 in community samples, 6 in clinical samples) and 27 in adulthood (7 in community samples, 20 in clinical samples). In both childhood/adolescence and adult samples, most community-based studies reported a positive association between irritability and suicidal ideation and/or attempt, while clinical studies reported mixed findings. More specifically, in clinical studies, the association of irritability with suicide-related outcomes (i) was not supported among adult depressed patients, (ii) findings were inconsistent in adult bipolar patients, (iii) for inpatients/outpatients with various psychiatric disorders/conditions, association was observed in adulthood but not in childhood/adolescence. LIMITATIONS Differences in methodology and definition/measurement of irritability limited the comparability of included studies. CONCLUSIONS Although irritability has been proposed as a promising transdiagnostic factor associated with suicide-related outcomes, the absence of consensus in the definition of irritability (vs anger or reactive/impulsive aggression), the poor methodological quality, and the lack of developmental considerations mitigate the conclusions.
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Affiliation(s)
- Massimiliano Orri
- McGill Group for Suicide Studies, Douglas Mental Health University Institute & Department of Psychiatry, McGill University, Montreal, Canada
| | - Lea C Perret
- McGill Group for Suicide Studies, Douglas Mental Health University Institute & Department of Psychiatry, McGill University, Montreal, Canada
| | - Gustavo Turecki
- McGill Group for Suicide Studies, Douglas Mental Health University Institute & Department of Psychiatry, McGill University, Montreal, Canada
| | - Marie-Claude Geoffroy
- Department of Educational and Counselling Psychology, McGill University, Montreal, Canada.
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131
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Uçar HN, Vural AP. Irritability and Parenting Styles in Adolescents With Attention-Deficit/Hyperactivity Disorder: A Controlled Study. J Psychosoc Nurs Ment Health Serv 2018; 56:33-43. [PMID: 29667700 DOI: 10.3928/02793695-20180412-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 02/22/2018] [Indexed: 11/20/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) affects functioning of the family, decreasing interactions and loyalty and increasing conflict between adolescents with ADHD and their families. Irritable mood and difficulties with emotional dysregulation are common in children with ADHD. The objective of the current study was to assess levels of irritability in adolescents with ADHD using self- and parent-report scales, and investigate the relationship between irritability levels and parental attitudes. A total of 47 adolescents with ADHD and 39 adolescents with typical development participated in the current study. Findings demonstrated that higher levels of parent-reported irritability were associated with decreased egalitarian attitudes in the ADHD group. Although other parental attitudes were not associated with self- and parent-reported irritability, evaluation of the relationship between parental attitudes and irritability in adolescents with ADHD, which can guide diagnosis and treatment of ADHD, is of critical importance. [Journal of Psychosocial Nursing and Mental Health Services, 56(9), 33-43.].
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132
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Dougherty LR, Schwartz KTG, Kryza-Lacombe M, Weisberg J, Spechler PA, Wiggins JL. Preschool- and School-Age Irritability Predict Reward-Related Brain Function. J Am Acad Child Adolesc Psychiatry 2018; 57:407-417.e2. [PMID: 29859556 DOI: 10.1016/j.jaac.2018.03.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 02/25/2018] [Accepted: 04/04/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Although chronic irritability in childhood is prevalent, impairing, and predictive of later maladjustment, its pathophysiology is largely unknown. Deficits in reward processing are hypothesized to play a role in irritability. The current study aimed to identify how the developmental timing of irritability during preschool- and school-age relates to reward-related brain function during school-age. METHOD Children's irritability was assessed during the preschool period (wave 1; ages 3.0-5.9 years) and 3 years later (wave 2; ages 5.9-9.6 years) using a clinical interview. At wave 2, children (N = 46; 28 female and 18 male) performed a monetary incentive delay task in which they received rewards, if they successfully hit a target, or no reward regardless of performance, during functional magnetic resonance imaging. RESULTS Children with more versus less severe preschool irritability, controlling for concurrent irritability, exhibited altered reward-related connectivity: right amygdala with insula and inferior parietal lobe as well as left ventral striatum with lingual gyrus, postcentral gyrus, superior parietal lobe, and culmen. Children with more versus less severe concurrent irritability, controlling for preschool irritability, exhibited a similar pattern of altered connectivity between left and right amygdalae and superior frontal gyrus and between left ventral striatum and precuneus and culmen. Neural differences associated with irritability were most evident between reward and no-reward conditions when participants missed the target. CONCLUSION Preschool-age irritability and concurrent irritability were uniquely associated with aberrant patterns of reward-related connectivity, highlighting the importance of developmental timing of irritability for brain function.
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Affiliation(s)
| | - Karen T G Schwartz
- San Diego State University, CA, and University of California, San Diego Joint Doctoral Program in Clinical Psychology
| | - Maria Kryza-Lacombe
- San Diego State University, CA, and University of California, San Diego Joint Doctoral Program in Clinical Psychology
| | - Jill Weisberg
- San Diego State University, CA, and University of California, San Diego Joint Doctoral Program in Clinical Psychology
| | | | - Jillian Lee Wiggins
- San Diego State University, CA, and University of California, San Diego Joint Doctoral Program in Clinical Psychology
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133
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Puiu AA, Wudarczyk O, Goerlich KS, Votinov M, Herpertz-Dahlmann B, Turetsky B, Konrad K. Impulsive aggression and response inhibition in attention-deficit/hyperactivity disorder and disruptive behavioral disorders: Findings from a systematic review. Neurosci Biobehav Rev 2018; 90:231-246. [PMID: 29689282 DOI: 10.1016/j.neubiorev.2018.04.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/13/2018] [Accepted: 04/17/2018] [Indexed: 01/07/2023]
Abstract
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.
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Affiliation(s)
- Andrei A Puiu
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, RWTH Aachen University, Aachen, Germany.
| | - Olga Wudarczyk
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Aachen, Germany.
| | - Katharina S Goerlich
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Aachen, Germany; Department of Neuroscience, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Mikhail Votinov
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Aachen, Germany; JARA-Institute Brain Structure-Function Relationship, Research Center Jülich and RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany; Institute of Neuroscience and Medicine 10, Research Center Jülich, Aachen, Germany.
| | - Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, RWTH Aachen University, Aachen, Germany.
| | - Bruce Turetsky
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA.
| | - Kerstin Konrad
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, RWTH Aachen University, Aachen, Germany.
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Di Giunta L, Iselin AMR, Lansford JE, Eisenberg N, Lunetti C, Thartori E, Basili E, Pastorelli C, Bacchini D, Uribe Tirado LM, Gerbino M. Parents' and early adolescents' self-efficacy about anger regulation and early adolescents' internalizing and externalizing problems: A longitudinal study in three countries. J Adolesc 2018; 64:124-135. [PMID: 29454294 PMCID: PMC5920650 DOI: 10.1016/j.adolescence.2018.01.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 01/25/2018] [Accepted: 01/27/2018] [Indexed: 01/20/2023]
Abstract
The present study examines whether early adolescents' self-efficacy beliefs about anger regulation mediate the relation between parents' self-efficacy beliefs about anger regulation and early adolescents' internalizing and externalizing problems. Participants were 534 early adolescents (T1: M age = 10.89, SD = .70; 50% female), their mothers (n = 534), and their fathers (n = 431). Families were drawn from Colombia, Italy, and the USA. Follow-up data were obtained two (T2) and three (T3) years later. At T1 and T3, parents' self-efficacy beliefs were self-reported and internalizing and externalizing problems were assessed via mothers', fathers', and early adolescents' reports. At T2, early adolescents' self-efficacy beliefs were self-reported Within the overall sample, mothers with higher self-efficacy beliefs about anger regulation had children with similar beliefs. Early adolescents' low self-efficacy beliefs were associated with higher internalizing and externalizing problems.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Dario Bacchini
- Psychology Department, Second University of Naples, Italy
| | | | - Maria Gerbino
- Psychology Department, Sapienza University of Rome, Italy
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135
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Kircanski K, Clayton ME, Leibenluft E, Brotman MA. Psychosocial Treatment of Irritability in Youth. CURRENT TREATMENT OPTIONS IN PSYCHIATRY 2018; 5:129-140. [PMID: 30319935 PMCID: PMC6181450 DOI: 10.1007/s40501-018-0141-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE OF REVIEW Chronic, severe irritability is a common presenting problem in children and adolescents. Disruptive mood dysregulation disorder (DMDD) was added to the DSM-5 in recognition of this public health need. Currently there are no well-established, evidence-based pharmacological or psychosocial treatments specifically for DMDD. Here, we focus on psychosocial interventions. In addition to reviewing published research, we present preliminary, open trial data on a novel exposure-based cognitive-behavioral therapy (CBT) targeting severe irritability, as is present in DMDD. RECENT FINDINGS In the published literature, parent management training (PMT) comprises parent-based interventions designed to treat youth disruptive behavior. Child-based interventions for disruptive behavior include CBT focused on social cognition and problem-solving. Based on identified treatment gaps for severe irritability in children and adolescents, novel psychosocial interventions are being developed. We have developed a CBT for severe irritability that integrates exposure techniques, drawn from anxiety treatment, with selected PMT techniques. Data from an open pilot trial (N=10) suggest feasibility. SUMMARY Promising psychosocial treatments are being developed for DMDD. Future directions include testing these new therapies against extant interventions. Increased research on the biological and psychological mechanisms mediating irritability will further bridge the treatment gap for youth and families.
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Affiliation(s)
| | | | - Ellen Leibenluft
- Emotion and Development Branch, National Institute of Mental Health
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Perepletchikova F, Nathanson D, Axelrod SR, Merrill C, Walker A, Grossman M, Rebeta J, Scahill L, Kaufman J, Flye B, Mauer E, Walkup J. Randomized Clinical Trial of Dialectical Behavior Therapy for Preadolescent Children With Disruptive Mood Dysregulation Disorder: Feasibility and Outcomes. J Am Acad Child Adolesc Psychiatry 2017; 56:832-840. [PMID: 28942805 DOI: 10.1016/j.jaac.2017.07.789] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 07/24/2017] [Accepted: 08/03/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Persistent irritability and behavior outbursts in disruptive mood dysregulation disorder (DMDD) are associated with severe impairment in childhood and with negative adolescent and adult outcomes. There are no empirically established treatments for DMDD. This study examined the feasibility and preliminary efficacy of dialectical behavior therapy adapted for preadolescent children (DBT-C) with DMDD. METHOD Children 7 to 12 years old with DMDD (N = 43) were randomly assigned 1:1 to DBT-C or treatment as usual (TAU). The 6 domains of feasibility included recruitment, randomization, retention, attendance, participants' satisfaction, and therapist adherence. Blinded raters assessed participants at baseline, after 8, 16, 24, and 32 weeks, and at 3-month follow-up. The primary efficacy outcome was the positive response rate on the Clinical Global Impression-Improvement scale. Improvements in behavior outbursts and angry/irritable mood were assessed by the Clinical Global Impression-Severity scale. RESULTS Mean number of participants randomized per month was 2.53 ± 2.72. Participants in DBT-C (n = 21) attended 89% of sessions compared with 48.6% in TAU (n = 22). Eight TAU participants (36.4%) dropped out compared with none in DBT-C. Parents and children in DBT-C expressed significantly higher treatment satisfaction than those in TAU. The rate of positive response was 90.4% in DBT-C compared with 45.5% in TAU, despite 3 times as many participants in TAU receiving psychiatric medications. Remission rates were 52.4% for DBT-C and 27.3% for TAU. Improvements were maintained at 3-month follow-up. Therapists showed adherence to DBT-C. CONCLUSION DBT-C demonstrated feasibility in all prespecified domains. Outcomes also indicated preliminary efficacy of DBT-C. Clinical trial registration information-Adapting DBT for Children With DMDD: Pilot RCT; http://clinicaltrials.gov/; NCT01862549.
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Affiliation(s)
| | - Donald Nathanson
- Weill Cornell Medicine and NewYork-Presbyterian Hospital, White Plains, NY
| | | | | | - Amy Walker
- Cognitive Behavioral Consultants, White Plains, NY
| | | | | | | | - Joan Kaufman
- Center for Child and Family Traumatic Stress, Kennedy Krieger Institute, Johns Hopkins School of Medicine, Baltimore, MD
| | - Barbara Flye
- Weill Cornell Medicine and NewYork-Presbyterian Hospital, White Plains, NY
| | | | - John Walkup
- Weill Cornell Medicine and NewYork-Presbyterian Hospital, White Plains, NY
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