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Paulus FW, Ohmann S, Möhler E, Plener P, Popow C. Emotional Dysregulation in Children and Adolescents With Psychiatric Disorders. A Narrative Review. Front Psychiatry 2021; 12:628252. [PMID: 34759846 PMCID: PMC8573252 DOI: 10.3389/fpsyt.2021.628252] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 08/27/2021] [Indexed: 12/14/2022] Open
Abstract
Background: Emotional dysregulation (ED) is a transdiagnostic construct defined as the inability to regulate the intensity and quality of emotions (such as, fear, anger, sadness), in order to generate an appropriate emotional response, to handle excitability, mood instability, and emotional overreactivity, and to come down to an emotional baseline. Because ED has not been defined as a clinical entity, and because ED plays a major role in child and adolescent psychopathology, we decided to summarize current knowledge on this topic based on a narrative review of the current literature. Methods: This narrative review is based on a literature search of peer-reviewed journals. We searched the databases ERIC, PsycARTICLES, PsycINFO and PSYNDEX on June 2, 2020 for peer reviewed articles published between 2000 and 2020 in English language for the preschool, school, and adolescent age (2-17 years) using the following search terms: "emotional dysregulation" OR "affect dysregulation," retrieving 943 articles. Results: The results of the literature search are presented in the following sections: the relationship between ED and psychiatric disorders (ADHD, Mood Disorders, Psychological Trauma, Posttraumatic Stress Disorder, Non-suicidal Self-Injury, Eating Disorders, Oppositional Defiant Disorder, Conduct Disorder, Disruptive Disruptive Mood Dysregulation Disorder, Personality Disorders, Substance Use Disorder, Developmental Disorders, Autism Spectrum Disorder, Psychosis and Schizophrenia, and Gaming Disorder), prevention, and treatment of ED. Conclusion: Basic conditions of ED are genetic disposition, the experience of trauma, especially sexual or physical abuse, emotional neglect in childhood or adolescence, and personal stress. ED is a complex construct and a comprehensive concept, aggravating a number of various mental disorders. Differential treatment is mandatory for individual and social functioning.
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Affiliation(s)
- Frank W Paulus
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Saarland University Medical Center, Homburg, Germany
| | - Susanne Ohmann
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria.,Austrian Society of Cognitive Behavioral Therapy (OeGVT), Vienna, Austria
| | - Eva Möhler
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Saarland University Medical Center, Homburg, Germany
| | - Paul Plener
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Christian Popow
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria.,Austrian Society of Cognitive Behavioral Therapy (OeGVT), Vienna, Austria.,Department of Child and Adolescent Psychiatry and Psychotherapy, Regional Psychiatric Hospital, Mauer, Austria
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Holtmann M, Mokros L, Kirschbaum-Lesch I, Kölch M, Plener PL, Ruckes C, Schulte-Markwort M, Legenbauer T. Adolescent depression: Study protocol for a randomized, controlled, double-blind multicenter parallel group trial of Bright Light Therapy in a naturalistic inpatient setting (DeLight). Trials 2018; 19:568. [PMID: 30340625 PMCID: PMC6194631 DOI: 10.1186/s13063-018-2949-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 09/28/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depressive disorders are among the most prominent health problems in youth. Even with the best available pharmacological and non-pharmacological treatments, remission rates are low. Without early treatment, depression in youth is associated with a high risk of symptom progression, chronicity, co-morbidity, and suicidal behavior. Thus, adolescent depression is a prime candidate for innovation in treatment. In depressive adults, meta-analytic evidence has proven that bright light therapy (BLT) is a potent low-threshold intervention, promising due to easy application, low side effects, and optimized compliance. In adolescents, studies with small samples show promising effects. This randomized controlled trial will examine the effectiveness of BLT in youth inpatients. METHODS/DESIGN In this randomized, controlled, double-blind multicenter parallel group trial, morning BLT is applied for four weeks in addition to treatment as usual (TAU) for depressed youth inpatients (daily morning exposure to bright light via light-emitting glasses, 10,000 lx, for 30 min) and will be compared to a control condition (placebo light treatment, red light, identical light glasses). The primary objective is to assess whether BLT reduces symptoms of depression in youth with greater effect compared to placebo light therapy. Secondary objectives are to examine the impact of BLT on responder status, application of antidepressant medication, and further depression-related symptoms (sleep, activity, quality of life, satisfaction with health, general psychopathology, alertness, and circadian function). N = 224 patients will be recruited in a naturalistic inpatient setting. A follow-up will be carried out after three and six months. DISCUSSION The study aims to discuss and evaluate BLT as an additive method supporting standardized clinical procedures dealing with severe to moderate depressive symptoms in youth. TRIAL REGISTRATION German Clinical Trials Register, DRKS00013188 . Registered on November 30, 2017.
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Affiliation(s)
- Martin Holtmann
- Clinic for Child and Adolescent Psychiatry, LWL University Hospital Hamm of the Ruhr-University Bochum, Heithofer Allee 64, 59071 Hamm, Germany
| | - Laura Mokros
- Clinic for Child and Adolescent Psychiatry, LWL University Hospital Hamm of the Ruhr-University Bochum, Heithofer Allee 64, 59071 Hamm, Germany
| | - Inken Kirschbaum-Lesch
- Clinic for Child and Adolescent Psychiatry, LWL University Hospital Hamm of the Ruhr-University Bochum, Heithofer Allee 64, 59071 Hamm, Germany
| | - Michael Kölch
- Department Child and Adolescent Psychiatry and Psychotherapy, Brandenburg Medical School, Neuruppin, Germany
| | - Paul L. Plener
- Department of Child and Adolescent Psychiatry and Psychotherapy, Ulm University, Ulm, Germany
| | - Christian Ruckes
- Interdisciplinary Centre for Clinical Trials, Mainz University, Mainz, Germany
| | | | - Tanja Legenbauer
- Clinic for Child and Adolescent Psychiatry, LWL University Hospital Hamm of the Ruhr-University Bochum, Heithofer Allee 64, 59071 Hamm, Germany
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Deutz MHF, Shi Q, Vossen HGM, Huijding J, Prinzie P, Deković M, van Baar AL, Woltering S. Evaluation of the Strengths and Difficulties Questionnaire-Dysregulation Profile (SDQ-DP). Psychol Assess 2018; 30:1174-1185. [PMID: 29927304 DOI: 10.1037/pas0000564] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The Dysregulation Profile (DP) has emerged as a measure of concurrent affective, behavioral and cognitive dysregulation, associated with severe psychopathology, and poor adjustment. While originally developed with the Child Behavior Checklist, more recently the DP has also been defined on the Strengths and Difficulties Questionnaire (SDQ), mostly with a 5-item, but also a 15-item, SDQ-DP measure. This study evaluated the SDQ-DP by examining its factor structure, measurement invariance, and construct validity. Different SDQ-DP operationalizations were compared. In a United States longitudinal community sample (N = 768), a bifactor model consisting of a general Dysregulation factor and three specific factors of Emotional Symptoms, Conduct Problems, and Hyperactivity-Inattention fitted best, across three different developmental periods (early childhood, middle childhood, and adolescence) and across three different reporters (parents, teachers, and youth). Measurement invariance across reporter, gender, and developmental period was demonstrated. These findings indicate that the SDQ-DP, like the CBCL-DP, reflects a broad syndrome of dysregulation that exists in addition to specific syndromes of emotional symptoms, conduct problems, and hyperactivity-inattention. SDQ-DP bifactor scores were strongly related with scores on the 5- and 15-item SDQ-DP measures and similarly concurrently associated with two markers of self-regulation, ego-resiliency and effortful control, and longitudinally with antisocial behavior and disciplinary measures. As reliability, validity, and stability was weaker for the SDQ-DP 5-item measure, use of all 15 items is recommended. Advantages of using a bifactor approach are discussed as well as the potential of the SDQ-DP as an easy screening measure of children at risk for developing serious psychopathology. (PsycINFO Database Record
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4
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[Test Reviews]. Prax Kinderpsychol Kinderpsychiatr 2018; 67:387-393. [PMID: 29716465 DOI: 10.13109/prkk.2018.67.4.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Waxmonsky JG, Mayes SD, Calhoun SL, Fernandez-Mendoza J, Waschbusch DA, Bendixsen BH, Bixler EO. The association between Disruptive Mood Dysregulation Disorder symptoms and sleep problems in children with and without ADHD. Sleep Med 2017; 37:180-186. [PMID: 28899532 DOI: 10.1016/j.sleep.2017.02.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 02/13/2017] [Accepted: 02/15/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Many youth experience persistent irritability and recurrent temper outbursts, conceptualized by DSM-5 as Disruptive Mood Dysregulation Disorder (DMDD). Sleep deprivation impairs emotion regulation which could increase rates of DMDD symptoms, especially in those with preexisting regulatory impairments, as seen with ADHD. However, there has been little examination of the relationship between chronic sleep problems and DMDD symptoms. METHODS Associations between DMDD symptoms and sleep parameters in children were assessed using parent-report and objective measures of sleep in a general population sample (N = 665) and an ADHD sample (N = 784). Irritability, temper outbursts, sleep problems and other psychological problems were assessed with the Pediatric Behavior Scale. The general population study also completed overnight polysomnography (PSG). RESULTS DMDD symptoms were reported in 9.2% of the community sample and 31.4% of the ADHD sample. In both samples, children with DMDD symptoms had significantly higher parent-reported sleep problems than children without DMDD symptoms. Children with sleep problems had significantly higher DMDD scores than children without sleep problems. However, DMDD symptoms were most strongly associated with oppositional behavior. Sleep problems were not a significant contributor. Hyperactivity-impulsivity was most strongly associated with sleep problems, and DMDD was not a significant contributor. Children with and without DMDD symptoms did not differ significantly on any PSG parameter. CONCLUSIONS Associations between parent-reported sleep problems and DMDD symptoms were due to their shared relationship with other behavioral problems. Therefore, chronic sleep problems do not appear to be a primary source of DMDD symptoms in children with or without ADHD.
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Affiliation(s)
- James G Waxmonsky
- Department of Psychiatry, Penn State College of Medicine, Hershey, PA, USA.
| | - Susan D Mayes
- Department of Psychiatry, Penn State College of Medicine, Hershey, PA, USA
| | - Susan L Calhoun
- Department of Psychiatry, Penn State College of Medicine, Hershey, PA, USA
| | | | | | | | - Edward O Bixler
- Department of Psychiatry, Penn State College of Medicine, Hershey, PA, USA
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Legenbauer T, Hübner J, Pinnow M, Ball A, Pniewski B, Holtmann M. Proper Emotion Recognition, Dysfunctional Emotion Regulation. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2016; 46:7-16. [PMID: 27685191 DOI: 10.1024/1422-4917/a000479] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE A considerable number of adolescents exhibit severe self-regulation deficits in affect and behavior, which are referred to as affective dysregulation (AD). AD may be conceptualized as a dimensional trait that, in its extreme form, resembles the diagnostic categories of severe mood dysregulation (SMD) or disruptive mood dysregulation disorder (DMDD). Assuming a shared pathway of psychopathology in AD and SMD, similar underlying dysfunctional mechanisms in emotion processing, particularly emotion recognition (RECOG) and regulation (REGUL), may be postulated. METHOD Adolescent inpatients with AD (CAD, N = 35), without AD (CCG, N = 28), and nonclinical controls (NCG; N = 28) were administered a morphed facial recognition task (RECOG). REGUL abilities, levels of irritability as well as depressive symptoms were also assessed. RESULTS We found no significant group differences in accuracy and thresholds for RECOG abilities. Patients with AD reported more dysfunctional REGUL strategies than did CCG and NCG. Both depression and AD, but not irritability, influenced the overall degree of maladaptive REGUL. CONCLUSION The broad phenotype of AD does not involve the deficits in RECOG reported for adolescents with a narrow phenotype (SMD); regarding REGUL strategies, AD seems to be associated with specific impairments.
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Affiliation(s)
- Tanja Legenbauer
- 1 Ruhr University Bochum, LWL-University Hospital for Child and Adolescent Psychiatry, Hamm, Germany.,a These authors contributed equally to this paper
| | - Jan Hübner
- 1 Ruhr University Bochum, LWL-University Hospital for Child and Adolescent Psychiatry, Hamm, Germany.,a These authors contributed equally to this paper
| | - Marlies Pinnow
- 2 Ruhr University Bochum, Motivation Lab, Institute of Cognitive Neuroscience, Bochum, Germany
| | - Anna Ball
- 1 Ruhr University Bochum, LWL-University Hospital for Child and Adolescent Psychiatry, Hamm, Germany
| | - Benjamin Pniewski
- 1 Ruhr University Bochum, LWL-University Hospital for Child and Adolescent Psychiatry, Hamm, Germany
| | - Martin Holtmann
- 1 Ruhr University Bochum, LWL-University Hospital for Child and Adolescent Psychiatry, Hamm, Germany
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Bogen S, Legenbauer T, Gest S, Holtmann M. Morning bright light therapy: a helpful tool for reducing comorbid symptoms of affective and behavioral dysregulation in juvenile depressed inpatients? A pilot trial. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2016; 45:34-41. [PMID: 27299514 DOI: 10.1024/1422-4917/a000442] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Objective In recent years, bright light therapy (BLT) has been used to treat depression and to stabilize circadian rhythms. In this study we evaluated whether it is also helpful for comorbid symptoms of affective and behavioral dysregulation in depressive inpatients. Method This article reports a secondary analysis comparing two subgroups of depressive participants with comorbid affective and behavioral dysregulation, captured with the dysregulation-profile of the Strengths and Difficulties Questionnaire (SDQ-DP; n = 16 vs. n = 11). Participants were randomly allocated to active BLT (10,000 lux) or control BLT (approx. 100 lux), and received 45 minutes of BLT for 2 weeks. SDQ-DP scores, sleep parameters, and circadian preference were assessed at baseline, after the intervention, and 3 weeks later. Results No direct effects on SDQ-DP scores were observed. Sleep improved in both conditions. Only in the active BLT condition was a circadian phase advance found. Correlation and regression analyses indicated an indirect, circadian effect for improved SDQ-DP scores. Conclusions The data of this pilot trial should be considered preliminary and merely descriptive. Further research is warranted.
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Affiliation(s)
- Sarah Bogen
- 1 Ruhr Universität Bochum, LWL Universitätsklinik Hamm
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Reidy BL, Hamann S, Inman C, Johnson KC, Brennan PA. Decreased sleep duration is associated with increased fMRI responses to emotional faces in children. Neuropsychologia 2016; 84:54-62. [PMID: 26821063 DOI: 10.1016/j.neuropsychologia.2016.01.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 01/13/2016] [Accepted: 01/24/2016] [Indexed: 01/08/2023]
Abstract
In adults and children, sleep loss is associated with affective dysregulation and increased responsivity to negative stimuli. Adult functional neuroimaging (fMRI) studies have demonstrated associations between restricted sleep and neural alterations in the amygdala and reward circuitry when viewing emotional picture and face stimuli. Despite this, few studies have examined the associations between short sleep duration and emotional responsivity in typically developing children, and no studies have investigated this relationship using fMRI. The current study examined the relationship between sleep duration and fMRI activation to emotional facial expressions in 15 male children (ages 7-11 years). During fMRI scanning, subjects viewed and made perceptual judgments regarding negative, neutral, and positive emotional faces. Maternal reported child sleep duration was negatively associated with (a) activation in the bilateral amygdala, left insula, and left temporal pole activation when viewing negative (i.e., fearful, disgust) vs. neutral faces, (b) right orbitofrontal and bilateral prefrontal activation when viewing disgust vs. neutral faces, and (c) bilateral orbitofrontal, right anterior cingulate, and left amygdala activation when viewing happy vs. neutral faces. Consistent with our prediction, we also noted that emotion-dependent functional connectivity between the bilateral amygdala and prefrontal cortex, cingulate, fusiform, and occipital cortex was positively associated with sleep duration. Paralleling similar studies in adults, these findings collectively suggest that decreased sleep duration in school-aged children may contribute to enhanced reactivity of brain regions involved in emotion and reward processing, as well as decreased emotion-dependent functional connectivity between the amygdala and brain regions associated with emotion regulation.
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Affiliation(s)
- Brooke L Reidy
- Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA 30322, USA
| | - Stephan Hamann
- Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA 30322, USA
| | - Cory Inman
- Department of Neurosurgery, Emory University School of Medicine, 1639 Pierce Drive NE, Atlanta, GA 30322, USA
| | - Katrina C Johnson
- Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA 30322, USA
| | - Patricia A Brennan
- Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA 30322, USA
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Bogen S, Legenbauer T, Gest S, Holtmann M. Lighting the mood of depressed youth: Feasibility and efficacy of a 2 week-placebo controlled bright light treatment for juvenile inpatients. J Affect Disord 2016; 190:450-456. [PMID: 26551404 DOI: 10.1016/j.jad.2015.09.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/06/2015] [Accepted: 09/15/2015] [Indexed: 12/22/2022]
Affiliation(s)
- Sarah Bogen
- LWL University Hospital of the Ruhr University Bochum, Hospital for Child and Adolescent Psychiatry, Heithofer Allee 64, 59071 Hamm, Germany
| | - Tanja Legenbauer
- LWL University Hospital of the Ruhr University Bochum, Hospital for Child and Adolescent Psychiatry, Heithofer Allee 64, 59071 Hamm, Germany.
| | - Stephanie Gest
- LWL University Hospital of the Ruhr University Bochum, Hospital for Child and Adolescent Psychiatry, Heithofer Allee 64, 59071 Hamm, Germany
| | - Martin Holtmann
- LWL University Hospital of the Ruhr University Bochum, Hospital for Child and Adolescent Psychiatry, Heithofer Allee 64, 59071 Hamm, Germany
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Gest S, Legenbauer T, Bogen S, Schulz C, Pniewski B, Holtmann M. Chronotherapeutics: An alternative treatment of juvenile depression. Med Hypotheses 2014; 82:346-9. [DOI: 10.1016/j.mehy.2014.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 12/11/2013] [Accepted: 01/03/2014] [Indexed: 01/25/2023]
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Holtmann M, Poustka L, Zepf FD, Banaschewski T, Priller J, Bölte S, Legenbauer T. Severe Affective and Behavioral Dysregulation in Youths Is Associated with a Proinflammatory State 1MH and LP contributed equally to the paper. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2013; 41:393-9. [DOI: 10.1024/1422-4917/a000255] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Objective: A heritable behavioral phenotype, the so-called Dysregulation Profile (DP), characterized by extreme scores on the syndrome scales Anxious/Depressed (A/D), Attention Problems (AP), and Aggressive Behavior (AGG), has been identified on the Child Behavior Checklist (CBCL). It characterizes children with severe affective and behavioral dysregulation. The present study examined possible alterations of the inflammatory system in CBCL-DP using a clinical sample of n = 133 children and adolescents. Method: Participants with the CBCL-DP scoring ≥ 2.5 SDs above average constituted the CBCL-DP subgroup (n = 51). Those with CBCL-DP scores of 1 SD or less above average were regarded as controls (n = 82). Groups were compared in terms of serum levels of C-reactive protein (CRP) and albumin. Results: Participants showing the CBCL-DP exhibited increased CRP and decreased albumin levels compared to controls. CRP was correlated with AGG, AP, and the CBCL-DP total score. A negative correlation was observed between albumin and AGG, AP, the CBCL-DP score, and A/D. These associations could not be attributed to differences in age, sex, weight, socioeconomic status, global functioning, or duration of illness. Conclusions: This is the first study to demonstrate associations between the CBCL-DP and a proinflammatory state. Limitations include the lack of a healthy control group, the use of a single measurement of inflammatory markers, and the lack of follow-up data. Future research should address whether inflammatory diathesis in these children confers increased susceptibility to later development of cardiovascular disease and other medical morbidities.
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Affiliation(s)
- Martin Holtmann
- Ruhr-University Bochum, LWL-University Hospital for Child and Adolescent Psychiatry, Hamm, Germany
- Department of Child and Adolescent Psychiatry and Psychotherapy, Goethe-University, Frankfurt/Main, Germany
| | - Luise Poustka
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
| | - Florian D. Zepf
- Department of Child and Adolescent Psychiatry and Psychotherapy, Goethe-University, Frankfurt/Main, Germany
- Department of Child & Adolescent Psychiatry & Psychotherapy, RWTH Aachen University, Germany
- JARA Translational Brain Medicine, Aachen, Germany
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
| | - Josef Priller
- Division of Experimental and Molecular Psychiatry, Department of Psychiatry and Psychotherapy; Charité University Medicine, Berlin
| | - Sven Bölte
- Department of Child and Adolescent Psychiatry and Psychotherapy, Goethe-University, Frankfurt/Main, Germany
- Center of Neurodevelopmental Disorders (KIND), Karolinska Institutet, Stockholm, Sweden
| | - Tanja Legenbauer
- Ruhr-University Bochum, LWL-University Hospital for Child and Adolescent Psychiatry, Hamm, Germany
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Bogen S, Legenbauer T, Bogen T, Gest S, Jensch T, Schneider S, Holtmann M. Morning light therapy for juvenile depression and severe mood dysregulation: study protocol for a randomized controlled trial. Trials 2013; 14:178. [PMID: 23773310 PMCID: PMC3689601 DOI: 10.1186/1745-6215-14-178] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 04/29/2013] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The prevalence of depression in young people is increasing. The predominant co-morbidities of juvenile depression include sleep disturbances and persistent problems with the sleep-wake rhythm, which have shown to influence treatment outcomes negatively. Severe mood dysregulation is another condition that includes depressive symptoms and problems with the sleep-wake rhythm. Patients with severe mood dysregulation show symptoms of depression, reduced need for sleep, and disturbances in circadian functioning which negatively affect both disorder-specific symptoms and daytime functioning. One approach to treating both depression and problems with the sleep-wake rhythm is the use of light therapy. Light therapy is now a standard therapy for ameliorating symptoms of seasonal affective disorder and depression in adults, but has not yet been investigated in children and adolescents. In this trial, the effects of 2 weeks of morning bright-light therapy on juvenile depression and severe mood dysregulation will be evaluated. METHODS/DESIGN A total of 60 patients with depression, aged between 12 and 18 years, in some cases presenting additional symptoms of affective dysregulation, will be included in this trial. Morning bright-light therapy will be implemented for 2 weeks (10 sessions of 45 minutes each), either with 'active' light (10,000 lux) or 'inactive' light (100 lux). A comprehensive test battery will be conducted before and after treatment and at follow-up 3 weeks later, to assess depression severity, sleep, and attention parameters. Melatonin levels will be measured by assessing the Dim Light Melatonin Onset. DISCUSSION In this pilot study, the use of morning bright-light therapy for juvenile depression and severe mood dysregulation shall be evaluated and discussed. TRIALS REGISTRATION Current Controlled Trials ISRCTN89305231.
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Affiliation(s)
- Sarah Bogen
- Hospital for Child and Adolescent Psychiatry, LWL University Hospital of the Ruhr-University Bochum, Hamm, Germany
| | - Tanja Legenbauer
- Hospital for Child and Adolescent Psychiatry, LWL University Hospital of the Ruhr-University Bochum, Hamm, Germany
| | - Thorsten Bogen
- Hospital for Child and Adolescent Psychiatry, LWL University Hospital of the Ruhr-University Bochum, Hamm, Germany
| | - Stephanie Gest
- Hospital for Child and Adolescent Psychiatry, LWL University Hospital of the Ruhr-University Bochum, Hamm, Germany
| | - Thomas Jensch
- Hospital for Child and Adolescent Psychiatry, LWL University Hospital of the Ruhr-University Bochum, Hamm, Germany
| | - Silvia Schneider
- Department of Psychology, Ruhr-University Bochum, Bochum, Germany
| | - Martin Holtmann
- Hospital for Child and Adolescent Psychiatry, LWL University Hospital of the Ruhr-University Bochum, Hamm, Germany
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