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Elvin OM, Modecki KL, Waters AM. An Expanded Conceptual Framework for Understanding Irritability in Childhood: The Role of Cognitive Control Processes. Clin Child Fam Psychol Rev 2024; 27:381-406. [PMID: 38856946 PMCID: PMC11222227 DOI: 10.1007/s10567-024-00489-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2024] [Indexed: 06/11/2024]
Abstract
Children prone to irritability experience significant functional impairments and internalising and externalising problems. Contemporary models have sought to elucidate the underlying mechanisms in irritability, such as aberrant threat and reward biases to improve interventions. However, the cognitive control processes that underlie threat (e.g., attention towards threats) and reward (e.g., attention towards reward-related cues) biases and the factors which influence the differential activation of positive and negative valence systems and thus leading to maladaptive activation of cognitive control processes (i.e., proactive and reactive control) are unclear. Thus, we aim to integrate extant theoretical and empirical research to elucidate the cognitive control processes underlying threat and reward processing that contribute to irritability in middle childhood and provide a guiding framework for future research and treatment. We propose an expanded conceptual framework of irritability that includes broad intraindividual and environmental vulnerability factors and propose proximal 'setting' factors that activate the negative valence and positive valence systems and proactive and reactive cognitive control processes which underpin the expression and progression of irritability. We consider the implications of this expanded conceptualisation of irritability and provide suggestions for future research.
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Affiliation(s)
- Olivia M Elvin
- School of Applied Psychology, Griffith University, Mount Gravatt Campus, Brisbane, QLD, Australia.
| | - Kathryn L Modecki
- Centre for Mental Health and School of Applied Psychology, Griffith University, Mount Gravatt Campus, Brisbane, QLD, Australia
- School of Psychological Science, University of Western Australia & Telethon Kids Institute, Perth, Australia
| | - Allison M Waters
- Centre for Mental Health and School of Applied Psychology, Griffith University, Mount Gravatt Campus, Brisbane, QLD, Australia.
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2
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Orsolini L, Longo G, Cicolini A, Volpe U. An expert opinion on the pharmacological interventions for Disruptive Mood Dysregulation Disorder (DMDD). Expert Opin Pharmacother 2024; 25:67-78. [PMID: 38186365 DOI: 10.1080/14656566.2024.2303422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/05/2024] [Indexed: 01/09/2024]
Abstract
INTRODUCTION Disruptive Mood Dysregulation Disorder (DMDD) was officially introduced as a new diagnostic entity in the Diagnostic and Statistical Manual of Mental Disorder, Fifth Edition (DSM-5), under the category of depressive disorders. AREAS COVERED A comprehensive overview and a critical commentary on the currently investigated psychopharmacological approaches for the treatment of DMDD have been here provided. EXPERT OPINION Behavioral and psychosocial interventions should be considered as first-line treatment strategies. When ineffective or partially effective, psychopharmacological strategy is recommended. Overall, pharmacological strategy should be preferred in those individuals with psychiatric comorbidities (e.g. ADHD). Indeed, so far published studies on pharmacological strategies in DMDD are scant and heterogeneous (i.e. age, assessment tools, symptomatology profile, comorbidity, and so forth). Therefore, DMDD psychopharmacological guidelines are needed, particularly to guide clinicians toward the patient's typical symptom profile who could benefit from psychopharmacological strategy.
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Affiliation(s)
- Laura Orsolini
- Unit of Clinical Psychiatry, Department of Neurosciences/DIMSC, Polytechnic University of Marche, Ancona, Italy
| | - Giulio Longo
- Unit of Clinical Psychiatry, Department of Neurosciences/DIMSC, Polytechnic University of Marche, Ancona, Italy
| | - Angelica Cicolini
- Unit of Clinical Psychiatry, Department of Neurosciences/DIMSC, Polytechnic University of Marche, Ancona, Italy
| | - Umberto Volpe
- Unit of Clinical Psychiatry, Department of Neurosciences/DIMSC, Polytechnic University of Marche, Ancona, Italy
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3
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Benarous X, Lahaye H, Pellerin H, Consoli A, Cohen D, Labelle R, Renaud J, Gérardin P, El-Khoury F, van der Waerden J, Guilé JM. Hard-to-treat or hard-to-catch? Clinical features and therapeutic outcomes of help-seeking foster care youths with mood disorders. Front Psychiatry 2023; 14:1211516. [PMID: 37900296 PMCID: PMC10603296 DOI: 10.3389/fpsyt.2023.1211516] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 10/02/2023] [Indexed: 10/29/2023] Open
Abstract
Introduction The high level of emotional problems in youths placed in foster care contrasts with the limited use of evidence-based treatments. This study aims to better characterize the clinical features and therapeutic outcomes of foster care youths with mood disorders. Methods A secondary analysis of data collected in the context of a French-Canadian clinical research network on pediatric mood disorders in four sites was conducted to compare three groups of patients with depressive or bipolar disorder: those without exposure to child welfare intervention (WCWI, n = 181), those who received non-placement psychosocial intervention (NPI, n = 62), and those in placement interventions (PI, n = 41). Results We observed a very high rate of academic problems in patients in the groups NPI/PI compared to those in the WCWI group. Patients in the PI group had more disruptive behavioral disorders (OR = 6.87, 95% CI [3.25-14.52]), trauma-related disorders (OR = 3.78, 95% CI [1.6-8.94]), and any neurodevelopmental disorders (OR = 2.73, 95% CI [1.36-5.49]) compared to the other groups (NPI/WCWI). Among inpatients, the Clinical Global Impression-Improvement scale and the change in the Children Global Assessment Scale during the hospital stay did not differ across the three groups. We observed a higher prescription rate of antipsychotics in the PI group compared to the NPI/WCWI groups, but no significant difference for antidepressants and mood stabilizers. Discussion These findings support the view that, when provided with dedicated support, fostered inpatient youths can improve in a range comparable to other inpatients. Undetected neurodevelopmental disorders and academic problems are likely important contributors of the burden of mood disorders in these youths.
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Affiliation(s)
- Xavier Benarous
- Department of Child and Adolescent Psychopathology, Amiens University Hospital, Amiens, France
- INSERM Unit U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardy Jules Verne (UPJV), Amiens, France
| | - Hélène Lahaye
- Department of Child and Adolescent Psychopathology, Amiens University Hospital, Amiens, France
- INSERM Unit U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardy Jules Verne (UPJV), Amiens, France
| | - Hugues Pellerin
- Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière University Hospital, APHP, Paris, France
| | - Angèle Consoli
- Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière University Hospital, APHP, Paris, France
| | - David Cohen
- Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière University Hospital, APHP, Paris, France
- CNRS UMR 7222, Institute for Intelligent Systems and Robotics, Sorbonne University, Paris, France
| | - Réal Labelle
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada
- Centre for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, Montréal, QC, Canada
| | - Johanne Renaud
- Manulife Centre for Breakthroughs in Teen Depression and Suicide Prevention, Douglas Mental Health University Institute, McGill University, Montréal, QC, Canada
- Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Priscille Gérardin
- Department of Child and Adolescent Psychopathology, Rouen University Hospital, Rouen, France
| | - Fabienne El-Khoury
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Equipe de Recherche en Epidémiologie Sociale, Paris, France
| | - Judith van der Waerden
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Equipe de Recherche en Epidémiologie Sociale, Paris, France
| | - Jean-Marc Guilé
- Department of Child and Adolescent Psychopathology, Amiens University Hospital, Amiens, France
- INSERM Unit U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardy Jules Verne (UPJV), Amiens, France
- Pôle de psychiatrie de l’enfant et de l’adolescent, Etablissement Publique de Santé Mentale de la Somme, Paris, France
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Hudson JL, Minihan S, Chen W, Carl T, Fu M, Tully L, Kangas M, Rosewell L, McDermott EA, Wang Y, Stubbs T, Martiniuk A. Interventions for Young Children's Mental Health: A Review of Reviews. Clin Child Fam Psychol Rev 2023; 26:593-641. [PMID: 37488453 PMCID: PMC10465658 DOI: 10.1007/s10567-023-00443-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2023] [Indexed: 07/26/2023]
Abstract
To determine the efficacy of intervention programs for young children (4-9 years) with emerging mental health needs, we conducted a review of meta-analytic and systematic reviews of the intervention literature. Of 41,061 abstracts identified and 15,076 screened, 152 review articles met the inclusion criteria. We reviewed interventions across multiple disciplines targeting: (1) general mental health concerns; (2) internalizing symptoms; (3) externalizing symptoms; (4) anxiety; (5) depression; (6) trauma; (7) symptoms of attention-deficit/hyperactivity disorder; and (8) mental health concerns associated with autism spectrum disorder. Substantial evidence was found for the efficacy of behavioral and cognitive behavioral interventions for general mental health concerns, externalizing symptoms (generally, as well as ADHD, conduct, and other behavioral symptoms) and internalizing symptoms (generally, as well as anxiety) aged 4-9 years. Emerging evidence was identified for interventions targeting trauma symptoms, depression symptoms, and social, emotional and behavioral symptoms in autism spectrum disorder in children aged 4-9 years. Currently there is only limited emerging evidence regarding non-behavioral or non-cognitive behavioral interventions for programs targeting children ages 4-9 years where the aim is to deliver an evidence-based program to improve child social, emotional and/or behavioral functioning. Given the recent rises in mental health needs reported in children, targeted behavioral-and/or cognitive behavior therapy-based interventions should be made widely available to children (and their families) who experience elevated symptoms.
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Affiliation(s)
- Jennifer L Hudson
- Black Dog Institute, University of New South Wales, Sydney, Australia.
| | - Savannah Minihan
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Wenting Chen
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Talia Carl
- Black Dog Institute, University of New South Wales, Sydney, Australia
- School of Psychology, University of Sydney, Sydney, Australia
| | - Michele Fu
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Lucy Tully
- School of Psychology, University of Sydney, Sydney, Australia
| | - Maria Kangas
- School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Linda Rosewell
- School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Emma A McDermott
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Yiwen Wang
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Thomas Stubbs
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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5
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The Feasibility, Acceptability, and Efficacy of Positive Search Training for Irritable Youth: A Single-Case Experimental Design. BEHAVIOUR CHANGE 2022. [DOI: 10.1017/bec.2022.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Although irritability is common in youth, research on treatment is in its infancy. Threat biases are more pronounced in irritable compared to low irritable youth, similar to evidence found in anxious youth. Therefore, interventions targeting these biases may be promising for reducing irritability. This study utilised a multiple baseline case series design to determine the feasibility, acceptability, and efficacy of positive search training (PST) for irritable children. Three children were included who met criteria for a principal diagnosis of Disruptive Mood Dysregulation Disorder (DMDD), and a secondary diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) or Major Depressive Disorder (MDD). PST was feasible with two of the three participants; one child refused to continue after one session. For the two participants who completed PST, acceptability was stable with moderate-to-high ratings of engagement and enjoyment, and high and stable treatment-relevant verbalisations of the key strategies. Both cases showed declines in DMDD severity across treatment and no longer met criteria at post-treatment. Both participants met criteria for Oppositional Defiant Disorder (ODD) at post-treatment (considered less severe for irritability than DMDD). Declines in parent-reported irritability occurred for both cases, however some returns to baseline were observed. Overall, PST for irritable youth shows promise as an acceptable and feasible intervention. Further studies are needed combining PST with strategies for secondary diagnoses, given its high comorbidity with disruptive behaviour disorders.
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6
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Forte A, Orri M, Turecki G, Galera C, Pompili M, Boivin M, Tremblay RE, Côté SM, Geoffroy MC. Identifying environmental pathways between irritability during childhood and suicidal ideation and attempt in adolescence: findings from a 20-year population-based study. J Child Psychol Psychiatry 2021; 62:1402-1411. [PMID: 33721915 DOI: 10.1111/jcpp.13411] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Irritable children are at increased risk of suicidal ideation and suicide attempt, but the underlying environmental mechanisms accounting for these associations are largely unknown. We aimed to investigate the mediating role of peer victimization and harsh parenting in the association between childhood irritability and adolescent suicidal ideation and attempt. METHOD N = 1,483 participants from the Québec Longitudinal Study of Child Development followed up from 5 months until 20 years of age (2018) with annual or biannual assessments. Irritability was operationalized using assessments of teacher-reported temper tantrums and reactive aggression. Suicidal ideation and suicide attempt at ages 13, 15, 17, and 20 years were self-reported. Peer victimization (self-reported at age 13) and harsh parenting (mothers reported at age 13) were considered as potential mediators. RESULTS We identified four trajectories of teacher-reported irritability symptoms from 6 to 12 years: low (74.8%), rising (12.9%), declining (7.3%), and persistent (4.9%). In adjusted models, children in the persistent and rising trajectories had, respectively, 2.81-fold (CI, 1.27-6.22) and 2.14-fold (CI, 1.20-3.81) increased odds of suicide attempt in adolescence, but not suicidal ideation. We found that a significant proportion of the association between irritability trajectories and suicide attempt was mediated by peer victimization (33% and 35% for rising and persistent, respectively), but there was no mediation via harsh parenting. CONCLUSIONS Our findings suggest that peer victimization may be a key mechanism explaining the increased suicide attempt risk of children presenting with persistently high or increasing irritability. Interventions to reduce peer victimization may be helpful to reduce suicide risk among irritable children.
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Affiliation(s)
- Alberto Forte
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy.,Department of Psychiatry and Substance Abuse, ASL Roma 5, Rome, Italy
| | - Massimiliano Orri
- McGill Group for Suicide Studies, Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada.,Bordeaux Population Health Research Centre, Inserm U1219, Université de Bordeaux, Bordeaux, France
| | - Gustavo Turecki
- McGill Group for Suicide Studies, Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | - Cedric Galera
- Bordeaux Population Health Research Centre, Inserm U1219, Université de Bordeaux, Bordeaux, France
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Michel Boivin
- School of Psychology, Laval University, Quebec, QC, Canada
| | - Richard E Tremblay
- Departments of Pediatrics and Psychology, University of Montreal, Montreal, QC, Canada.,School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland
| | - Sylvana M Côté
- Bordeaux Population Health Research Centre, Inserm U1219, Université de Bordeaux, Bordeaux, France.,Department of Social and Preventive Medicine, University of Montreal, Montreal, QC, Canada
| | - Marie-Claude Geoffroy
- McGill Group for Suicide Studies, Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada.,Department of Education and Counselling Psychology, McGill University, Montreal, QC, Canada
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7
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Naim R, Kircanski K, Gold A, German RE, Davis M, Perlstein S, Clayton M, Revzina O, Brotman MA. Across-subjects multiple baseline trial of exposure-based cognitive-behavioral therapy for severe irritability: a study protocol. BMJ Open 2021; 11:e039169. [PMID: 33692176 PMCID: PMC7949376 DOI: 10.1136/bmjopen-2020-039169] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 12/12/2020] [Accepted: 12/19/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Irritability is defined as a tendency towards anger in response to frustration. Clinically, impairing irritability is a significant public health problem. There is a need for mechanism-based psychotherapies targeting severe irritability as it manifests in the context of disruptive mood dysregulation disorder (DMDD). This study protocol describes a randomised multiple baseline design testing the preliminary efficacy of a new treatment, exposure-based cognitive-behavioral therapy for severe irritability in youth, which also integrates components of parent management training. We will investigate associations of this intervention with primary clinical measures, as well as ecological momentary assessment measures. METHODS AND ANALYSIS Forty youth will be enrolled. Participants, aged 8-17 years, must present at least one of two core symptoms of DMDD: abnormal mood or increased reactivity to negative emotional stimuli, with severe impairment in one domain (home, school, peers) and moderate in another, or moderate impairment in at least two domains. Each participant is randomised to a 2-week, 4-week or 6-week baseline observation period, followed by 12 active treatment sessions. Clinical ratings are conducted at baseline, biweekly (clinician), weekly (parent/child) throughout treatment, post-treatment, and 3-month and 6-month follow-up (clinician). Clinician ratings on the Affective Reactivity Index and Clinical Global Impressions-Improvement scale for DMDD are our primary outcome measures. Secondary outcome measures include parent and child reports of irritability. Post hoc additional symptom measures include clinician, parent and self-ratings of depression, anxiety and overall functional impairment. Prospective, digitally based event sampling of symptoms is acquired for a week pre-treatment, mid-treatment and post-treatment. Based on our pathophysiological model of irritability implicating frustrative non-reward, aberrant threat processing and instrumental learning, we probe these three brain-based targets using functional MRI paradigms to assess target engagement. ETHICS AND DISSEMINATION The research project and all related materials were submitted and approved by the appropriate Institutional Review Board (IRB) of the National Institute of Mental Health (NIMH). TRIAL REGISTRATION NUMBERS NCT02531893 and NCT00025935.
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Affiliation(s)
- Reut Naim
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Katharina Kircanski
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Andrea Gold
- Pediatric Anxiety Research Center, Bradley Hospital, Riverside, Rhode Island, USA
- Department of Psychiatry & Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ramaris E German
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Mollie Davis
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Samantha Perlstein
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Michal Clayton
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Olga Revzina
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Melissa A Brotman
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
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Malhi GS, Bell E, Bassett D, Boyce P, Bryant R, Hazell P, Hopwood M, Lyndon B, Mulder R, Porter R, Singh AB, Murray G. The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust N Z J Psychiatry 2021; 55:7-117. [PMID: 33353391 DOI: 10.1177/0004867420979353] [Citation(s) in RCA: 236] [Impact Index Per Article: 78.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To provide advice and guidance regarding the management of mood disorders, derived from scientific evidence and supplemented by expert clinical consensus to formulate s that maximise clinical utility. METHODS Articles and information sourced from search engines including PubMed, EMBASE, MEDLINE, PsycINFO and Google Scholar were supplemented by literature known to the mood disorders committee (e.g. books, book chapters and government reports) and from published depression and bipolar disorder guidelines. Relevant information was appraised and discussed in detail by members of the mood disorders committee, with a view to formulating and developing consensus-based recommendations and clinical guidance. The guidelines were subjected to rigorous consultation and external review involving: expert and clinical advisors, key stakeholders, professional bodies and specialist groups with interest in mood disorders. RESULTS The Royal Australian and New Zealand College of Psychiatrists mood disorders clinical practice guidelines 2020 (MDcpg2020) provide up-to-date guidance regarding the management of mood disorders that is informed by evidence and clinical experience. The guideline is intended for clinical use by psychiatrists, psychologists, primary care physicians and others with an interest in mental health care. CONCLUSION The MDcpg2020 builds on the previous 2015 guidelines and maintains its joint focus on both depressive and bipolar disorders. It provides up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus. MOOD DISORDERS COMMITTEE Gin S Malhi (Chair), Erica Bell, Darryl Bassett, Philip Boyce, Richard Bryant, Philip Hazell, Malcolm Hopwood, Bill Lyndon, Roger Mulder, Richard Porter, Ajeet B Singh and Greg Murray.
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Affiliation(s)
- Gin S Malhi
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Erica Bell
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | | | - Philip Boyce
- Department of Psychiatry, Westmead Hospital and the Westmead Clinical School, Wentworthville, NSW, Australia.,Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Philip Hazell
- Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne and Professorial Psychiatry Unit, Albert Road Clinic, Melbourne, VIC, Australia
| | - Bill Lyndon
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Ajeet B Singh
- The Geelong Clinic Healthscope, IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Greg Murray
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia
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9
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Derella OJ, Burke JD, Romano-Verthelyi AM, Butler EJ, Johnston OG. Feasibility and acceptability of a brief cognitive-behavioral group intervention for chronic irritability in youth. Clin Child Psychol Psychiatry 2020; 25:778-789. [PMID: 32370543 DOI: 10.1177/1359104520918331] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Chronic irritability is a core feature of oppositional defiant disorder (ODD) and disruptive mood dysregulation disorder (DMDD), but few irritability-specific interventions have been tested. Existing evidence-based treatments for disruptive behavior problems offer a strong template. This pilot study was conducted to develop and evaluate a brief irritability-specific module of a validated cognitive-behavioral group intervention for children (Stop Now And Plan (SNAP) Program). Stop now and plan for irritability (I-SNAP) retained core elements of SNAP in a shortened 6-week format. Community families with irritable children (M = 8.44 years, SD = 1.42) were recruited for parent and child emotion regulation skills groups. Of 18 children enrolled (72% male), 14 completed (78%). Half of children attended all six sessions, though homework compliance was lower. All parents reported favorable impressions and would recommend I-SNAP to others. Significant improvements were seen from pre- to post-treatment across parent-reported irritability, ODD symptoms, emotion regulation, and disciplinary effectiveness. This pilot study provides initial support suggesting I-SNAP may be feasible to implement and acceptable to parents. In addition, pilot analyses demonstrated that this brief group intervention was associated with positive outcomes consistent with treatment targets. This preliminary evidence supports the need for further research to assess I-SNAP's effects on irritability relative to control groups.
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Affiliation(s)
- Olivia J Derella
- Department of Psychological Sciences, University of Connecticut, USA
| | - Jeffrey D Burke
- Department of Psychological Sciences, University of Connecticut, USA
| | | | - Emilie J Butler
- Department of Psychological Sciences, University of Connecticut, USA
| | - Oliver G Johnston
- Department of Psychological Sciences, University of Connecticut, USA
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10
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Vacher C, Goujon A, Romo L, Purper-Ouakil D. Efficacy of psychosocial interventions for children with ADHD and emotion dysregulation: a systematic review. Psychiatry Res 2020; 291:113151. [PMID: 32619822 DOI: 10.1016/j.psychres.2020.113151] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 03/09/2020] [Accepted: 05/26/2020] [Indexed: 12/22/2022]
Abstract
Attention-Deficit Hyperactivity Disorder (ADHD) is frequently associated with emotion dysregulation (ED) that is characterized by excessive and inappropriate emotional reactions. Children with ADHD and ED present significant social, academic and family functioning impairments. These findings indicate that ED should be regularly monitored in children with ADHD and should be managed with targeted therapeutic interventions. However, few studies have evaluated the efficacy of psychosocial interventions to manage ED in children with ADHD. The aim of this systematic review was to assess the effects of psychosocial interventions for children with ADHD and ED, particularly their benefits and limitations. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) model. A systematic literature search of different databases in February 2018 allowed the identification of five randomized controlled trials, one quasi-experimental study, and four open-label uncontrolled studies. Analysis of the results reported in these studies suggested that psychosocial interventions can improve severe irritability and aggressive behavior in children with ADHD and ED. However, the short trial duration, the lack of follow-up and of control group in several studies, and the heterogeneity of the outcome measures affected the result interpretation. Future studies should use standardized measures of ED and larger samples.
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Affiliation(s)
- Cécile Vacher
- Centre Hospitalo-Universitaire de Montpellier, Service Médecine Psychologique de l'Enfant et de l'Adolescent, Montpellier, Hérault, France; CLIPSYD EA-4430, UFR Sciences Psychologiques et Sciences de l'Education, Université de Nanterre, Nanterre, Hauts de Seine, France.
| | - Allison Goujon
- Centre Hospitalo-Universitaire de Montpellier, Service Médecine Psychologique de l'Enfant et de l'Adolescent, Montpellier, Hérault, France
| | - Lucia Romo
- CLIPSYD EA-4430, UFR Sciences Psychologiques et Sciences de l'Education, Université de Nanterre, Nanterre, Hauts de Seine, France; CMME, Hôpital Sainte-Anne, GHU Paris Psychiatrie et Neurosciences; INSERM UMR1266 Institute of Psychiatry and Neuroscience of Paris
| | - Diane Purper-Ouakil
- Centre Hospitalo-Universitaire de Montpellier, Service Médecine Psychologique de l'Enfant et de l'Adolescent, Montpellier, Hérault, France; INSERM U1018 CESP/Psychiatry, development and trajectories, Montpellier
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11
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Effective use of atomoxetine to treat six inpatient youths with disruptive mood dysregulation disorder without attention deficit disorder. CNS Spectr 2020; 25:455-457. [PMID: 31218979 DOI: 10.1017/s1092852919001020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Benarous X, Renaud J, Breton JJ, Cohen D, Labelle R, Guilé JM. Are youths with disruptive mood dysregulation disorder different from youths with major depressive disorder or persistent depressive disorder? J Affect Disord 2020; 265:207-215. [PMID: 32090743 DOI: 10.1016/j.jad.2020.01.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 11/27/2019] [Accepted: 01/05/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Although the disruptive mood dysregulation disorder (DMDD) was included in the depressive disorders (DD) section of the DSM-5, common and distinctive features between DMDD and the pre-existing DD (i.e., major depressive disorder, MDD, and persistent depressive disorder, PDD) received little scrutiny. METHODS Youths consecutively assessed as outpatients at two Canadian mood clinics over four years were included in the study (n = 163; mean age:13.4 ± 0.3; range:7-17). After controlling for inter-rater agreement, data were extracted from medical charts, using previously validated chart-review instruments. RESULTS Twenty-two percent of youths were diagnosed with DMDD (compared to 36% for MDD and 25% for PDD), with substantial overlap between the three disorders. Youths with DMDD were more likely to have a comorbid non-depressive psychiatric disorder - particularly attention deficit hyperactivity disorder, odds ratio (OR=3.9), disruptive, impulse-control and conduct disorder (OR=3.0) or trauma- and stressor-related disorder (OR=2.5). Youths with DMDD did not differ with regard to the level of global functioning, but reported more school and peer-relationship difficulties compared to MDD and/or PDD. The vulnerability factors associated with mood disorders (i.e., history of parental depression and adverse life events) were found at a comparable frequency across the three groups. LIMITATIONS The retrospective design and the selection bias for mood disordered patients restricted the generalizability of the results. CONCLUSIONS Youths with DMDD share several clinical features with youths with MDD and PDD. Further studies are required to determine the developmental trajectories and the benefits of expanding pharmacotherapy for DD to DMDD.
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Affiliation(s)
- Xavier Benarous
- Child and Adolescent Psychopathology Services, Amiens University Hospital, Amiens, France; INSERM Unit U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardy Jules Verne (UPJV), Amiens, France; Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Johanne Renaud
- Manulife Centre for Breakthroughs in Teen Depression and Suicide Prevention, Douglas Mental Health University Institute, McGill University, Montreal, Canada; Department of psychiatry, McGill University, Montreal, Canada
| | | | - David Cohen
- Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France; CNRS UMR 7222, Institute for Intelligent Systems and Robotics, Sorbonne Universités, UPMC, Paris, France
| | - Réal Labelle
- Department of psychiatry, University of Montreal, Montreal, Canada; Département de psychologie, Université du Québec à Montréal, Montréal, Canada; Centre de recherche, Hôpital en santé mentale Rivière-des-Prairies, CIUSSS du Nord-de-l'Île-de-Montréal, Canada; Centre for Research and Intervention on Suicide, Ethical Issues and End-of-life practices, (CRISE), Montreal, Canada
| | - Jean-Marc Guilé
- Child and Adolescent Psychopathology Services, Amiens University Hospital, Amiens, France; INSERM Unit U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardy Jules Verne (UPJV), Amiens, France; Department of psychiatry, McGill University, Montreal, Canada.
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Towbin K, Vidal-Ribas P, Brotman MA, Pickles A, Miller KV, Kaiser A, Vitale AD, Engel C, Overman GP, Davis M, Lee B, McNeil C, Wheeler W, Yokum CH, Haring CT, Roule A, Wambach CG, Sharif-Askary B, Pine DS, Leibenluft E, Stringaris A. A Double-Blind Randomized Placebo-Controlled Trial of Citalopram Adjunctive to Stimulant Medication in Youth With Chronic Severe Irritability. J Am Acad Child Adolesc Psychiatry 2020; 59:350-361. [PMID: 31128268 PMCID: PMC9706653 DOI: 10.1016/j.jaac.2019.05.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 03/08/2019] [Accepted: 05/03/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Despite the clinical importance of chronic and severe irritability, there is a paucity of controlled trials for its pharmacological treatment. Here, we examine the effects of adding citalopram (CTP) to methylphenidate (MPH) in the treatment of chronic severe irritability in youth using a double-blind randomized placebo-controlled design. METHOD After a lead-in phase of open treatment with stimulant, 53 youth meeting criteria for severe mood dysregulation (SMD) were randomly assigned to receive CTP or placebo (PBO) for 8 weeks. A total of 49 participants, 48 of them (98%) meeting disruptive mood dysregulation disorder (DMDD) criteria, were included in the intent-to-treat analysis. The primary outcome measure was the proportion of response based on improvements of irritability at the week 8 of the trial. RESULTS At the end of the trial, a significantly higher proportion of response was seen in those participants randomly assigned to CTP+MPH compared to PBO+MPH (35% CTP+MPH versus 6% PBO+MPH; odds ratio = 11.70, 95% CI = 2.00-68.16, p = 0.006). However, there were no differences in functional impairment between groups at the end of the trial. No differences were found in any adverse effect between treatment groups, and no trial participant exhibited hypomanic or manic symptoms. CONCLUSION Adjunctive CTP might be efficacious in the treatment of chronic severe irritability in youth resistant to stimulant treatment alone. CLINICAL TRIAL REGISTRATION INFORMATION A Controlled Trial of Serotonin Reuptake Inhibitors Added to Stimulant Medication in Youth With Severe Mood Dysregulation; https://clinicaltrials.gov; NCT00794040.
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Affiliation(s)
- Kenneth Towbin
- Mood Brain and Development Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | - Pablo Vidal-Ribas
- Mood Brain and Development Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD.,Institute of Psychiatry, Psychology & Neuroscience, King’s College London, UK
| | - Melissa A. Brotman
- Neuroscience and Novel Therapeutics, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | - Andrew Pickles
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, UK
| | - Katherine V. Miller
- Mood Brain and Development Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | - Ariela Kaiser
- Mood Brain and Development Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | - Aria D. Vitale
- Mood Brain and Development Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | - Chana Engel
- Mood Brain and Development Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | | | - Mollie Davis
- Section on Mood Dysregulation and Neuroscience, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | - Beth Lee
- College of Nursing, University of Arizona, Tuscon
| | - Cheri McNeil
- Section on Mood Dysregulation and Neuroscience, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | - Wanda Wheeler
- Section on Mood Dysregulation and Neuroscience, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | - Catherine H. Yokum
- Section on Mood Dysregulation and Neuroscience, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | | | | | | | | | - Daniel S. Pine
- Section on Development and Affective Neuroscience, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | - Ellen Leibenluft
- Section on Mood Dysregulation and Neuroscience, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | - Argyris Stringaris
- Mood Brain and Development Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD.
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Rice T, Simon H, Barckak D, Maiyuran H, Chan V, Hassan Y, Tatum J, Coffey BJ. Amantadine for Treatment of Disruptive Mood Dysregulation Disorder Symptoms. J Child Adolesc Psychopharmacol 2019; 29:642-646. [PMID: 31592724 DOI: 10.1089/cap.2019.29172.bjc] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Timothy Rice
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Hannah Simon
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Danielle Barckak
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Harinee Maiyuran
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Vivian Chan
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Yonis Hassan
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jasmine Tatum
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Barbara J Coffey
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
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Benarous X, Morales P, Mayer H, Iancu C, Edel Y, Cohen D. Internet Gaming Disorder in Adolescents With Psychiatric Disorder: Two Case Reports Using a Developmental Framework. Front Psychiatry 2019; 10:336. [PMID: 31133904 PMCID: PMC6524313 DOI: 10.3389/fpsyt.2019.00336] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 04/29/2019] [Indexed: 01/08/2023] Open
Abstract
Internet gaming disorder (IGD) has been a controversial entity with various opinions about its clinical relevance as an independent mental disorder. This debate has also included discussions about the relationships between problematic gaming, various psychiatric disorders, and personality traits and dimensions. This paper outlines a developmental-theory based model of Internet gaming misuse inspired by the treatment of two adolescent inpatients. The two clinical vignettes illustrate distinct developmental pathways: an "internalized pathway" via the development of social anxiety, emotional and behavioral avoidance; and an "externalized pathway" with a low level of emotional regulation strategies and impulsivity. In both clinical cases, attachment issues played a key role to understand the specific associations of risk and maintaining factors for IGD, and gaming behaviors may be seen as specific forms of maladaptive self-regulatory strategies for these two youths. These clinical observations support the assumption that gaming use problematic in adolescents should be viewed with a developmental approach, including key aspects of emotional development that represent significant targets for therapeutic interventions.
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Affiliation(s)
- Xavier Benarous
- Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière Hospital, Paris, France
- INSERM Unit U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardy Jules Verne (UPJV), Amiens, France
| | - Pierre Morales
- Department of Addiction, Hôpital Pitié-Salpêtrière, Paris, France
| | - Hanna Mayer
- Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière Hospital, Paris, France
| | - Cosmin Iancu
- Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière Hospital, Paris, France
| | - Yves Edel
- Department of Addiction, Hôpital Pitié-Salpêtrière, Paris, France
| | - David Cohen
- Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière Hospital, Paris, France
- CNRS UMR 7222, Institute for Intelligent Systems and Robotics, Sorbonnes Université, Paris, France
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Benarous X, Consoli A, Cohen D, Renaud J, Lahaye H, Guilé JM. Suicidal behaviors and irritability in children and adolescents: a systematic review of the nature and mechanisms of the association. Eur Child Adolesc Psychiatry 2019; 28:667-683. [PMID: 30293122 DOI: 10.1007/s00787-018-1234-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 10/01/2018] [Indexed: 11/29/2022]
Abstract
While many psychiatric disorders are associated with an increased risk for suicidal behaviors (SB) in children and adolescents, a few studies have explored the role of clinical symptoms based on a dimensional approach. Irritability is seen as a marker, a general psychopathology, and a symptom of both externalizing and internalizing disorders. In this review, we are interested in determining whether and how irritability can predict SB in youth. First, we reviewed consistencies and variation in the literature linking irritability to suicidal ideation (SI) and suicide attempt (SA). Second, based on the available models, we proposed specific mechanistic pathways, whereby irritability may modulate the risk for SB. Irritability has been found associated with SB both in cross-sectional and in longitudinal studies. The relation is consistent in different settings (i.e., general population and clinical settings) and across psychiatric disorders. The association is reduced but persists after adjusting for psychiatric disorder, including depression. On one hand, irritability constitutes a risk factor for SI via the onset of internalized disorder. On the other hand, irritable youth may be more prone to attempt suicide when experiencing SI. The measures for irritability were heterogeneous. A limited number of studies were designed to explore the role of mediators and/or moderators. Recognizing irritability in children and adolescents is a key issue with regards to suicide prevention.
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Affiliation(s)
- Xavier Benarous
- Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière Hospital, 83, boulevard de l'Hôpital, 75013, Paris, France. .,INSERM Unit U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardy Jules Verne (UPJV), Amiens, France.
| | - Angèle Consoli
- Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière Hospital, 83, boulevard de l'Hôpital, 75013, Paris, France.,GRC-15, Dimensional approach of Child and Adolescent Psychotic Episodes, Pierre and Marie Curie University (UPMC), Paris, France
| | - David Cohen
- Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière Hospital, 83, boulevard de l'Hôpital, 75013, Paris, France.,CNRS, UMR 7222, Institute for Intelligent Systems and Robotics, Sorbonne Université, UPMC, Paris, France
| | - Johanne Renaud
- Manulife Centre for Breakthroughs in Teen Depression and Suicide Prevention, Douglas Mental Health University Institute, McGill University, Montreal, Canada.,Department of Psychiatry, McGill University, Montreal, Canada
| | - Hélène Lahaye
- Child and Adolescent Psychopathology Department, Amiens University Hospital, Amiens, France
| | - Jean-Marc Guilé
- INSERM Unit U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardy Jules Verne (UPJV), Amiens, France.,Department of Psychiatry, McGill University, Montreal, Canada.,Child and Adolescent Psychopathology Department, Amiens University Hospital, Amiens, France
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Moreno C, Zuddas A. Re-thinking treatment targets in child and adolescent psychiatry. Eur Child Adolesc Psychiatry 2019; 28:289-291. [PMID: 30820669 DOI: 10.1007/s00787-019-01299-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Carmen Moreno
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense (UCM), IiSGM, CIBERSAM, Madrid, Spain.
| | - Alessandro Zuddas
- Department of Biomedical Sciences, Section Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy.,Child and Adolescent Neuropsychiatry, ''A. Cao'' Paediatric Hospital, "G. Brotzu" Hospital Trust, Via E. Jenner, 09121, Cagliari, Italy
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Abstract
Mood disorders include all types of depression and bipolar disorder, and mood disorders are sometimes called affective disorders. We will discuss newly developing two issues in affective disorders in children and adolescents. Those are the new diagnostic challenges using neuroimaging techniques in affective disorders and the introduction of disruptive mood dysregulation disorder (DMDD). During the 1980s, mental health professionals began to recognize symptoms of mood disorders in children and adolescents, as well as adults. However, children and adolescents do not necessarily have or exhibit the same symptoms as adults. It is more difficult to diagnose mood disorders in children, especially because children are not always able to express how they feel. Child mental health professionals believe that mood disorders in children and adolescents remain one of the most underdiagnosed mental health problems. We are currently trying to introduce the new diagnostic technique-machine learning in children and adolescents with MDD. We will discuss the current progress in the clinical application of machine learning for MDD. After that, we would also discuss a new challenging diagnosis-DMDD. We are still suffering from a lack of evidence when trying to treat the patients with DMDD. In addition, there are some debates about the diagnostic validity of DMDD. We will explain the current situation of DMDD studies and the future directions in the study of DMDD.
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Delaplace R, Garny de La Rivière S, Bon Saint Come M, Lahaye H, Popov I, Rey N, Visticot A, Guilé JM. Sleep and disruptive mood dysregulation disorder: A pilot actigraphy study. Arch Pediatr 2018; 25:S0929-693X(18)30109-X. [PMID: 29909941 DOI: 10.1016/j.arcped.2018.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 05/01/2018] [Accepted: 05/20/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To explore the clinical characteristics and motor activity profile during sleep periods of children and adolescents presenting with disruptive mood dysregulation disorder (DMDD). METHOD Twenty-one youths (mean age±standard deviation, 11.7±3 years) wore a wrist actigraph for 9 consecutive days (including both school days and non-school days), to measure sleep parameters: sleep latency, sleep efficiency and the number and duration of periods of wakefulness after sleep onset (WASO). We divided the night-time actigraphy recording sessions into three sections and compared the first and last thirds of the night. RESULTS All the study participants had a psychiatric comorbidity (primarily attention deficit hyperactivity disorder, depressive disorder or anxiety disorder). On non-school days, bedrest onset and activity onset were shifted later by about 1h. There was no significant difference between school days and non-school days with regard to the total sleep time. Sleep efficiency was significantly greater on non-school days. Sleep was fragmented on both school days and non-school days. The mean number of episodes of WASO was 24.9 for school days and 30.9 for non-school days. Relative to the first third of the night, we observed a significantly greater number of episodes of WASO during the last third of the night, a period associated with a larger proportion of rapid eye movement (REM) sleep. DISCUSSION Sleep appeared to be fragmented in the study population of youths with DMDD. The greater frequency of WASO in the last third of the night points to a possible impairment of the motor inhibition normally associated with REM sleep.
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Affiliation(s)
- R Delaplace
- GRAMFC, Inserm 1105, université Picardie-Jules-Verne et CHU d'Amiens, 80480 Amiens, France
| | - S Garny de La Rivière
- GRAMFC, Inserm 1105, université Picardie-Jules-Verne et CHU d'Amiens, 80480 Amiens, France; Service de psychopathologie de l'enfant et de l'adolescent, CHU d'Amiens, 80480 Amiens, France
| | - M Bon Saint Come
- Service de psychopathologie de l'enfant et de l'adolescent, CHU d'Amiens, 80480 Amiens, France
| | - H Lahaye
- GRAMFC, Inserm 1105, université Picardie-Jules-Verne et CHU d'Amiens, 80480 Amiens, France; Service de psychopathologie de l'enfant et de l'adolescent, CHU d'Amiens, 80480 Amiens, France
| | - I Popov
- CRC pédiatrique, CHU d'Amiens, 80480 Amiens, France
| | - N Rey
- Service de psychopathologie de l'enfant et de l'adolescent, CHU d'Amiens, 80480 Amiens, France
| | - A Visticot
- Service de psychopathologie de l'enfant et de l'adolescent, CHU d'Amiens, 80480 Amiens, France; Centre hospitalier, boulevard Georges-Besnier, 62000 Arras, France
| | - J-M Guilé
- GRAMFC, Inserm 1105, université Picardie-Jules-Verne et CHU d'Amiens, 80480 Amiens, France; Service de psychopathologie de l'enfant et de l'adolescent, CHU d'Amiens, 80480 Amiens, France.
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