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Malhi GS, Bell E. Missed conceptions about paediatric bipolar disorder: a reply and discussion of DMDD. Acta Neuropsychiatr 2024; 36:187-188. [PMID: 38523512 DOI: 10.1017/neu.2024.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Affiliation(s)
- Gin S Malhi
- Academic Department of Psychiatry, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- CADE Clinic and Mood-T, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Erica Bell
- Academic Department of Psychiatry, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- CADE Clinic and Mood-T, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia
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2
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Park YT, Han D, Kim KH, Kim H, Yoon HJ, Lane C, Kim BR, Jeong JY. Feasibility of extracting cancer stage and metastasis codes from health insurance claims of outpatients and expressibility in ICD-11: a cross-sectional study using national health insurance data from South Korea. BMJ Open 2024; 14:e073952. [PMID: 38401892 PMCID: PMC10895217 DOI: 10.1136/bmjopen-2023-073952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 02/08/2024] [Indexed: 02/26/2024] Open
Abstract
OBJECTIVES This study aimed to evaluate the incidence of health insurance claims recording the cancer stage and TNM codes representing tumor extension size (T), lymph node metastasis (N), and distant metastasis (M) for patients diagnosed with cancer and to determine whether this extracted data could be applied to the new ICD-11 codes. DESIGN A cross-sectional study design was used, with the units of analysis as individual outpatients. Two dependent variables were extraction feasibility of cancer stage and TNM metastasis information from each claim. Expressibility of the two variables in ICD-11 was descriptively analysed. SETTING AND PARTICIPANTS The study was conducted in South Korea and study participants were outpatients: lung cancer (LC) (46616), stomach cancer (SC) (50103) and colorectal cancer (CC) (54707). The data set consisted of the first health insurance claim of each patient visiting a hospital from 1 July to 31 December 2021. RESULTS The absolute extraction success rates for cancer stage based on claims with cancer stage was 33.3%. The rates for stage for LC, SC and CC were 30.1%, 35.5% and 34.0%, respectively. The rate for TNM was 11.0%. The relative extraction success rates for stage compared with that for CC (the reference group) were lower for patients with LC (adjusted OR (aOR), 0.803; 95% CI 0.782 to 0.825; p<0.0001) but higher for SC (aOR 1.073; 95% CI 1.046 to 1.101; p<0.0001). The rates of TNM compared that for CC were 40.7% lower for LC (aOR, 0.593; 95% CI 0.569 to 0.617; p<0.0001) and 43.0% lower for SC (aOR 0.570; 95% CI 0.548 to 0.593; p<0.0001). There were limits to expressibility in ICD-11 regarding the detailed cancer stage and TNM metastasis codes. CONCLUSION Extracting cancer stage and TNM codes from health insurance claims were feasible, but expressibility in ICD-11 codes was limited. WHO may need to create specific cancer stage and TNM extension codes for ICD-11 due to the absence of current rules in ICD-11.
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Affiliation(s)
- Young-Taek Park
- HIRA Research Institute, Health Insurance Review & Assessment Service (HIRA), Wonju-si, Republic of Korea
| | - Dongwoon Han
- Department of Preventive Medicine, Hanyang University, Seoul, Republic of Korea
| | - Kyoung-Hoon Kim
- Department of Health Administration, Kongju National University, Gongju-si, Republic of Korea
| | - Hoguen Kim
- Healthcare Review Committee, Health Insurance Review & Assessment Service (HIRA), Seoul, Republic of Korea
| | | | - Chris Lane
- Health Workforce Analytics and Intelligence, Ministry of Health, Wellington, New Zealand
| | - Byeo-Ri Kim
- Division of ICD-11 Domestic Implementation, Health Insurance Review & Assessment Service (HIRA), Wonju-si, Republic of Korea
| | - Joo-Yeon Jeong
- Division of Medical Loss Compensation, Health Insurance Review & Assessment Service (HIRA), Wonju-si, Republic of Korea
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3
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Özyurt G, Öztürk Y, Tufan AE, Akay A, İnal N. Differential Effects of Disruptive Mood Dysregulation Disorder Comorbidity in Attention Deficit Hyperactivity Disorder on Social Cognition and Empathy. J Atten Disord 2024; 28:458-468. [PMID: 38069496 DOI: 10.1177/10870547231215516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
OBJECTIVE This study aimed to investigate social cognition and empathy properties in children among Disruptive Mood Dysregulation Disorder (DMDD) + Attention and Hyperactivity Disorder(ADHD); ADHD and healthy controls from Türkiye. METHODS Twenty-two children with DMDD were compared to matched 30 children with ADHD and 60 healthy controls. We administered Affective Reactivity Index (ARI), KaSi Empathy Scale, Kiddie-SADS, and Reading Mind in the Eyes Test (RMET) to evaluate Theory of Mind skills to all study participants. RESULTS DMDD + ADHD group had lower performance in ToM skills and empathy than in two groups. The ARI scores were found to be statistically significantly higher in the DMDD group than in two groups. It was also found that ARI, empathy, and ToM scores were significantly related in children with DMDD + ADHD. CONCLUSION These results might be important to understand the difficulties in social functioning and interpersonal relationship in children with DMDD and ADHD. Children with DMDD may attend specific therapeutic programs which include specific techniques in social cognition, emotion regulation, and irritability.
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Affiliation(s)
- Gonca Özyurt
- School of Medicine, Katip Çelebi University, İzmir, Turkey
| | - Yusuf Öztürk
- Bolu Abant İzzet Baysal University, Bolu, Turkey
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Andrade BF. Discussant: Distilling symptom heterogeneity in youth with ODD: a commentary on Leadbeater et al., 2023. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2023; 32:236-238. [PMID: 38034407 PMCID: PMC10686221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Affiliation(s)
- Brendan F Andrade
- Senior Scientist, Campbell Family Mental Health Research Institute, Margaret and Wallace McCain Centre for Child Youth and Family Mental Health at the Centre for Addiction and Mental Health; Associate Professor, Department of Psychiatry, University of Toronto
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5
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Leadbeater BJ, Merrin GJ, Contreras A, Ames ME. Trajectories of oppositional defiant disorder severity from adolescence to young adulthood and substance use, mental health, and behavioral problems. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2023; 32:224-235. [PMID: 38034412 PMCID: PMC10686226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 04/29/2023] [Indexed: 12/02/2023]
Abstract
Background Oppositional Defiant Disorder (ODD) is a disruptive behavioral disorder; however, increasing evidence emphasizes irritable mood as a primary symptom of ODD. Objectives This study investigated whether heterogeneous groups (classes) of individuals can be differentiated based on ODD sub-dimensions (irritability and defiance) or on overall ODD symptoms longitudinally. We also examine associations between ODD trajectory class and comorbid substance use (heavy episodic drinking, cannabis use), mental health (depression and anxiety) and behavioral symptoms (ADHD, aggression and substance use) in both adolescence and young adulthood (controlling for adolescent levels of each of these concerns). Method Data were from a randomly recruited community sample of 662 Canadian youth (T1 ages 12-18) followed biennially for 10 years (T6 ages 22-29). Results Growth mixture models revealed trajectories classes of ODD based on severity of symptoms. A three-class solution provided the best fit with Low (n = 119; 18%), Moderate (n = 473; 71.5%), and High (n = 70; 10.6%) ODD classes. Class trajectory differences were similarity based on symptoms severity (rather than type) for symptom sub-dimensions (irritability defiance). Adolescent and young adult substance use, mental health symptoms, and behavioral problems were significantly higher for the High ODD trajectory class compared to both other classes. Youth in the Moderate ODD trajectory class also showed higher comorbid symptoms in adolescence and young adulthood, compared to the Low ODD trajectory class. Conclusion Early identification of children and adolescents with high or moderate ODD symptoms and interventions that simultaneously address defiance and irritability are supported by the findings.
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Affiliation(s)
| | | | | | - Megan E Ames
- University of Victoria, Victoria, British Columbia
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6
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Keeley J, Reed GM, Rebello T, Brechbiel J, Garcia-Pacheco JA, Adebayo K, Esan O, Majekodunmi O, Ojagbemi A, Onofa L, Robles R, Matsumoto C, Medina-Mora ME, Kogan CS, Kulygina M, Gaebel W, Zhao M, Roberts MC, Sharan P, Ayuso-Mateos JL, Khoury B, Stein DJ, Lovell AM, Pike K, Creed F, Gureje O. Case-controlled field study of the ICD-11 clinical descriptions and diagnostic requirements for Bodily Distress Disorders. J Affect Disord 2023; 333:271-277. [PMID: 37100177 DOI: 10.1016/j.jad.2023.04.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/31/2023] [Accepted: 04/18/2023] [Indexed: 04/28/2023]
Abstract
AIMS Mental disorders characterized by preoccupation with distressing bodily symptoms and associated functional impairment have been a target of major reconceptualization in the ICD-11, in which a single category of Bodily Distress Disorder (BDD) with different levels of severity replaces most of the Somatoform Disorders in ICD-10. This study compared the accuracy of clinicians' diagnosis of disorders of somatic symptoms using either the ICD-11 or ICD-10 diagnostic guidelines in an online study. METHODS Clinically active members of the World Health Organization's Global Clinical Practice Network (N = 1065) participating in English, Spanish, or Japanese were randomly assigned to apply ICD-11 or ICD-10 diagnostic guidelines to one of nine pairs of standardized case vignettes. The accuracy of the clinicians' diagnoses as well as their ratings of the guidelines' clinical utility were assessed. RESULTS Overall, clinicians were more accurate using ICD-11 compared to ICD-10 for every presentation of a vignette characterized primarily by bodily symptoms associated with distress and impairment. Clinicians who made a diagnosis of BDD using ICD-11 were generally correct in applying the severity specifiers for the condition. LIMITATIONS This sample may represent some self-selection bias and thus may not generalize to all clinicians. Additionally, diagnostic decisions with live patients may lead to different results. CONCLUSIONS The ICD-11 diagnostic guidelines for BDD represent an improvement over those for Somatoform Disorders in ICD-10 in regard to clinicians' diagnostic accuracy and perceived clinical utility.
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Affiliation(s)
- Jared Keeley
- Virginia Commonwealth University, Department of Psychology, United States of America.
| | - Geoffrey M Reed
- Columbia University Vagelos College of Physicians and Surgeons, Department of Psychiatry, United States of America; World Health Organization, Department of Mental Health and Substance Use, Switzerland
| | - Tahilia Rebello
- Columbia University Vagelos College of Physicians and Surgeons, Department of Psychiatry, United States of America; New York State Psychiatric Institute, United States of America
| | - Julia Brechbiel
- Virginia Commonwealth University, Department of Psychology, United States of America
| | | | - Kazeem Adebayo
- Ladoke Akintola University of Technology, Department of Psychiatry, Nigeria
| | - Oluyomi Esan
- University of Ibadan, Department of Psychiatry, Nigeria
| | | | - Akin Ojagbemi
- University of Ibadan, Department of Psychiatry, Nigeria
| | - Lucky Onofa
- Federal Neuropsychiatric Hospital, Abeokuta, Nigeria
| | - Rebeca Robles
- Instituto Nacional de Psiquiatría 'Ramón de la Fuente Muñiz', Centro de Investigación en Salud Mental Global, Mexico
| | | | - Maria Elena Medina-Mora
- Instituto Nacional de Psiquiatría 'Ramón de la Fuente Muñiz', Centro de Investigación en Salud Mental Global, Mexico; Universidad National Autónoma de México, Faculty of Psychology, Mexico
| | - Cary S Kogan
- University of Ottawa, School of Psychology, Canada
| | - Maya Kulygina
- N.A. Alexeev Mental Health Clinic, Training and Research Center, Russian Federation
| | - Wolfgang Gaebel
- Heinrich-Heine University, Medical Faculty, Department of Psychiatry and Psychotherapy, Germany
| | - Min Zhao
- Shanghai Mental Health Center, China; Shanghai Jiaotong University School of Medicine, China
| | - Michael C Roberts
- University of Kansas, Clinical Child Psychology Program, United States of America
| | | | | | - Brigitte Khoury
- American University of Beirut Medical Center, Department of Psychiatry, Lebanon
| | - Dan J Stein
- University of Cape Town, Department of Psychiatry, SAMRC Unit on Risk & Resilience in Mental Disorders, South Africa
| | - Anne M Lovell
- Institut National de la Santé et de la Recherche Médicale CERMES, France
| | - Kathleen Pike
- Columbia University, Global Mental Health Program, United States of America
| | | | - Oye Gureje
- Federal Neuropsychiatric Hospital, Abeokuta, Nigeria
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7
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Abstract
OBJECTIVES Paediatric bipolar disorder - bipolar disorder occurring in prepubertal children - is a diagnosis subject to considerable controversy. Whilst historically considered to be very rare, proponents since the 1990s have argued that mania can present differently in children and, as such, is much more common than previously thought. Such proposals raise questions about the validity of proposed phenotypes and potential risks of iatrogenic harm. METHODS I critically examine the construct of paediatric bipolar disorder using Robins and Guze's (1970, American Journal of Psychiatry126, 983-987) influential criteria for the validity of a psychiatric diagnosis. I review, in turn, evidence relating to its clinical description, delimitation from other conditions, follow-up studies, family studies, laboratory studies, and treatment response. RESULTS Across domains, existing research highlights significant challenges establishing the diagnosis. This includes significant heterogeneity in operationalising criteria for children; variable or poor inter-rater reliability; difficulty distinguishing paediatric bipolar disorder from other conditions; large differences in rates of diagnosis between the United States of America and other countries; limited evidence of continuity with adult forms; and a lack of evidence for proposed paediatric phenotypes in children at genetic high-risk of the condition. Laboratory and treatment studies are limited, but also do not provide support for the construct. CONCLUSIONS Evidence for the more widespread existence of paediatric bipolar disorder and its various proposed phenotypes remains weak. The ongoing popularity of the diagnosis, most evident in America, may reflect social pressures and broader limitations in psychiatric nosology. The uncertainty around the diagnosis highlights the need for careful longitudinal assessment of children potentially affected.
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Panda TK, Singhai K, Nebhinani N, Pareek V, Jain S. Diagnostic and Therapeutic Challenges in an Adolescent with Comorbid Oppositional Defiant Disorder and Bipolar Disorder. JOURNAL OF INDIAN ASSOCIATION FOR CHILD AND ADOLESCENT MENTAL HEALTH 2023. [DOI: 10.1177/09731342231156497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Oppositional defiant disorder (ODD) is often found to be comorbid with bipolar disorder (BD) in children and adolescents. Both disorders are characterized by chronic irritability, emotional dysregulation, and behavioral problems. These overlapping symptoms often lead to diagnostic difficulty. In addition, ODD-BD comorbidity also presents multiple therapeutic challenges. Here, we describe the case of an adolescent male, who presented with comorbid ODD and BD, along with multiple diagnostic and therapeutic challenges.
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Affiliation(s)
- Tushar Kanta Panda
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Kartik Singhai
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Naresh Nebhinani
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Vrinda Pareek
- Department of Psychiatry, Medical College, Baroda, Gujarat, India
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9
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Stepanova E, Langfus JA, Youngstrom EA, Evans SC, Stoddard J, Young AS, Van Eck K, Findling RL. Finding a Needed Diagnostic Home for Children with Impulsive Aggression. Clin Child Fam Psychol Rev 2023; 26:259-271. [PMID: 36609931 DOI: 10.1007/s10567-022-00422-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 01/09/2023]
Abstract
Aggressive behavior is one of the most common reasons for referrals of youth to mental health treatment. While there are multiple publications describing different types of aggression in children, it remains challenging for clinicians to diagnose and treat aggressive youth, especially those with impulsively aggressive behaviors. The reason for this dilemma is that currently several psychiatric diagnoses include only some of the common symptoms of aggression in their criteria. However, no single diagnosis or diagnostic specifier adequately captures youth with impulsive aggression (IA). Here we review select current diagnostic categories, including behavior and mood disorders, and suggest that they do not provide an adequate description of youth with IA. We also specifically focus on the construct of IA as a distinct entity from other diagnoses and propose a set of initial, provisional diagnostic criteria based on the available evidence that describes youth with IA to use for future evaluation.
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Affiliation(s)
- Ekaterina Stepanova
- Virginia Commonwealth University, 1308 Sherwood Ave, Richmond, VA, 23220, USA.
| | - Joshua A Langfus
- University of North Carolina at Chapel Hill, 235 E Cameron Ave, CB# 3270, Chapel Hill, NC, 27514, USA
| | - Eric A Youngstrom
- University of North Carolina at Chapel Hill, 103 Westchester Pl, Chapel Hill, NC, 27514-5237, USA
| | - Spencer C Evans
- University of Miami, 5665 Ponce de Leon Blvd, Coral Gables, FL, 33146, USA
| | - Joel Stoddard
- University of Colorado Anschutz Medical Campus, Aurora, 13123 East 16Th Ave, Aurora, CO, 80045, USA
| | - Andrea S Young
- Johns Hopkins University, 1800 Orleans Street, Bloomberg 12N, Baltimore, MD, 21287, USA
| | - Kathryn Van Eck
- Johns Hopkins University, 1800 Orleans Street, Bloomberg 12N, Baltimore, MD, 21287, USA
| | - Robert L Findling
- Virginia Commonwealth University, 501 N 2Nd St 4Th Floor, PO Box 980308, Richmond, VA, 23298-0308, USA
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10
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Carlson GA, Singh MK, Amaya-Jackson L, Benton TD, Althoff RR, Bellonci C, Bostic JQ, Chua JD, Findling RL, Galanter CA, Gerson RS, Sorter MT, Stringaris A, Waxmonsky JG, McClellan JM. Narrative Review: Impairing Emotional Outbursts: What They Are and What We Should Do About Them. J Am Acad Child Adolesc Psychiatry 2023; 62:135-150. [PMID: 35358662 DOI: 10.1016/j.jaac.2022.03.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/31/2022] [Accepted: 03/21/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Impairing emotional outbursts, defined by extreme anger or distress in response to relatively ordinary frustrations and disappointments, impact all mental health care systems, emergency departments, schools, and juvenile justice programs. However, the prevalence, outcome, and impact of outbursts are difficult to quantify because they are transdiagnostic and not explicitly defined by current diagnostic nosology. Research variably addresses outbursts under the rubrics of tantrums, anger, irritability, aggression, rage attacks, or emotional and behavioral dysregulation. Consistent methods for identifying and assessing impairing emotional outbursts across development or systems of care are lacking. METHOD The American Academy of Child and Adolescent Psychiatry Presidential Task Force (2019-2021) conducted a narrative review addressing impairing emotional outbursts within the limitations of the existing literature and independent of diagnosis. RESULTS Extrapolating from the existing literature, best estimates suggest that outbursts occur in 4%-10% of community children (preschoolers through adolescents). Impairing emotional outbursts may respond to successful treatment of the primary disorder, especially for some children with attention-deficit/hyperactivity disorder whose medications have been optimized. However, outbursts are generally multi-determined and often represent maladaptive or deficient coping strategies and responses. CONCLUSION Evidence-based strategies are necessary to address factors that trigger, reinforce, or excuse the behaviors and to enhance problem-solving skills. Currently available interventions yield only modest effect sizes for treatment effect. More specific definitions and measures are needed to track and quantify outbursts and to design and assess the effectiveness of interventions. Better treatments are clearly needed.
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Affiliation(s)
- Gabrielle A Carlson
- Renaissance School of Medicine at Stony Brook University, Putnam Hall, South Campus, Stony Brook, New York.
| | | | | | - Tami D Benton
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | | | - Jeff Q Bostic
- MedStar Georgetown University Hospital, Washington, DC
| | - Jaclyn Datar Chua
- Perelman School of Medicine, University of Pennsylvania, Philadelphia; University of Pennsylvania, Philadelphia
| | | | - Cathryn A Galanter
- SUNY Downstate, Brooklyn, New York; Kings County Hospital Center, Brooklyn, New York
| | | | - Michael T Sorter
- Cincinnati Children's Hospital and the University of Cincinnati, Ohio
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11
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Di Vincenzo M. New research on validity and clinical utility of ICD-11 vs. ICD-10 and DSM-5 diagnostic categories. World Psychiatry 2023; 22:171-172. [PMID: 36640408 PMCID: PMC9840503 DOI: 10.1002/wps.21053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/08/2022] [Indexed: 01/15/2023] Open
Affiliation(s)
- Matteo Di Vincenzo
- WHO Collaborating Centre for Research and Training in Mental Health, Naples, Italy
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12
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Fongaro E, Picot MC, Stringaris A, Belloc C, Verissimo AS, Franc N, Purper-Ouakil D. Parent training for the treatment of irritability in children and adolescents: a multisite randomized controlled, 3-parallel-group, evaluator-blinded, superiority trial. BMC Psychol 2022; 10:273. [DOI: 10.1186/s40359-022-00984-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 11/09/2022] [Indexed: 11/24/2022] Open
Abstract
Abstract
Background
Irritability is common in children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD) and with anxiety/depressive disorders. Although youth irritability is linked with psychiatric morbidity, little is known regarding its non-pharmacological treatments. Developing non-pharmacological treatments for children with severe, chronic irritability is an important target for clinical research. To achieve this goal, we will test the benefits of parent-focused therapies in reducing irritability. The aim of the study is to compare Parent Management Training (PMT) and Non-Violent Resistance Training (NVR) programs with treatment-as-usual (TAU) on the improvement of irritability in children and adolescents with a baseline Parent-rated Affective Reactivity Index of 4 or higher, in the context of ADHD and other emotional and behavioural disorders. Additionally, we will assess (i) improvement of irritability at different times and according to different informants (parents, children, clinicians); (ii) improvement of parental strategies; and (iii) acceptability of the interventions, exploring possible mechanisms of the therapeutic effect.
Methods
Two hundred and seventy participants between 6 and 15 years with ADHD and other emotional and behavioural disorders will be recruited and randomly assigned with their parents to the PMT, NVR, and TAU groups. PMT and NVR programs have 10 online sessions and two booster sessions at 1 and at 3 months. The primary outcome measure is the change from baseline at 3 months after completion of the program of the Clinician-rated Affective Rating Scale (CL-ARI) assessed by a blind evaluator. Secondary outcome measures include the change from baseline from those scales: the CL-ARI, the Clinical Global Impression Improvement scale, the Parenting and Familial Adjustment Scales, the Child-rated Cranky thermometers and the Parent-rated ARI. We will assess the parent’s expressed emotions and reflexivity during the online five-minute speech sample, clinical dimensions through the Child Behavior Checklist 6–18 and the Inventory of Callous Unemotional traits. Evaluations will be done remotely at baseline and at 1- and 3-months follow-up visits.
Discussion
We expect a benefit in controlling irritability in the treatment groups. This will constitute an important achievement in promoting parental support programs in the treatment of irritability in the context of emotional and behavioural disorders.
Clinicaltrials.gov. Number: NCT05528926. Registered on the 2nd of September, 2022.
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13
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Fredrick JW, Rodriguez B, Lynch JD, Loren RE, Tamm L. Differential diagnoses of irritability and temper loss in a 6-year-old. Clin Child Psychol Psychiatry 2022; 27:1263-1276. [PMID: 35090368 DOI: 10.1177/13591045211070166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Irritability and temper loss are common concerns among young children seen for mental health diagnostic evaluations and represent features of nearly a dozen childhood mental health conditions. Thus, careful assessment of irritability and temper loss is essential for informing case conceptualization, diagnosis, and treatment recommendations. The current case study provides a clinical description of a 6-year-old Black male ("Tyler") seen in a tertiary pediatric medical center for concerns related to significant inattention, hyperactivity, impulsivity, oppositional behaviors, irritability, and severe temper loss displayed at home and school. The clinical description summarizes findings from rating scales and diagnostic evaluations, case conceptualization, as well as treatment recommendations. Detailed suggestions for clinicians regarding strategies for assessing irritability and temper loss and questions to consider when seeking clarification to inform differential diagnoses are provided.
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Affiliation(s)
- Joseph W Fredrick
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, RinggoldID:2518Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Beatriz Rodriguez
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, RinggoldID:2518Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Psychology, RinggoldID:2515Xavier University, Cincinnati, OH, USA
| | - James D Lynch
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, RinggoldID:2518Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Psychology, RinggoldID:2514University of Cincinnati, Cincinnati, OH, USA
| | - Richard Ea Loren
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, RinggoldID:2518Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Leanne Tamm
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, RinggoldID:2518Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
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14
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Robles R, de la Peña FR, Medina-Mora ME, de Los Dolores Márquez-Caraveo ME, Domínguez T, Juárez F, Rojas AG, Sarmiento-Hernández EI, Feria M, Sosa L, Aguerre RE, Ortiz S, Real T, Rebello T, Sharan P, Reed GM. ICD-11 Guidelines for Mental and Behavioral Disorders of Children and Adolescents: Reliability and Clinical Utility. Psychiatr Serv 2022; 73:396-402. [PMID: 34433288 DOI: 10.1176/appi.ps.202000830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE ICD-11 clinical guidelines for mental and behavioral disorders must be tested in clinical settings to guarantee their usefulness worldwide. The purpose of this study was to evaluate interrater reliability and clinical utility of the ICD-11 guidelines for children and adolescents in assessing and diagnosing mood, anxiety, and fear-related disorders; attention-deficit hyperactivity disorder (ADHD); and disruptive behavioral disorder (DBD). METHODS Children and adolescents ages 6-17 from two specialized settings in Mexico City were interviewed. Each was interviewed by a pair of psychiatrists (interviewer and observer), who independently codified established diagnoses and evaluated the clinical utility of the guidelines with each participant. Kappa values were calculated to determine the level of general diagnostic correlation between the two clinicians. RESULTS A total of 25 psychiatrists evaluated 52 children and adolescents. Kappa values between clinicians ranged from 0.46 to 0.53 for mood, anxiety, and fear-related disorders and for ADHD; the kappa value was 0.81 for DBD guidelines. Over 80% of psychiatrists reported that the guidelines, qualifiers, and descriptions of developmental presentations were quite useful. CONCLUSIONS ICD-11 guidelines for mental and behavioral disorders of children and adolescents demonstrated mostly moderate interrater reliability and strong interrater reliability in the case of DBD. A large proportion of clinicians regarded the guidelines as quite useful clinical tools.
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Affiliation(s)
- Rebeca Robles
- Centro de Investigación en Salud Mental Globa (Robles, Medina-Mora, Domínguez, Real), Unidad de Fomento a la Investigación (de la Peña), Dirección de Investigaciones Epidemiológicas y Psicosociales (Domínguez, Juárez), and Clínica de la Adolescencia, Dirección de Servicios Clínicos (Feria, Sosa, Aguerre), Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México; Departamento de Psiquiatría y Salud Mental, Universidad Nacional Autónoma de México, Ciudad de México (Medina-Mora, Ortiz); Departamento de Investigación (de los Dolores Márquez-Caraveo), Departamento de Enseñanza (Rojas), and Direción General (Sarmiento-Hernández), Hospital Psiquiátrico Infantil "Dr. Juan N. Navarro," Ciudad de México; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Rebello, Reed); National Drug Dependence Treatment Centre, World Health Organization Collaborating Centre on Substance Abuse, All India Institute of Medical Sciences, Ansari Nagar, India (Sharan)
| | - Francisco R de la Peña
- Centro de Investigación en Salud Mental Globa (Robles, Medina-Mora, Domínguez, Real), Unidad de Fomento a la Investigación (de la Peña), Dirección de Investigaciones Epidemiológicas y Psicosociales (Domínguez, Juárez), and Clínica de la Adolescencia, Dirección de Servicios Clínicos (Feria, Sosa, Aguerre), Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México; Departamento de Psiquiatría y Salud Mental, Universidad Nacional Autónoma de México, Ciudad de México (Medina-Mora, Ortiz); Departamento de Investigación (de los Dolores Márquez-Caraveo), Departamento de Enseñanza (Rojas), and Direción General (Sarmiento-Hernández), Hospital Psiquiátrico Infantil "Dr. Juan N. Navarro," Ciudad de México; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Rebello, Reed); National Drug Dependence Treatment Centre, World Health Organization Collaborating Centre on Substance Abuse, All India Institute of Medical Sciences, Ansari Nagar, India (Sharan)
| | - María Elena Medina-Mora
- Centro de Investigación en Salud Mental Globa (Robles, Medina-Mora, Domínguez, Real), Unidad de Fomento a la Investigación (de la Peña), Dirección de Investigaciones Epidemiológicas y Psicosociales (Domínguez, Juárez), and Clínica de la Adolescencia, Dirección de Servicios Clínicos (Feria, Sosa, Aguerre), Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México; Departamento de Psiquiatría y Salud Mental, Universidad Nacional Autónoma de México, Ciudad de México (Medina-Mora, Ortiz); Departamento de Investigación (de los Dolores Márquez-Caraveo), Departamento de Enseñanza (Rojas), and Direción General (Sarmiento-Hernández), Hospital Psiquiátrico Infantil "Dr. Juan N. Navarro," Ciudad de México; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Rebello, Reed); National Drug Dependence Treatment Centre, World Health Organization Collaborating Centre on Substance Abuse, All India Institute of Medical Sciences, Ansari Nagar, India (Sharan)
| | - María Elena de Los Dolores Márquez-Caraveo
- Centro de Investigación en Salud Mental Globa (Robles, Medina-Mora, Domínguez, Real), Unidad de Fomento a la Investigación (de la Peña), Dirección de Investigaciones Epidemiológicas y Psicosociales (Domínguez, Juárez), and Clínica de la Adolescencia, Dirección de Servicios Clínicos (Feria, Sosa, Aguerre), Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México; Departamento de Psiquiatría y Salud Mental, Universidad Nacional Autónoma de México, Ciudad de México (Medina-Mora, Ortiz); Departamento de Investigación (de los Dolores Márquez-Caraveo), Departamento de Enseñanza (Rojas), and Direción General (Sarmiento-Hernández), Hospital Psiquiátrico Infantil "Dr. Juan N. Navarro," Ciudad de México; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Rebello, Reed); National Drug Dependence Treatment Centre, World Health Organization Collaborating Centre on Substance Abuse, All India Institute of Medical Sciences, Ansari Nagar, India (Sharan)
| | - Tecelli Domínguez
- Centro de Investigación en Salud Mental Globa (Robles, Medina-Mora, Domínguez, Real), Unidad de Fomento a la Investigación (de la Peña), Dirección de Investigaciones Epidemiológicas y Psicosociales (Domínguez, Juárez), and Clínica de la Adolescencia, Dirección de Servicios Clínicos (Feria, Sosa, Aguerre), Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México; Departamento de Psiquiatría y Salud Mental, Universidad Nacional Autónoma de México, Ciudad de México (Medina-Mora, Ortiz); Departamento de Investigación (de los Dolores Márquez-Caraveo), Departamento de Enseñanza (Rojas), and Direción General (Sarmiento-Hernández), Hospital Psiquiátrico Infantil "Dr. Juan N. Navarro," Ciudad de México; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Rebello, Reed); National Drug Dependence Treatment Centre, World Health Organization Collaborating Centre on Substance Abuse, All India Institute of Medical Sciences, Ansari Nagar, India (Sharan)
| | - Francisco Juárez
- Centro de Investigación en Salud Mental Globa (Robles, Medina-Mora, Domínguez, Real), Unidad de Fomento a la Investigación (de la Peña), Dirección de Investigaciones Epidemiológicas y Psicosociales (Domínguez, Juárez), and Clínica de la Adolescencia, Dirección de Servicios Clínicos (Feria, Sosa, Aguerre), Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México; Departamento de Psiquiatría y Salud Mental, Universidad Nacional Autónoma de México, Ciudad de México (Medina-Mora, Ortiz); Departamento de Investigación (de los Dolores Márquez-Caraveo), Departamento de Enseñanza (Rojas), and Direción General (Sarmiento-Hernández), Hospital Psiquiátrico Infantil "Dr. Juan N. Navarro," Ciudad de México; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Rebello, Reed); National Drug Dependence Treatment Centre, World Health Organization Collaborating Centre on Substance Abuse, All India Institute of Medical Sciences, Ansari Nagar, India (Sharan)
| | - Armida Granados Rojas
- Centro de Investigación en Salud Mental Globa (Robles, Medina-Mora, Domínguez, Real), Unidad de Fomento a la Investigación (de la Peña), Dirección de Investigaciones Epidemiológicas y Psicosociales (Domínguez, Juárez), and Clínica de la Adolescencia, Dirección de Servicios Clínicos (Feria, Sosa, Aguerre), Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México; Departamento de Psiquiatría y Salud Mental, Universidad Nacional Autónoma de México, Ciudad de México (Medina-Mora, Ortiz); Departamento de Investigación (de los Dolores Márquez-Caraveo), Departamento de Enseñanza (Rojas), and Direción General (Sarmiento-Hernández), Hospital Psiquiátrico Infantil "Dr. Juan N. Navarro," Ciudad de México; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Rebello, Reed); National Drug Dependence Treatment Centre, World Health Organization Collaborating Centre on Substance Abuse, All India Institute of Medical Sciences, Ansari Nagar, India (Sharan)
| | - Emmanuel Isaías Sarmiento-Hernández
- Centro de Investigación en Salud Mental Globa (Robles, Medina-Mora, Domínguez, Real), Unidad de Fomento a la Investigación (de la Peña), Dirección de Investigaciones Epidemiológicas y Psicosociales (Domínguez, Juárez), and Clínica de la Adolescencia, Dirección de Servicios Clínicos (Feria, Sosa, Aguerre), Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México; Departamento de Psiquiatría y Salud Mental, Universidad Nacional Autónoma de México, Ciudad de México (Medina-Mora, Ortiz); Departamento de Investigación (de los Dolores Márquez-Caraveo), Departamento de Enseñanza (Rojas), and Direción General (Sarmiento-Hernández), Hospital Psiquiátrico Infantil "Dr. Juan N. Navarro," Ciudad de México; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Rebello, Reed); National Drug Dependence Treatment Centre, World Health Organization Collaborating Centre on Substance Abuse, All India Institute of Medical Sciences, Ansari Nagar, India (Sharan)
| | - Miriam Feria
- Centro de Investigación en Salud Mental Globa (Robles, Medina-Mora, Domínguez, Real), Unidad de Fomento a la Investigación (de la Peña), Dirección de Investigaciones Epidemiológicas y Psicosociales (Domínguez, Juárez), and Clínica de la Adolescencia, Dirección de Servicios Clínicos (Feria, Sosa, Aguerre), Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México; Departamento de Psiquiatría y Salud Mental, Universidad Nacional Autónoma de México, Ciudad de México (Medina-Mora, Ortiz); Departamento de Investigación (de los Dolores Márquez-Caraveo), Departamento de Enseñanza (Rojas), and Direción General (Sarmiento-Hernández), Hospital Psiquiátrico Infantil "Dr. Juan N. Navarro," Ciudad de México; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Rebello, Reed); National Drug Dependence Treatment Centre, World Health Organization Collaborating Centre on Substance Abuse, All India Institute of Medical Sciences, Ansari Nagar, India (Sharan)
| | - Liz Sosa
- Centro de Investigación en Salud Mental Globa (Robles, Medina-Mora, Domínguez, Real), Unidad de Fomento a la Investigación (de la Peña), Dirección de Investigaciones Epidemiológicas y Psicosociales (Domínguez, Juárez), and Clínica de la Adolescencia, Dirección de Servicios Clínicos (Feria, Sosa, Aguerre), Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México; Departamento de Psiquiatría y Salud Mental, Universidad Nacional Autónoma de México, Ciudad de México (Medina-Mora, Ortiz); Departamento de Investigación (de los Dolores Márquez-Caraveo), Departamento de Enseñanza (Rojas), and Direción General (Sarmiento-Hernández), Hospital Psiquiátrico Infantil "Dr. Juan N. Navarro," Ciudad de México; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Rebello, Reed); National Drug Dependence Treatment Centre, World Health Organization Collaborating Centre on Substance Abuse, All India Institute of Medical Sciences, Ansari Nagar, India (Sharan)
| | - Romina E Aguerre
- Centro de Investigación en Salud Mental Globa (Robles, Medina-Mora, Domínguez, Real), Unidad de Fomento a la Investigación (de la Peña), Dirección de Investigaciones Epidemiológicas y Psicosociales (Domínguez, Juárez), and Clínica de la Adolescencia, Dirección de Servicios Clínicos (Feria, Sosa, Aguerre), Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México; Departamento de Psiquiatría y Salud Mental, Universidad Nacional Autónoma de México, Ciudad de México (Medina-Mora, Ortiz); Departamento de Investigación (de los Dolores Márquez-Caraveo), Departamento de Enseñanza (Rojas), and Direción General (Sarmiento-Hernández), Hospital Psiquiátrico Infantil "Dr. Juan N. Navarro," Ciudad de México; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Rebello, Reed); National Drug Dependence Treatment Centre, World Health Organization Collaborating Centre on Substance Abuse, All India Institute of Medical Sciences, Ansari Nagar, India (Sharan)
| | - Silvia Ortiz
- Centro de Investigación en Salud Mental Globa (Robles, Medina-Mora, Domínguez, Real), Unidad de Fomento a la Investigación (de la Peña), Dirección de Investigaciones Epidemiológicas y Psicosociales (Domínguez, Juárez), and Clínica de la Adolescencia, Dirección de Servicios Clínicos (Feria, Sosa, Aguerre), Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México; Departamento de Psiquiatría y Salud Mental, Universidad Nacional Autónoma de México, Ciudad de México (Medina-Mora, Ortiz); Departamento de Investigación (de los Dolores Márquez-Caraveo), Departamento de Enseñanza (Rojas), and Direción General (Sarmiento-Hernández), Hospital Psiquiátrico Infantil "Dr. Juan N. Navarro," Ciudad de México; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Rebello, Reed); National Drug Dependence Treatment Centre, World Health Organization Collaborating Centre on Substance Abuse, All India Institute of Medical Sciences, Ansari Nagar, India (Sharan)
| | - Tania Real
- Centro de Investigación en Salud Mental Globa (Robles, Medina-Mora, Domínguez, Real), Unidad de Fomento a la Investigación (de la Peña), Dirección de Investigaciones Epidemiológicas y Psicosociales (Domínguez, Juárez), and Clínica de la Adolescencia, Dirección de Servicios Clínicos (Feria, Sosa, Aguerre), Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México; Departamento de Psiquiatría y Salud Mental, Universidad Nacional Autónoma de México, Ciudad de México (Medina-Mora, Ortiz); Departamento de Investigación (de los Dolores Márquez-Caraveo), Departamento de Enseñanza (Rojas), and Direción General (Sarmiento-Hernández), Hospital Psiquiátrico Infantil "Dr. Juan N. Navarro," Ciudad de México; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Rebello, Reed); National Drug Dependence Treatment Centre, World Health Organization Collaborating Centre on Substance Abuse, All India Institute of Medical Sciences, Ansari Nagar, India (Sharan)
| | - Tahilia Rebello
- Centro de Investigación en Salud Mental Globa (Robles, Medina-Mora, Domínguez, Real), Unidad de Fomento a la Investigación (de la Peña), Dirección de Investigaciones Epidemiológicas y Psicosociales (Domínguez, Juárez), and Clínica de la Adolescencia, Dirección de Servicios Clínicos (Feria, Sosa, Aguerre), Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México; Departamento de Psiquiatría y Salud Mental, Universidad Nacional Autónoma de México, Ciudad de México (Medina-Mora, Ortiz); Departamento de Investigación (de los Dolores Márquez-Caraveo), Departamento de Enseñanza (Rojas), and Direción General (Sarmiento-Hernández), Hospital Psiquiátrico Infantil "Dr. Juan N. Navarro," Ciudad de México; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Rebello, Reed); National Drug Dependence Treatment Centre, World Health Organization Collaborating Centre on Substance Abuse, All India Institute of Medical Sciences, Ansari Nagar, India (Sharan)
| | - Patrap Sharan
- Centro de Investigación en Salud Mental Globa (Robles, Medina-Mora, Domínguez, Real), Unidad de Fomento a la Investigación (de la Peña), Dirección de Investigaciones Epidemiológicas y Psicosociales (Domínguez, Juárez), and Clínica de la Adolescencia, Dirección de Servicios Clínicos (Feria, Sosa, Aguerre), Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México; Departamento de Psiquiatría y Salud Mental, Universidad Nacional Autónoma de México, Ciudad de México (Medina-Mora, Ortiz); Departamento de Investigación (de los Dolores Márquez-Caraveo), Departamento de Enseñanza (Rojas), and Direción General (Sarmiento-Hernández), Hospital Psiquiátrico Infantil "Dr. Juan N. Navarro," Ciudad de México; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Rebello, Reed); National Drug Dependence Treatment Centre, World Health Organization Collaborating Centre on Substance Abuse, All India Institute of Medical Sciences, Ansari Nagar, India (Sharan)
| | - Geoffrey M Reed
- Centro de Investigación en Salud Mental Globa (Robles, Medina-Mora, Domínguez, Real), Unidad de Fomento a la Investigación (de la Peña), Dirección de Investigaciones Epidemiológicas y Psicosociales (Domínguez, Juárez), and Clínica de la Adolescencia, Dirección de Servicios Clínicos (Feria, Sosa, Aguerre), Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México; Departamento de Psiquiatría y Salud Mental, Universidad Nacional Autónoma de México, Ciudad de México (Medina-Mora, Ortiz); Departamento de Investigación (de los Dolores Márquez-Caraveo), Departamento de Enseñanza (Rojas), and Direción General (Sarmiento-Hernández), Hospital Psiquiátrico Infantil "Dr. Juan N. Navarro," Ciudad de México; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Rebello, Reed); National Drug Dependence Treatment Centre, World Health Organization Collaborating Centre on Substance Abuse, All India Institute of Medical Sciences, Ansari Nagar, India (Sharan)
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15
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Matthys W, Schutter DJLG. Improving Our Understanding of Impaired Social Problem-Solving in Children and Adolescents with Conduct Problems: Implications for Cognitive Behavioral Therapy. Clin Child Fam Psychol Rev 2022; 25:552-572. [PMID: 35165840 DOI: 10.1007/s10567-021-00376-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 12/14/2022]
Abstract
In cognitive behavioral therapy (CBT) children and adolescents with conduct problems learn social problem-solving skills that enable them to behave in more independent and situation appropriate ways. Empirical studies on psychological functions show that the effectiveness of CBT may be further improved by putting more emphasis on (1) recognition of the type of social situations that are problematic, (2) recognition of facial expressions in view of initiating social problem-solving, (3) effortful emotion regulation and emotion awareness, (4) behavioral inhibition and working memory, (5) interpretation of the social problem, (6) affective empathy, (7) generation of appropriate solutions, (8) outcome expectations and moral beliefs, and (9) decision-making. To improve effectiveness, CBT could be tailored to the individual child's or adolescent's impairments of these psychological functions which may depend on the type of conduct problems and their associated problems.
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Affiliation(s)
- Walter Matthys
- Department of Clinical Child and Family Studies, Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, The Netherlands.
| | - Dennis J L G Schutter
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, The Netherlands
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16
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Harima Y, Miyawaki D, Goto A, Hirai K, Sakamoto S, Hama H, Kadono S, Nishiura S, Inoue K. Associations Between Chronic Irritability and Sensory Processing Difficulties in Children and Adolescents. Front Psychiatry 2022; 13:860278. [PMID: 35573381 PMCID: PMC9095987 DOI: 10.3389/fpsyt.2022.860278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 04/05/2022] [Indexed: 11/13/2022] Open
Abstract
Irritability is one of the most common reasons for which children and adolescents are referred for psychiatric evaluation and care. However, clinical irritability is difficult to define; thus, its prevalence varies widely. Chronic irritability may be associated with sensory processing difficulties (SPD), but little is known about the relationship between these two factors in clinical populations. In this study, we examined the prevalence of chronic irritability and its association with SPD in 166 children aged 5-16 years who were referred to the psychiatric outpatient clinic of the Osaka City University Hospital. Chronic irritability and parent-reported scores for the Short Sensory Profile, Infant Behavior Checklist-Revised, Child Behavior Checklist, and Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children (Present and Lifetime version) questionnaires were used for assessment. A total of 22 children (13.2%) presented with chronic irritability (i.e., the irritability group) and were more likely to have oppositional defiant disorder, externalizing problems, and attention issues than those without chronic irritability (i.e., the control group). SPD were reported in eight (36%) patients in the irritability group and in 21 (15%) in the control group (p = 0.029). Moreover, compared to the control group, the irritability group showed a significant difference in almost all items of the Short Sensory Profile. Chronic irritability was associated with more severe overall SPD, even after adjusting for possible confounding factors (internalizing and externalizing problems, age, sex, and low income). We provide evidence to support our hypothesis that chronic irritability is associated with SPD in children and adolescents. Therefore, SPD should be assessed to provide appropriate interventions in children and adolescents with chronic irritability.
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Affiliation(s)
- Yuji Harima
- Department of Neuropsychiatry, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Dai Miyawaki
- Department of Neuropsychiatry, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Ayako Goto
- Department of Neuropsychiatry, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Kaoru Hirai
- Department of Neuropsychiatry, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.,Department of Pediatrics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Shoko Sakamoto
- Department of Neuropsychiatry, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Hiroki Hama
- Department of Neuropsychiatry, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Shin Kadono
- Department of Neuropsychiatry, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Sayaka Nishiura
- Department of Neuropsychiatry, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Koki Inoue
- Department of Neuropsychiatry, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
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17
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Giordano GM. Worldwide initiatives aimed to train professionals in the use of the ICD-11. Ann Gen Psychiatry 2021; 20:49. [PMID: 34727935 PMCID: PMC8561919 DOI: 10.1186/s12991-021-00370-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 09/04/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The chapter on mental disorders of the 11th revision of the International Classification of Diseases (ICD-11) has been now finalized. Training of mental health professionals in the use of the chapter is taking place worldwide. Information is provided on the ICD-11 training courses taking place recently, including that co-organized by the Naples World Health Organization (WHO) Collaborating Centre on Research and Training in Mental Health and the European Psychiatric Association; those which will be held in the next few months, such as the one co-organized by the World Psychiatric Association and the Global Mental Health Academy, to be held online from 8 to 29 November 2021; and the training course set up by the WHO Collaborating Centre on Mental Health at the Columbia University, in collaboration with the WHO Department of Mental Health and Substance Use, which can be accessed only by the members of the WHO Global Clinical Practice Network. CONCLUSION Psychiatrists of all countries of the world are encouraged to become familiar with the ICD-11 chapter on mental disorders, which will be adopted shortly by most countries worldwide.
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Affiliation(s)
- Giulia M Giordano
- WHO Collaborating Centre for Research and Training in Mental Health, University of Campania L. Vanvitelli, Naples, Italy.
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18
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Affiliation(s)
- Luigi Giuliani
- WHO Collaborating Centre for Research and Training in Mental HealthUniversity of Campania L. VanvitelliNaplesItaly
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A novel multidimensional questionnaire for the assessment of emotional dysregulation in adolescents: Reactivity, Intensity, Polarity and Stability questionnaire-youth version (RIPoSt-Y). J Affect Disord 2021; 291:359-367. [PMID: 34089928 DOI: 10.1016/j.jad.2021.05.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/09/2021] [Accepted: 05/23/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The failure to regulate emotions, namely emotional dysregulation (ED), is a relevant construct in adolescent psychiatry, in terms of prognostic and developmental implications. We developed and validated a novel self-report questionnaire for the assessment of ED, the RIPoSt-Y, both in clinical and non-clinical samples. METHODS Items selection and subscales construction were conducted on healthy controls (n=374), while test-retest reliability was evaluated in a subsample (n=72); internal consistency was examined both in the control group and in two clinical samples, respectively including patients with Bipolar Spectrum Disorders (BSD; n=44) and ADHD (n=34). Construct, concurrent and convergent validity were also assessed. RESULTS Thirty-one items were finally retained, and three subscales were identified (Affective Instability, Emotional Reactivity, Interpersonal Sensitivity). Test-retest was significant for each subscale with moderate-to-good correlations, and internal consistency showed good-to-excellent coefficients. Construct validity was supported by significant differences between patients and controls and gender-related differences. Concurrent validity was confirmed through significant associations with two subscales of the CHT-Q, while convergent validity proved to be significant with the CBCL/YSR dysregulation-profile. Cut-offs were also computed to discriminate clinically significant scores of ED. LIMITATIONS The use of a school-based survey to recruit controls could have biased our results; gender distributions between clinical and non-clinical samples were significantly different. CONCLUSIONS Our novel questionnaire proved to be a valid and reliable tool able to assess the presence of ED in youths and to characterize this fundamental construct in its multidimensional facets.
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Evans SC, Roberts MC, Guler J, Keeley JW, Reed GM. Taxonomy and utility in the diagnostic classification of mental disorders. J Clin Psychol 2021; 77:1921-1936. [PMID: 33638149 DOI: 10.1002/jclp.23125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 12/24/2020] [Accepted: 01/21/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE One strategy for improving the clinical utility of mental health diagnostic systems is to better align them with how clinicians conceptualize psychopathology in practice. This approach was used in International Classification of Diseases 11th Revision (ICD-11) development, but its underlying assumption-a link between taxonomic "fit" and clinical utility-remains untested. METHODS Using data from global mental health clinician samples (combined N = 5404), we investigated the association between taxonomic fit and clinical utility in mental disorder categories. RESULTS The overall association between fit and utility was positive (r = 0.19) but statistically not different from zero (95% confidence interval [CI]: -0.06, 0.43) in this small sample (N = 39 ICD/DSM categories). However, a positive association became clear after correcting for outliers (r = 0.34 [0.05, 0.58] or higher). Further insights were apparent for specific diagnoses given their locations in the scatterplot. CONCLUSIONS Results suggest a positive link between taxonomic fit and clinical utility in mental disorder diagnoses, highlighting future research directions.
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Affiliation(s)
- Spencer C Evans
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Michael C Roberts
- Clinical Child Psychology Program, University of Kansas, Lawrence, Kansas, USA
| | - Jessy Guler
- Clinical Child Psychology Program, University of Kansas, Lawrence, Kansas, USA
| | - Jared W Keeley
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Geoffrey M Reed
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA.,Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
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First MB, Gaebel W, Maj M, Stein DJ, Kogan CS, Saunders JB, Poznyak VB, Gureje O, Lewis-Fernández R, Maercker A, Brewin CR, Cloitre M, Claudino A, Pike KM, Baird G, Skuse D, Krueger RB, Briken P, Burke JD, Lochman JE, Evans SC, Woods DW, Reed GM. An organization- and category-level comparison of diagnostic requirements for mental disorders in ICD-11 and DSM-5. World Psychiatry 2021; 20:34-51. [PMID: 33432742 PMCID: PMC7801846 DOI: 10.1002/wps.20825] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
In 2013, the American Psychiatric Association (APA) published the 5th edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-5). In 2019, the World Health Assembly approved the 11th revision of the International Classification of Diseases (ICD-11). It has often been suggested that the field would benefit from a single, unified classification of mental disorders, although the priorities and constituencies of the two sponsoring organizations are quite different. During the development of the ICD-11 and DSM-5, the World Health Organization (WHO) and the APA made efforts toward harmonizing the two systems, including the appointment of an ICD-DSM Harmonization Group. This paper evaluates the success of these harmonization efforts and provides a guide for practitioners, researchers and policy makers describing the differences between the two systems at both the organizational and the disorder level. The organization of the two classifications of mental disorders is substantially similar. There are nineteen ICD-11 disorder categories that do not appear in DSM-5, and seven DSM-5 disorder categories that do not appear in the ICD-11. We compared the Essential Features section of the ICD-11 Clinical Descriptions and Diagnostic Guidelines (CDDG) with the DSM-5 criteria sets for 103 diagnostic entities that appear in both systems. We rated 20 disorders (19.4%) as having major differences, 42 disorders (40.8%) as having minor definitional differences, 10 disorders (9.7%) as having minor differences due to greater degree of specification in DSM-5, and 31 disorders (30.1%) as essentially identical. Detailed descriptions of the major differences and some of the most important minor differences, with their rationale and related evidence, are provided. The ICD and DSM are now closer than at any time since the ICD-8 and DSM-II. Differences are largely based on the differing priorities and uses of the two diagnostic systems and on differing interpretations of the evidence. Substantively divergent approaches allow for empirical comparisons of validity and utility and can contribute to advances in the field.
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Affiliation(s)
- Michael B First
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Mario Maj
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Dan J Stein
- Department of Psychiatry, University of Cape Town and South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Cape Town, South Africa
| | - Cary S Kogan
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - John B Saunders
- Centre for Youth Substance Abuse Research, University of Queensland, Brisbane, QLD, Australia
| | - Vladimir B Poznyak
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Oye Gureje
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | - Roberto Lewis-Fernández
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Andreas Maercker
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Chris R Brewin
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Marylene Cloitre
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Psychiatry and Behavioural Sciences, Stanford University, Stanford, CA, USA
| | - Angelica Claudino
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Kathleen M Pike
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Gillian Baird
- Newcomen Centre, Evelina Children's Hospital, Guys & St. Thomas NHS Foundation Trust, London, UK
| | - David Skuse
- Brain and Behaviour Science Unit, Institute of Child Health, University College London, London, UK
| | - Richard B Krueger
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jeffrey D Burke
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - John E Lochman
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | | | - Douglas W Woods
- Offiice of the Provost and Department of Psychology, Marquette University, Milwaukee, WI, USA
| | - Geoffrey M Reed
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
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