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Vacher C, Romo L, Dereure M, Soler M, Picot MC, Purper-Ouakil D. Efficacy of cognitive behavioral therapy on aggressive behavior in children with attention deficit hyperactivity disorder and emotion dysregulation: study protocol of a randomized controlled trial. Trials 2022; 23:124. [PMID: 35130934 PMCID: PMC8819925 DOI: 10.1186/s13063-022-05996-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is frequently associated with emotional dysregulation (ED). ED is characterized by excessive and inappropriate emotional reactions compared to social norms, uncontrolled and rapid shifts in emotion, and attention focused on emotional stimuli. Few studies have evaluated non-pharmacological interventions to improve ED in children with ADHD. The current randomized controlled trial assesses the efficacy of a cognitive behavioral therapy (CBT) intervention compared with a theater-based intervention (TBI) in children with ADHD and ED. METHODS Sixty-eight 7- to 13-year-old children with ADHD and ED will be recruited and randomly assigned to the CBT or TBI group. CBT aims to reduce ED by teaching anger management strategies. TBI seeks to reduce ED by improving emotion understanding and expression through mimics and movement. In both groups, children participate in 15 1-h sessions, and parents participate in 8 sessions of a parent management program. The primary outcome measure is the change in the "Aggression" sub-score of the Child Behavior Checklist (CBCL). Secondary outcome measures include overall impairment (Children's Global Assessment Scale, Strengths and Difficulties Questionnaire), personality profile (Hierarchical Personality Inventory for Children), executive function (Behavioral Rating Inventory of Executive Function), quality of life (Kidscreen-27), parental stress (Parenting Stress Index, 4th edition), parental depression (Beck Depression Inventory-II), and impact of child disorders on the quality of the family life (Parental Quality of Life and Developmental Disorder). DISCUSSION Children with ADHD and ED are at risk of functional impairment and poor outcomes and have specific therapeutic needs. This randomized controlled trial wants to assess non-pharmacological treatment options for this population. TRIAL REGISTRATION Clinicaltrials.gov. NCT03176108 . Registered on June 5, 2017.
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Affiliation(s)
- C 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. .,INSERM U 1018, CESP, Psychiatrie du développement - Evaluer et traiter les troubles émotionnels et du neurodéveloppement (ETE-ND), Montpellier, France.
| | - L Romo
- CLIPSYD EA-4430, UFR Sciences Psychologiques et Sciences de l'Education, Université de Nanterre, Nanterre, Hauts de Seine, France.,Service de Pathologies professionnelles et de l'environnement, Assistance Publique des Hôpitaux de Paris, Hôpital Universitaire Raymond Poincaré, Garches, France
| | - M Dereure
- Unité de Recherche Clinique et Epidémiologie, Département de l'Information Médicale, Centre Hospitalo-Universitaire de Montpellier, Montpellier, Hérault, France
| | - M Soler
- Unité de Recherche Clinique et Epidémiologie, Département de l'Information Médicale, Centre Hospitalo-Universitaire de Montpellier, Montpellier, Hérault, France
| | - M C Picot
- Unité de Recherche Clinique et Epidémiologie, Département de l'Information Médicale, Centre Hospitalo-Universitaire de Montpellier, Montpellier, Hérault, France.,Centre d'Investigation Clinique, Hôpital Saint Eloi, Centre Hospitalo-Universitaire de Montpellier, Montpellier, Hérault, France
| | - D Purper-Ouakil
- Centre Hospitalo-Universitaire de Montpellier, Service Médecine Psychologique de l'Enfant et de l'Adolescent, Montpellier, Hérault, France.,INSERM U 1018, CESP, Psychiatrie du développement - Evaluer et traiter les troubles émotionnels et du neurodéveloppement (ETE-ND), Montpellier, France
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Chronic olanzapine administration causes metabolic syndrome through inflammatory cytokines in rodent models of insulin resistance. Sci Rep 2019; 9:1582. [PMID: 30733507 PMCID: PMC6367387 DOI: 10.1038/s41598-018-36930-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 11/23/2018] [Indexed: 01/16/2023] Open
Abstract
Olanzapine is a second-generation anti-psychotic drug used to prevent neuroinflammation in patients with schizophrenia. However, the long-term administration of olanzapine leads to insulin resistance (IR); the mechanisms of this effect remains poorly understood. Using cellular and rodent models of IR induced by olanzapine, we found that chronic olanzapine treatment induces differential inflammatory cytokine reactions in peripheral adipose and the central nervous system. Long-term treatment of olanzapine caused metabolic symptoms, including IR, by markedly elevating the plasma levels of pro-inflammatory cytokines, including IL-1ß, IL-6, IL-8 and TNFα; these findings are consistent with observations from schizophrenia patients chronically treated with olanzapine. Our observations of differential inflammatory cytokine responses in white adipose tissues from the prefrontal cortex in the brain indicated cell type-specific effects of the drug. These cytokines induced IR by activating NF-kB through the suppression of IkBα. Functional blockade of the components p50/p65 of NF-kB rescued olanzapine-induced IR in NIH-3T3 L1-derived adipocytes. Our findings demonstrate that olanzapine induces inflammatory cytokine reactions in peripheral tissues without adversely affecting the central nervous system and suggest that chronic olanzapine treatment of schizophrenia patients may cause inflammation-mediated IR with minimal or no adverse effects in the brain.
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Rao U. DSM-5: disruptive mood dysregulation disorder. Asian J Psychiatr 2014; 11:119-23. [PMID: 25453714 PMCID: PMC4254488 DOI: 10.1016/j.ajp.2014.03.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Revised: 02/25/2014] [Accepted: 03/05/2014] [Indexed: 11/19/2022]
Abstract
This paper will describe historical perspectives for the introduction of disruptive mood dysregulation disorder in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), criteria for the diagnosis, as well as information on epidemiology, clinical presentation and longitudinal course, pathophysiology, and treatment. The diagnosis of disruptive mood dysregulation disorder requires frequent, persistent, severe temper outbursts out of proportion to the situation and developmental context in combination with persistent, angry/irritable mood between the temper outbursts. Because of the limited available data, the inclusion of this new diagnosis in DSM-5 has been controversial. Regardless of this controversy, it is clear that youth experiencing such symptoms are highly impaired and utilize significant health services. Therefore, we need to expand our efforts to better understand the complex construct of this phenotype in order to improve the assessment, diagnosis and treatment of this condition.
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Affiliation(s)
- Uma Rao
- Center for Molecular and Behavioral Neuroscience, Department of Psychiatry and Behavioral Sciences, Meharry Medical College, Nashville, TN, USA; Department of Psychiatry, The Kennedy Center, Vanderbilt University, Nashville, TN, USA.
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Abstract
Chronic, severe irritability is common in childhood and is very impairing. Furthermore, childhood irritability predicts suicidality, social impairment, and depressive and anxiety disorders in adulthood. Focusing on both normative and pathologic development, we review the construct of irritability from its origins in aggression and disruptive behavior research to its contemporary relevance for affective psychopathology. We then describe two broad neurocognitive systems that show promise in differentiating irritable from nonirritable youths: aberrant processing of emotional stimuli and impaired context-sensitive regulation. We suggest behavioral, neurocognitive, and physiologic measures that may aid in studying severe irritability and assessing its therapeutics. Finally, we argue for therapeutic trials targeting severe irritability that address emotional aspects of irritability in addition to the associated disruptive behavior.
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Lecardeur L, Benarous X, Milhiet V, Consoli A, Cohen D. [Management of bipolar 1 disorder in children and adolescents]. Encephale 2014; 40:143-53. [PMID: 24656684 DOI: 10.1016/j.encep.2014.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 02/17/2014] [Indexed: 11/15/2022]
Abstract
Lifetime prevalence of child and adolescent bipolar 1 disorder (BD1) is nearly 0.1 %. Even though it is not a frequent disorder in young people, there is an increased interest for this disorder at this age, because of the poor outcome, the severe functional impairments and the major risk of suicide. Diagnosis is complex in view of the more frequent comorbidities, the variability with an age-dependant clinical presentation, and the overlap in symptom presentation with other psychiatric disorders (e.g. disruptive disorders in prepubertal the child and schizophrenia in the adolescent). The presentation in adolescents is very similar to that in adults and in prepubertal children chronic persistent irritability and rapid mood oscillation are often at the foreground. For a while, such presentations were considered as BD-not otherwise specified (BD-NOS), which can explain the outburst of the prevalence of bipolar disorder in children in the US. Longitudinal studies that look for the outcome of such emotional dysregulations have not revealed an affiliation with bipolar disorder spectrum, but with depressive disorders in adulthood. The diagnosis of Disruptive Mood Dysregulation Disorder was proposed in the DSM-5 to identify these children and to prevent confusion with bipolar disorder. The goals of the pharmacological and psychosocial treatments are to control or ameliorate the symptoms, to avoid new episodes or recurrences, to improve psychosocial functioning and well-being, and to prevent suicide. In the US, lithium and four atypical antipsychotics have been approved by the FDA for 10 to 13-year-olds (risperidone, olanzapine, aripiprazole and quetiapine). In France, only lithium salts (after the age of 16) and aripiprazole (after the age of 13) are recommended. Psychosocial treatments, such as a familial or individual approach are developing.
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Affiliation(s)
- L Lecardeur
- Équipe mobile de soins intensifs, centre Esquirol, CHU de Caen, avenue Côte-de-Nacre, 14033 Caen, France; CNRS, UMR 6301 ISTCT, ISTS group, GIP CYCERON, 14074 Caen, France; CEA, DSV/I2BM, UMR 6301 ISTCT, 14074 Caen, France; Université de Caen Basse-Normandie, UMR 6301 ISTCT, 14074 Caen, France.
| | - X Benarous
- Service de psychiatrie de l'enfant et de l'adolescent, hôpital Pitié-Salpêtrière, AP-HP, 75651 Paris cedex 13, France
| | - V Milhiet
- Service de psychiatrie de l'enfant et de l'adolescent, hôpital Pitié-Salpêtrière, AP-HP, 75651 Paris cedex 13, France
| | - A Consoli
- Service de psychiatrie de l'enfant et de l'adolescent, hôpital Pitié-Salpêtrière, AP-HP, 75651 Paris cedex 13, France
| | - D Cohen
- Service de psychiatrie de l'enfant et de l'adolescent, hôpital Pitié-Salpêtrière, AP-HP, 75651 Paris cedex 13, France; CNRS UMR 7222, institut des systèmes intelligents et robotiques, université Pierre-et-Marie-Curie, 75252 Paris cedex 05, France
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Johnson K, McGuinness TM. Disruptive mood dysregulation disorder: a new diagnosis in the DSM-5. J Psychosoc Nurs Ment Health Serv 2014; 52:17-20. [PMID: 24444386 DOI: 10.3928/02793695-20140113-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This article explores a new diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.)-disruptive mood dysregulation disorder (DMDD). Frequent comorbidities of DMDD include oppositional defiant disorder and attention-deficit/hyperactivity disorder. The evolution of DMDD and how this diagnostic category may remedy an overdiagnosis of pediatric bipolar disorder are discussed.
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