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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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Afzal T, Hipolito JL, Jin L. A Systematic Review of Misdiagnosis of Pediatric Bipolar Disorder: Assessments and Recommendations. Res Child Adolesc Psychopathol 2024; 52:659-670. [PMID: 38109022 DOI: 10.1007/s10802-023-01163-9] [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] [Accepted: 12/12/2023] [Indexed: 12/19/2023]
Abstract
Bipolar disorders (BP) are a class of psychiatric disorders with a complex symptom presentation. This systematic review aims to summarize literature pertaining to the misdiagnosis of pediatric BP using the DSM-IV and DSM-5 criteria, while emphasizing the negative impact that untreated BP has on life outcomes. This paper also attempts to outline and summarize available recommendations which may aid in improving diagnostic accuracy of pediatric BP. Scholars Portal Journals, PsychINFO, and MEDLINE databases were used to search articles until March 21, 2023. Inclusion criteria limited this review to articles published between 1995 and 2022 using a pediatric (age < 18) sample. Exclusion criteria omitted articles containing samples with self-reported diagnoses. A total of 15 articles are included in this review; study results were synthesized using a narrative summary. Youth with BP are most frequently misdiagnosed with attention-deficit hyperactive disorder (ADHD), schizophrenia, and major depressive disorder (MDD). Misdiagnosis can lead to inappropriate intervention plans and a delay in proper treatment, negatively impacting a child's quality of life by contributing to social, occupational, and economic adversity. Finally, this review addresses the need for future quantitative research on the implications of false negative diagnoses of pediatric BP.
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Affiliation(s)
- Tabeer Afzal
- Psychology Department, Brock University, Plaza Building (PLZ), 1812 Sir Isaac Brock Way, St. Catharines, ON, L2S 3A1, Canada.
| | - Justin Louis Hipolito
- School of Interdisciplinary Science, McMaster University, Hamilton, ON, L8S 4L8, Canada
| | - Laura Jin
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, ON, L8S 4L8, Canada
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3
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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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Burke JD, Butler EJ, Shaughnessy S, Karlovich AR, Evans SC. Evidence-Based Assessment of DSM-5 Disruptive, Impulse Control, and Conduct Disorders. Assessment 2024; 31:75-93. [PMID: 37551425 DOI: 10.1177/10731911231188739] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
The assessment of oppositional defiant disorder, conduct disorder, antisocial personality disorder, and intermittent explosive disorder-the Disruptive, Impulse Control and Conduct Disorders-can be affected by biases in clinical judgment, including overestimating concerns about distinguishing symptoms from normative behavior and stigma associated with diagnosing antisocial behavior. Recent nosological changes call for special attention during assessment to symptom dimensions of limited prosocial emotions and chronic irritability. The present review summarizes best practices for evidence-based assessment of these disorders and discusses tools to identify their symptoms. Despite the focus on disruptive behavior disorders, their high degree of overlap with disruptive mood dysregulation disorder can complicate assessment. Thus, the latter disorder is also included for discussion here. Good practice in the assessment of disruptive behavior disorders involves using several means of information gathering (e.g., clinical interview, standardized rating scales or checklists), ideally via multiple informants (e.g., parent-, teacher-, and self-report). A commitment to providing a full and accurate diagnostic assessment, with careful and attentive reference to diagnostic guidelines, will mitigate concerns regarding biases.
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Grasser LR, Erjo T, Goodwin MS, Naim R, German RE, White J, Cullins L, Tseng WL, Stoddard J, Brotman MA. Can peripheral psychophysiological markers predict response to exposure-based cognitive behavioral therapy in youth with severely impairing irritability? A study protocol. BMC Psychiatry 2023; 23:926. [PMID: 38082431 PMCID: PMC10712194 DOI: 10.1186/s12888-023-05421-4] [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: 10/10/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Irritability, an increased proneness to anger, is a primary reason youth present for psychiatric care. While initial evidence supports the efficacy of exposure-based cognitive behavioral therapy (CBT) for youth with clinically impairing irritability, treatment mechanisms remain unclear. Here, we propose to measure peripheral psychophysiological indicators of arousal-heart rate (HR)/electrodermal activity (EDA)-and regulation-heart rate variability (HRV)-during exposures to anger-inducing stimuli as potential predictors of treatment efficacy. The objective of this study is to evaluate whether in-situ biosensing data provides peripheral physiological indicators of in-session response to exposures. METHODS Blood volume pulse (BVP; from which HR and HRV canl be derived) and EDA will be collected ambulatorily using the Empatica EmbracePlus from 40 youth (all genders; ages 8-17) undergoing six in-person exposure treatment sessions, as part of a multiple-baseline trial of exposure-based CBT for clinically impairing irritability. Clinical ratings of irritability will be conducted at baseline, weekly throughout treatment, and at 3-month and 6-month follow-ups via the Clinical Global Impressions Scale (CGI) and the Affective Reactivity Index (ARI; clinician-, parent-, and child-report). Multilevel modeling will be used to assess within- and between-person changes in physiological arousal and regulation throughout exposure-based CBT and to determine whether individual differences are predictive of treatment response. DISCUSSION This study protocol leverages a wearable biosensor (Empatica) to continuously record HR/HRV (derived from BVP) and EDA during in-person exposure sessions for youth with clinically impairing irritability. Here, the goal is to identify changes in physiological arousal (EDA, HR) and regulation (HRV) over the course of treatment in tandem with changes in clinical symptoms. TRIAL REGISTRATION The participants in this study come from an overarching clinical trial (trial registration numbers: NCT02531893 first registered on 8/25/2015; last updated on 8/25/2023). The research project and all related materials were submitted and approved by the appropriate Institutional Review Board of the National Institute of Mental Health (NIMH).
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Affiliation(s)
- Lana Ruvolo Grasser
- Neuroscience and Novel Therapeutics Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.
| | - Trinity Erjo
- Neuroscience and Novel Therapeutics Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Matthew S Goodwin
- Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Reut Naim
- School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Ramaris E German
- Neuroscience and Novel Therapeutics Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Jamell White
- Neuroscience and Novel Therapeutics Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Lisa Cullins
- Neuroscience and Novel Therapeutics Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Wan-Ling Tseng
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Joel Stoddard
- Department of Psychiatry and Biomedical Informatics, University of Colorado, School of Medicine, Aurora, CO, USA
| | - Melissa A Brotman
- Neuroscience and Novel Therapeutics Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
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Boodoo R, Lagman JG, Jairath B, Baweja R. A Review of ADHD and Childhood Trauma: Treatment Challenges and Clinical Guidance. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2022. [DOI: 10.1007/s40474-022-00256-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Isbell LM, Kang S, Barysky G, Quinn G. Stigmatizing attitudes toward Disruptive Mood Dysregulation Disorder (DMDD) in parents vs. non-parents: Effects of medication and genetic etiology. PLoS One 2022; 17:e0274185. [PMID: 36084061 PMCID: PMC9462715 DOI: 10.1371/journal.pone.0274185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 08/23/2022] [Indexed: 12/03/2022] Open
Abstract
Stigmatizing attitudes toward children with psychopathology represent a barrier to treatment and well-being, yet almost no research has investigated what contributes to these attitudes. This study examines the effects of medication treatment and genetic etiology on stigmatizing attitudes toward a relatively new and controversial disorder–Disruptive Mood Dysregulation Disorder (DMDD). Participants (159 parents, 225 non-parents) completed a vignette study on Amazon’s Mechanical Turk (MTurk) in which a child displayed behaviors consistent with DMDD. The child was described as either taking psychiatric medication or not, and the vignette described the child’s condition as either genetic or did not mention etiology. Participants who were parents reported greater stigma when the etiology (genetic prime vs. no prime) matched the perceived appropriate treatment (medication vs. no medication). Among parents, a child treated with medication who had a genetic disorder, and a child who was not treated with medication and for whom genetic etiology was not primed, were most stigmatized. No differences emerged among non-parents. These findings highlight the importance of considering multiple factors (parental status, congruence between treatment and perceived disorder etiology) when investigating mental health stigma and underscore the need to further investigate such nuances to inform anti-stigma interventions.
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Affiliation(s)
- Linda M. Isbell
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, United States of America
- * E-mail:
| | - Sungha Kang
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, United States of America
| | - Gregory Barysky
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, United States of America
| | - Grace Quinn
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, United States of America
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8
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Krishna AG, Goyal N, Ram D, Rajan AK, Kshitiz KK. Hunger Hormones in Disruptive Mood Dysregulation Disorder in Adolescents: An Exploratory Study. ADOLESCENT PSYCHIATRY 2022. [DOI: 10.2174/2210676612666220415112851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Hunger hormones, including ghrelin and leptin, are associated with appetitive behaviors in various psychiatric disorders. Biochemical and hormonal status in disruptive mood dysregulation disorder (DMDD) in adolescents is largely unexplored.
Objectives:
The study aimed to assess levels of leptin and ghrelin and find their association with lipid profiles in adolescents with DMDD.
Methods:
Twenty adolescents with a DSM 5 diagnosis of DMDD with age and gender-matched 19 healthy controls were recruited, followed by clinical assessment. They were assessed for leptin, ghrelin, and lipid profiles, respectively.
Results:
Adolescents with DMDD were comparable in age, education, family income, domicile status, psychiatric illness in the family, and body mass index (BMI) with matched controls. There was no difference in mean lipid profile and ghrelin in both groups. However, the DMDD group had statistically significant higher mean level of leptin as compared to the control group (t=1.84, p < 0.05). As measured by the Modified Overt Aggression Scale in DMDD, aggression showed a significant positive correlation with measures of lipid profile.
Conclusion:
Adolescents with DMDD have elevated serum leptin levels. Further research is needed to confirm this finding.
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Affiliation(s)
| | - Nishant Goyal
- Associate Professor of Psychiatry, Centre for Child and Adolescent Psychiatry, Central Institute of Psychiatry, Ranchi
| | - Dushad Ram
- Associate Professor of Psychiatry, College of Medicine, Shaqra University, Shaqra
| | | | - K. K. Kshitiz
- Professor of Biochemistry, Central Institute of Psychiatry, Ranchi
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9
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Otto C, Kaman A, Barkmann C, Döpfner M, Görtz-Dorten A, Ginsberg C, Zaplana Labarga S, Treier AK, Roessner V, Hanisch C, Koelch M, Banaschewski T, Ravens-Sieberer U. The DADYS-Screen: Development and Evaluation of a Screening Tool for Affective Dysregulation in Children. Assessment 2022; 30:1080-1094. [PMID: 35301874 PMCID: PMC10152573 DOI: 10.1177/10731911221082709] [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] [Indexed: 12/18/2022]
Abstract
Affective dysregulation (AD) in children is characterized by persistent irritability and severe temper outbursts. This study developed and evaluated a screening questionnaire for AD in children. The development included the generation of an initial item pool from existing instruments, a Delphi rating of experts, focus groups with experts and parents, and psychometric analyses of clinical and population-based samples. Based on data of a large community-based study, the final screening questionnaire was developed (n = 771; 49.7 % female; age M = 10.02 years; SD = 1.34) and evaluated (n = 8,974; 48.7 % female; age M = 10.00 years; SD = 1.38) with methods from classical test theory and item response theory. The developed DADYS-Screen (Diagnostic Tool for Affective Dysregulation in Children-Screening Questionnaire) includes 12 items with good psychometric properties and scale characteristics including a good fit to a one-factorial model in comparison to the baseline model, although only a "mediocre" fit according to the root mean square error of approximation (RMSEA). Results could be confirmed using a second and larger data set. Overall, the DADYS-Screen is able to identify children with AD, although it needs further investigation using clinical data.
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Affiliation(s)
| | - Anne Kaman
- University Medical Center Hamburg-Eppendorf, Germany
| | | | | | | | | | | | | | | | | | - Michael Koelch
- University of Ulm, Germany.,Rostock University Medical Center, Germany
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10
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Findling RL, Zhou X, George P, Chappell PB. Diagnostic Trends and Prescription Patterns in Disruptive Mood Dysregulation Disorder and Bipolar Disorder. J Am Acad Child Adolesc Psychiatry 2022; 61:434-445. [PMID: 34091008 DOI: 10.1016/j.jaac.2021.05.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/05/2021] [Accepted: 05/27/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Disruptive mood dysregulation disorder (DMDD) was introduced in DSM-5 to distinguish a subset of chronically irritable youth who may be incorrectly diagnosed and/or treated for pediatric bipolar disorder (BPD). This study characterized the rate of new treatment episodes and treated prevalence of BPD and DMDD from a longitudinal electronic health record database and examined the impact of DMDD on prescription trends. METHOD A retrospective cohort study using 2008-2018 Optum electronic health record data was conducted. Youth aged 10 to < 18 years with ≥ 183 days of database enrollment before the study cohort entry were included. Annual new treatment episode rates per 1,000 patient-years and treated prevalence (%) were estimated. Prescriptions for medications, concomitant diagnoses, and acute mental health service use for 2016-2018 were evaluated. RESULTS There were 7,677 youths with DMDD and 6,480 youths with BPD identified. Mean age (13-15 years) and ethnicity were similar for both groups. A rise in new treatment episode rates (0.87-1.75 per 1,000 patient-years, p < .0001) and treated prevalence (0.08%-0.35%, p < .0001) of DMDD diagnoses (2016-2018) following diagnosis inception was paralleled by decreasing new treatment episode rates (1.22-1.14 per 1,000 patient-years, p < .01) and treated prevalence (0.42%-0.36%, p < .0001) of BPD diagnoses (2015-2018). More youth in the DMDD group were prescribed medications compared with the BPD group (81.9% vs 69.4%), including antipsychotics (58.9% vs 51.0%). Higher proportions of youth with DMDD vs youth with BPD had disruptive behavior disorders (eg, 35.9% vs 20.5% had oppositional defiant disorder), and required inpatient hospitalization related to their mental health disorder (45.0% vs 33.0%). CONCLUSION Diagnosis of DMDD has had rapid uptake in clinical practice but is associated with increased antipsychotic and polypharmacy prescriptions and higher rates of comorbidity and inpatient hospitalization in youth with a DMDD diagnosis compared with a BPD diagnosis.
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Affiliation(s)
| | - Xiaofeng Zhou
- Epidemiology, Worldwide Safety and Regulatory, Pfizer Inc, New York
| | - Prethibha George
- Epidemiology, Worldwide Safety and Regulatory, Pfizer Inc, New York
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11
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Seo JS, Bahk WM, Woo YS, Park YM, Kim W, Jeong JH, Shim SH, Lee JG, Jang SH, Yang CM, Wang SM, Jung MH, Sung HM, Choo IH, Yoon BH, Lee SY, Jon DI, Min KJ. Korean Medication Algorithm for Depressive Disorder 2021, Fourth Revision: An Executive Summary. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2021; 19:751-772. [PMID: 34690130 PMCID: PMC8553538 DOI: 10.9758/cpn.2021.19.4.751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 08/11/2021] [Indexed: 12/19/2022]
Abstract
Objective In the 19 years since the Korean College of Neuropsychopharmacology and the Korean Society for Affective Disorders developed the Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD) in 2002, four revisions have been conducted. Methods To increase survey efficiency in this revision, to cover the general clinical practice, and to compare the results with previous KMAP-DD series, the overall structure of the questionnaire was maintained. The six sections of the questionnaire were as follows: 1) pharmacological treatment strategies for major depressive disorder (MDD) with/without psychotic features; 2) pharmacological treatment strategies for persistent depressive disorder and other depressive disorder subtypes; 3) consensus for treatment-resistant depression; 4) the choice of an antidepressant in the context of safety, adverse effects, and comorbid physical illnesses; 5) treatment strategies for special populations (children/adolescents, elderly, and women); and 6) non-pharmacological biological therapies. Recommended first-, second-, and third-line strategies were derived statistically. Results There has been little change in the four years since KMAP-DD 2017 due to the lack of newly introduced drug or treatment strategies. However, shortened waiting time between the initial and subsequent treatments, increased preference for atypical antipsychotics (AAPs), especially aripiprazole, and combination strategies with AAPs yield an active and somewhat aggressive treatment trend in Korea. Conclusion We expect KMAP-DD to provide clinicians with useful information about the specific strategies and medications appropriate for treating patients with MDD by bridging the gap between clinical real practice and the evidence-based world.
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Affiliation(s)
- Jeong Seok Seo
- Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Won-Myong Bahk
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Sup Woo
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young-Min Park
- Department of Psychiatry, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Won Kim
- Department of Psychiatry, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jong-Hyun Jeong
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Se-Hoon Shim
- Department of Psychiatry, Soonchunhyang University Cheonan Hospital, College of Medicine, Soonchunhyang University, Cheonan, Korea
| | - Jung Goo Lee
- Department of Psychiatry, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Seung-Ho Jang
- Department of Psychiatry, Wonkwang University Hospital, School of Medicine, Wonkwang University, Iksan, Korea
| | - Chan-Mo Yang
- Department of Psychiatry, Wonkwang University Hospital, School of Medicine, Wonkwang University, Iksan, Korea
| | - Sheng-Min Wang
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Myung Hun Jung
- Department of Psychiatry, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Hyung Mo Sung
- Department of Psychiatry, Soonchunhyang University Gumi Hospital, College of Medicine, Soonchunhyang University, Gumi, Korea
| | - Il Han Choo
- Department of Neuropsychiatry, College of Medicine, Chosun University, Gwangju, Korea.,Department of Psychiatry, Chosun University Hospital, Gwangju, Korea
| | - Bo-Hyun Yoon
- Department of Psychiatry, Naju National Hospital, Naju, Korea
| | - Sang-Yeol Lee
- Department of Psychiatry, Wonkwang University Hospital, School of Medicine, Wonkwang University, Iksan, Korea
| | - Duk-In Jon
- Department of Psychiatry, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Kyung Joon Min
- Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, Korea
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12
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Abstract
Explosive outbursts (EO) by students are an intensely distressing experience for that student as well as for all school staff and students present during the outburst. These EO are characterized by rapid escalations, usually far out of proportion to precipitating events, may include significant verbal and/or physical aggression, require intensive staff intervention, are often difficult for the student to process, and are typically recurrent. These explosions cross multiple psychiatric and educational diagnostic categories and require diverse interventions to address behavioral, emotional, impulsive, and sensory components. Interventions for each stage of an EO can be used to deescalate these events.
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Affiliation(s)
- Jeff Q Bostic
- Department of Psychiatry, MedStar Georgetown University Hospital, 2115 Wisconsin Avenue, Northwest, Suite 200, Washington, DC 20007, USA.
| | | | - D Cunningham
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
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13
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Waxmonsky JG, Baweja R, Bansal PS, Waschbusch DA. A Review of the Evidence Base for Psychosocial Interventions for the Treatment of Emotion Dysregulation in Children and Adolescents. Child Adolesc Psychiatr Clin N Am 2021; 30:573-594. [PMID: 34053687 DOI: 10.1016/j.chc.2021.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Many children with a range of psychiatric diagnoses manifest impaired levels of emotion dysregulation (ED). Over the past decade, there has been increasing examination of psychosocial interventions for ED. We found preliminary evidence of positive effects for a wide range of psychosocial treatments that were associated with improvements in emotion recognition, emotional reactivity, and emotion regulation. More studies are needed because results are limited by the small number of controlled trials, heavy reliance on parent ratings, and heterogeneity of the samples.
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Affiliation(s)
- James G Waxmonsky
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, 500 University Dr, Hershey, PA 17033, USA.
| | - Raman Baweja
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, 500 University Dr, Hershey, PA 17033, USA
| | - Pevitr S Bansal
- Department of Psychology in the College of Arts and Sciences at the University of Kentucky, 171 Funkhouser Drive, Lexington, KY, USA
| | - Daniel A Waschbusch
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, 500 University Dr, Hershey, PA 17033, USA
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14
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Lin YJ, Tseng WL, Gau SSF. Psychiatric comorbidity and social adjustment difficulties in children with disruptive mood dysregulation disorder: A national epidemiological study. J Affect Disord 2021; 281:485-492. [PMID: 33383391 PMCID: PMC8142276 DOI: 10.1016/j.jad.2020.12.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/09/2020] [Accepted: 12/11/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND We examined correlates, psychiatric comorbidities, and social adjustment difficulties in children with disruptive mood dysregulation disorder (DMDD) from a national epidemiological study in Taiwan. METHODS The sample consisted of 4816 children, who were 3rd, 5th, and 7th graders from schools randomly chosen based on the urbanization level in a recent national survey of childhood mental disorders. Among the 4816 children (2520 boys, 52.3%) interviewed using the Kiddie epidemiologic version of the Schedule for Affective Disorders and Schizophrenia (K-SADS-E) for the DSM-5, 30 children were diagnosed as DMDD (23 boys, 76.7%). They and their parents also reported on the Social Adjustment Inventory for Children and Adolescents (SAICA). We conducted regressions for survey data that controlled for stratification and clustering. RESULTS The weighted prevalence of DMDD was 0.3~0.76% in Taiwanese children. Lower parental educational levels, male predominance, higher psychiatric comorbidities, and worse self-report school functions (e.g., more behavioral problems with peers) were observed in children with DMDD than those without. Additional analyses revealed that oppositional defiant disorder (ODD) but not DMDD was related to conduct disorder. Children with ODD with or without DMDD had more problems regarding attitudes toward school, academic performance, and parent-child interaction at home than those with DMDD-only. LIMITATIONS Small sample size of DMDD. CONCLUSIONS DMDD is a rare disorder in the community. Children with DMDD had more psychiatric comorbidities, and subjectively experienced more difficulties than those without. DMDD and ODD both resulted in severe impairment yet in different domains.
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Affiliation(s)
- Yu-Ju Lin
- Department of Psychiatry, National Taiwan University and College of Medicine, Taiwan,Department of Psychiatry, Far Eastern Memorial Hospital, Taiwan
| | - Wan-Ling Tseng
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Susan Shur-Fen Gau
- Department of Psychiatry, National Taiwan University and College of Medicine, Taiwan; Graduate Institute of Brain and Mind Sciences, and Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taiwan.
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Sahu S, Saldanha D, Chaudhury S, Menon P, Marella S, Kalkat VS. Demographic and psychosocial profile of disruptive mood dysregulation disorder in Indian settings. Ind Psychiatry J 2020; 29:228-236. [PMID: 34158706 PMCID: PMC8188932 DOI: 10.4103/ipj.ipj_226_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/06/2020] [Accepted: 01/19/2021] [Indexed: 11/24/2022] Open
Abstract
AIMS The aim of this study was to assess the demographic and psychosocial profile of the children with and without disruptive mood dysregulation disorder (DMDD) attending psychiatric and pediatric OPD and evaluation of the phenomenology of children diagnosed with DMDD. MATERIALS AND METHODS Children of 6-16 years attending the psychiatric outpatient department were screened by self-made peer-reviewed questionnaire and further underwent diagnostic evaluation using DSM 5 diagnostic criteria. Socioeconomic status (SES) was assessed using the Kuppuswamy scale. Affective Reactivity Index (ARI) was used to measure the severity of irritability. Overall behavioral problems were assessed on Conner's parent rating scale and impairment in functioning on the Children's Global Assessment of Functioning Scale. RESULTS A total of nine subjects were diagnosed with DMDD out of 500. The mean age of children with DMDD was higher than other children. DMDD children had better SES. Multiple psychosocial factors such as broken family, family history of psychiatric illness, and childhood adversities including sexual abuse were found to be a contributory factor. Those diagnosed with DMDD had significant conduct and learning problem along with moderate to severe irritability and a mean CGAS value of 50.66 which implies that children with DMDD had moderate impairment in functioning. CONCLUSIONS DMDD cases have male preponderance, urban background, and belong to upper and middle socioeconomic strata. Conduct problems, academic decline, hyperactivity, impulsivity, and mild degree of impairment in anxiety, along with moderate to severe irritability produce impairment in their overall functioning of these children.
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Affiliation(s)
- Samiksha Sahu
- Department of Psychiatry, Gandhi Medical College and Hamidia Hospital, Bhopal, Madhya Pradesh, India
| | - Daniel Saldanha
- Department of Psychiatry, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pune, Maharashtra, India
| | - Suprakash Chaudhury
- Department of Psychiatry, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pune, Maharashtra, India
| | - Preethi Menon
- Department of Psychiatry, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pune, Maharashtra, India
| | - Shivaji Marella
- Department of Psychiatry, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pune, Maharashtra, India
| | - Vasdev Singh Kalkat
- Department of Psychiatry, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pune, Maharashtra, India
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Hameed U, Dellasega C, Scandinaro A. Assessment of irritability in school-aged children by pediatric, family practice, and psychiatric providers. Clin Child Psychol Psychiatry 2020; 25:333-345. [PMID: 31353938 DOI: 10.1177/1359104519865591] [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: 11/15/2022]
Abstract
BACKGROUND Irritability, a common behavioral problem for school-aged children, is often first assessed by primary care providers, who manage about a third of mental health conditions in children. Until recent changes in the Diagnostic and Statistical Manual of Mental Disorders (DSM), irritability was often associated with mood disorders, which may have led to increases in bipolar disorder diagnosis and prescription of mood stabilizing medication. OBJECTIVE Our aim was to explore differences between the approaches psychiatric and primary care providers use to assess irritability. METHODS A single trained interviewer conducted detailed interviews and collected demographic data from a homogeneous group of physicians that saturated with a sample size of 17 pediatric, family medicine, and psychiatric providers who evaluate and treat school-aged children. Qualitative and quantitative data were collected and analyzed. RESULTS In general, primary care providers chose to refer children with irritability to mental health specialists when medication management became complex, while the psychiatric providers chose behavior modification and parent education strategies rather than medications. The psychiatric group had a significantly higher caseload mix, prior experience with irritability, and more confidence in their assessment capabilities. There was lack of continuing medical education about irritability in all groups. CONCLUSION This preliminary study highlights the importance of collaboration between primary care and subspecialties to promote accurate assessment and subsequent treatment of school-aged children with irritability, who can represent a safety concern for self and others. More research is needed to establish an efficient method of assessing and managing irritability in primary care and better utilization of specialists.
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Affiliation(s)
- Usman Hameed
- Child and Adolescent Psychiatry, Penn State College of Medicine, USA
| | | | - Anna Scandinaro
- Departments of Psychiatry and Humanities, Penn State College of Medicine, USA
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Bruno A, Celebre L, Torre G, Pandolfo G, Mento C, Cedro C, Zoccali RA, Muscatello MRA. Focus on Disruptive Mood Dysregulation Disorder: A review of the literature. Psychiatry Res 2019; 279:323-330. [PMID: 31164249 DOI: 10.1016/j.psychres.2019.05.043] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 12/28/2022]
Abstract
The inclusion of the Disruptive Mood Dysregulation Disorder (DMDD) in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), under the category of depressive disorders, provides a diagnosis for those children and adolescents with severe persistent irritability and temper outbursts, once misdiagnosed as Bipolar Disorders. The main and constantly present features of DMDD are chronic, non-episodic and persistent irritability, and temper tantrums disproportionate with the trigger. DMDD is characterized by high rates of comorbidity with other psychiatric disorders. Its main clinical manifestations overlap with Oppositional Defiant Disorder, Conduct Disorder, and Attention-Deficit/Hyperactivity Disorder. For this diagnostic overlap and the increasing use of pharmacological treatments in children and adolescents, the inclusion of DMDD diagnosis has been subjected to many criticisms. Since it is a new diagnostic entity, literature on DMDD prevalence, epidemiology, risk factors, and treatment guidelines, is still sparse and unclear. The aim of this review is to collect and analyze the literature on DMDD diagnostic criteria and main hallmarks, with particular attention to comorbidities and treatment options.
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Affiliation(s)
- Antonio Bruno
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 1, 98125 Messina, Italy.
| | - Laura Celebre
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 1, 98125 Messina, Italy
| | - Giovanna Torre
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 1, 98125 Messina, Italy
| | - Gianluca Pandolfo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 1, 98125 Messina, Italy
| | - Carmela Mento
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 1, 98125 Messina, Italy
| | - Clemente Cedro
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 1, 98125 Messina, Italy
| | - Rocco A Zoccali
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 1, 98125 Messina, Italy
| | - Maria Rosaria Anna Muscatello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 1, 98125 Messina, Italy
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Noyce G. Atypical Antipsychotic Drugs for Disruptive Behaviour Disorders in Children and Youths. Issues Ment Health Nurs 2019; 40:185-186. [PMID: 30620631 DOI: 10.1080/01612840.2018.1546036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Graham Noyce
- a School of Health Sciences and Social Work , University of Portsmouth , Portsmouth , UK
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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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21
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Seo JS, Bahk WM, Wang HR, Woo YS, Park YM, Jeong JH, Kim W, Shim SH, Lee JG, Jon DI, Min KJ. Korean Medication Algorithm for Depressive Disorders 2017: Third Revision. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2018; 16:67-87. [PMID: 29397669 PMCID: PMC5810446 DOI: 10.9758/cpn.2018.16.1.67] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 08/01/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE In 2002, the Korean Society for Affective Disorders developed the guidelines for the treatment of major depressive disorder (MDD), and revised it in 2006 and 2012. The third revision of these guidelines was undertaken to reflect advances in the field. METHODS Using a 44-item questionnaire, an expert consensus was obtained on pharmacological treatment strategies for MDD 1) without or 2) with psychotic features, 3) depression subtypes, 4) maintenance, 5) special populations, 6) the choice of an antidepressant (AD) regarding safety and adverse effects, and 7) non-pharmacological biological therapies. Recommended first, second, and third-line strategies were derived statistically. RESULTS AD monotherapy is recommended as the first-line strategy for non-psychotic depression in adults, children/adolescents, elderly adults, patient with persistent depressive disorder, and pregnant women or patients with postpartum depression or premenstrual dysphoric disorder. The combination of AD and atypical antipsychotics (AAP) was recommended for psychotic depression in adult, child/adolescent, postpartum depression, and mixed features or anxious distress. Most experts recommended stopping the ongoing initial AD and AAP after a certain period in patients with one or two depressive episodes. As an MDD treatment modality, 92% of experts are considering electroconvulsive therapy and 46.8% are applying it clinically, while 86% of experts are considering repetitive transcranial magnetic stimulation but only 31.6% are applying it clinically. CONCLUSION The pharmacological treatment strategy in 2017 is similar to that of Korean Medication Algorithm for Depressive Disorder 2012. The preference of AAPs was more increased.
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Affiliation(s)
- Jeong Seok Seo
- Department of Psychiatry, Konkuk University School of Medicine, Cheongju,
Korea
| | - Won-Myong Bahk
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Hee Ryung Wang
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Young Sup Woo
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Young-Min Park
- Department of Psychiatry, Ilsan Paik Hospital, Inje University College of Medicine, Goyang,
Korea
| | - Jong-Hyun Jeong
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Won Kim
- Department of Psychiatry, Seoul Paik Hospital, Inje University College of Medicine, Seoul,
Korea
- Korea/Stress Research Institute, Inje University, Seoul,
Korea
| | - Se-Hoon Shim
- Department of Psychiatry, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan,
Korea
| | - Jung Goo Lee
- Department of Psychiatry, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan,
Korea
- Paik Institute for Clinical Research, Department of Health Science and Technology, Graduate School of Inje University, Busan,
Korea
| | - Duk-In Jon
- Department of Psychiatry, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang,
Korea
| | - Kyung Joon Min
- Department of Psychiatry, Chung-Ang University College of Medicine, Seoul,
Korea
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Sagar-Ouriaghli I, Milavic G, Barton R, Heaney N, Fiori F, Lievesley K, Singh J, Santosh P. Comparing the DSM-5 construct of Disruptive Mood Dysregulation Disorder and ICD-10 Mixed Disorder of Emotion and Conduct in the UK Longitudinal Assessment of Manic Symptoms (UK-LAMS) Study. Eur Child Adolesc Psychiatry 2018; 27:1095-1104. [PMID: 29730721 PMCID: PMC6133106 DOI: 10.1007/s00787-018-1149-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 03/27/2018] [Indexed: 12/15/2022]
Abstract
It is important to understand new diagnostic entities in classifications of psychopathology such as the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) (code F34.8) construct of Disruptive Mood Dysregulation Disorder (DMDD) and to compare it with possible equivalent disorders in other classificatory systems such as the International Classification of Diseases-10 (ICD-10), which has a category that superficially appears similar, that is, Mixed Disorder of Emotion and Conduct (MDEC) (code F92). In this study, the United Kingdom (UK) arm (UK-LAMS) of the US National Institute of Mental Health (NIMH) supported Longitudinal Assessment of Manic Symptoms (LAMS) multi-site study was used to evaluate and retrospectively construct DMDD and MDEC diagnoses in order to compare them and understand the conditions they co-occur with, in order to improve the clinical understanding. In particular, the phenomenology of UK-LAMS participants (n = 117) was used to determine whether DMDD is a unique entity within the DSM-5. The findings showed that 24 of 68 participants with either DMDD or MDEC (35.3%) fulfilled both diagnostic criteria for DMDD and MDEC, suggesting that these entities do contain overlapping features, particularly symptoms relating to Oppositional Defiant Disorder (ODD)/Conduct Disorder (CD), Attention Deficit Hyperactivity Disorder (ADHD)/Hyperkinetic Disorder (HKD) and/or an anxiety disorder. The data also showed that most of the participants who met DMDD criteria also fulfilled the diagnostic criteria for ODD/CD, ADHD, followed by an anxiety disorder. In this context, this raises the issue whether DMDD is a unique construct or whether the symptomology for DMDD can be better explained as a specifier for ODD/CD and ADHD. Unlike DMDD, MDEC clearly specifies that the label should only be used if emotional and conduct disorders co-exist.
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Affiliation(s)
- I. Sagar-Ouriaghli
- Department of Child and Adolescent Psychiatry, King’s College London, London, UK
| | - G. Milavic
- South London and Maudsley NHS Foundation Trust, London, UK
| | - R. Barton
- South London and Maudsley NHS Foundation Trust, London, UK
| | - N. Heaney
- Department of Child and Adolescent Psychiatry, King’s College London, London, UK
| | - F. Fiori
- Department of Child and Adolescent Psychiatry, King’s College London, London, UK ,Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD) Research Team, South London and Maudsley NHS Foundation Trust, 4 Windsor Walk, Denmark Hill, London, SE5 8BB UK
| | - K. Lievesley
- Department of Child and Adolescent Psychiatry, King’s College London, London, UK
| | - J. Singh
- Department of Child and Adolescent Psychiatry, King’s College London, London, UK
| | - Paramala Santosh
- Department of Child and Adolescent Psychiatry, King's College London, London, UK. .,Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD) Research Team, South London and Maudsley NHS Foundation Trust, 4 Windsor Walk, Denmark Hill, London, SE5 8BB, UK.
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Suzer Gamli I, Tahiroglu AY. Six months methylphenidate treatment improves emotion dysregulation in adolescents with attention deficit/hyperactivity disorder: a prospective study. Neuropsychiatr Dis Treat 2018; 14:1329-1337. [PMID: 29872300 PMCID: PMC5973442 DOI: 10.2147/ndt.s164807] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Individuals with attention deficit/hyperactivity disorder (ADHD) may suffer from emotional dysregulation (ED), although this symptom is not listed among the diagnostic criteria. Methylphenidate (MPH) is useful in reducing emotional symptoms in ADHD. The aim of the present study was to determine both psychosocial risk factors and presence of ED in adolescents with ADHD before and after MPH treatment. PARTICIPANTS AND METHODS Eighty-two patients aged 12-18 years with ADHD were included as participants. The Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime, the Difficulties in Emotion Regulation Scale (DERS), sociodemographic form, and the Inventory of Statements About Self-Injury were administered. Results were compared before and after 6 months MPH treatment. RESULTS A significant improvement was detected on DERS for impulsivity (15.9±6.8 initial vs 14.2±6.5 final test, p<0.01) and total score (88.4±23.3 initial vs 82.4±2.7 final test, p<0.05) across all patients taking MPH regardless of subtype and sex. Despite treatment, a significant difference remained for impulsivity, strategies, and total score in patients with comorbid oppositional defiant disorder (ODD) compared with those without ODD, but no difference was detected for conduct disorder comorbidity. In patients who self-harm, scores for goals, impulsivity, strategies, clarity, and total score were higher before treatment: furthermore, impulsivity and total score remained high after treatment. In maltreated patients, goals, impulsivity, strategies, and total scores were significantly higher before treatment; however, their symptoms were ameliorated after treatment with MPH. CONCLUSION Individuals with severe ED may "self-medicate" by smoking and/or self-harming. MPH led to significant improvements in ED possibly owing, in part, to a decrease in impulsivity, so that individuals felt more able to supervise their emotions and engage in goal-directed behaviors. ED should be considered particularly in patients with additional psychosocial factors and ODD comorbidity, and included in the treatment plan.
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Affiliation(s)
- Ipek Suzer Gamli
- Sanliurfa Education and Research Hospital, Eyyubiye, Sanliurfa, Turkey
| | - Aysegul Yolga Tahiroglu
- Child and Adolescent Psychiatry Department, Cukurova University School of Medicine, Saricam, Adana, Turkey
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Ogasawara K, Nakamura Y, Kimura H, Aleksic B, Ozaki N. Issues on the diagnosis and etiopathogenesis of mood disorders: reconsidering DSM-5. J Neural Transm (Vienna) 2017; 125:211-222. [PMID: 29275445 DOI: 10.1007/s00702-017-1828-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 12/12/2017] [Indexed: 10/18/2022]
Abstract
The authors present a narrative review from the diagnostic and nosologic viewpoints of mood disorders (bipolar and depressive ones) by revisiting the revision from the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, Text Revision to DSM-5, including the following: the separation of the bipolar and depressive sections; the addition of increased energy and continuation of symptoms to the hypo/manic criteria; the elimination of mixed episodes; the creation of new categories and specifiers ("other specified bipolar and related disorder", "disruptive mood dysregulation disorder", "with anxious distress", "with mixed features", "with peripartum onset"); the categorization of hypo/manic episodes during antidepressant treatment into bipolar disorder; the elimination of the "bereavement exclusion"; the ambiguous separation between bipolar I and II; the insufficient distinction between "other specified bipolar and related disorders" and major depressive disorder; the differentiation regarding borderline personality disorder; agitation; premenstrual dysphoric disorder; and society and psychiatry. Through this analysis, we point out both the achievements and limitations of DSM-5. In addition, to examine the future direction of psychiatry, we introduce our cohort study regarding maternal depression and an outline of the National Institute of Mental Health's Research Domain Criteria project in the US. Finally, we advocate the importance of elucidating etiopathogeneses by starting from or going beyond the DSM operational diagnostic system, which has shown great efficacy.
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Affiliation(s)
- Kazuyoshi Ogasawara
- Bioethics Research Center, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan. .,Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Yukako Nakamura
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Hiroyuki Kimura
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Branko Aleksic
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Norio Ozaki
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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Perepletchikova F, Nathanson D, Axelrod SR, Merrill C, Walker A, Grossman M, Rebeta J, Scahill L, Kaufman J, Flye B, Mauer E, Walkup J. Randomized Clinical Trial of Dialectical Behavior Therapy for Preadolescent Children With Disruptive Mood Dysregulation Disorder: Feasibility and Outcomes. J Am Acad Child Adolesc Psychiatry 2017; 56:832-840. [PMID: 28942805 DOI: 10.1016/j.jaac.2017.07.789] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 07/24/2017] [Accepted: 08/03/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Persistent irritability and behavior outbursts in disruptive mood dysregulation disorder (DMDD) are associated with severe impairment in childhood and with negative adolescent and adult outcomes. There are no empirically established treatments for DMDD. This study examined the feasibility and preliminary efficacy of dialectical behavior therapy adapted for preadolescent children (DBT-C) with DMDD. METHOD Children 7 to 12 years old with DMDD (N = 43) were randomly assigned 1:1 to DBT-C or treatment as usual (TAU). The 6 domains of feasibility included recruitment, randomization, retention, attendance, participants' satisfaction, and therapist adherence. Blinded raters assessed participants at baseline, after 8, 16, 24, and 32 weeks, and at 3-month follow-up. The primary efficacy outcome was the positive response rate on the Clinical Global Impression-Improvement scale. Improvements in behavior outbursts and angry/irritable mood were assessed by the Clinical Global Impression-Severity scale. RESULTS Mean number of participants randomized per month was 2.53 ± 2.72. Participants in DBT-C (n = 21) attended 89% of sessions compared with 48.6% in TAU (n = 22). Eight TAU participants (36.4%) dropped out compared with none in DBT-C. Parents and children in DBT-C expressed significantly higher treatment satisfaction than those in TAU. The rate of positive response was 90.4% in DBT-C compared with 45.5% in TAU, despite 3 times as many participants in TAU receiving psychiatric medications. Remission rates were 52.4% for DBT-C and 27.3% for TAU. Improvements were maintained at 3-month follow-up. Therapists showed adherence to DBT-C. CONCLUSION DBT-C demonstrated feasibility in all prespecified domains. Outcomes also indicated preliminary efficacy of DBT-C. Clinical trial registration information-Adapting DBT for Children With DMDD: Pilot RCT; http://clinicaltrials.gov/; NCT01862549.
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Affiliation(s)
| | - Donald Nathanson
- Weill Cornell Medicine and NewYork-Presbyterian Hospital, White Plains, NY
| | | | | | - Amy Walker
- Cognitive Behavioral Consultants, White Plains, NY
| | | | | | | | - Joan Kaufman
- Center for Child and Family Traumatic Stress, Kennedy Krieger Institute, Johns Hopkins School of Medicine, Baltimore, MD
| | - Barbara Flye
- Weill Cornell Medicine and NewYork-Presbyterian Hospital, White Plains, NY
| | | | - John Walkup
- Weill Cornell Medicine and NewYork-Presbyterian Hospital, White Plains, NY
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Loy JH, Merry SN, Hetrick SE, Stasiak K. Atypical antipsychotics for disruptive behaviour disorders in children and youths. Cochrane Database Syst Rev 2017; 8:CD008559. [PMID: 28791693 PMCID: PMC6483473 DOI: 10.1002/14651858.cd008559.pub3] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND This is an update of the original Cochrane Review, last published in 2012 (Loy 2012). Children and youths with disruptive behaviour disorders may present to health services, where they may be treated with atypical antipsychotics. There is increasing usage of atypical antipsychotics in the treatment of disruptive behaviour disorders. OBJECTIVES To evaluate the effect and safety of atypical antipsychotics, compared to placebo, for treating disruptive behaviour disorders in children and youths. The aim was to evaluate each drug separately rather than the class effect, on the grounds that each atypical antipsychotic has different pharmacologic binding profile (Stahl 2013) and that this is clinically more useful. SEARCH METHODS In January 2017, we searched CENTRAL, MEDLINE, Embase, five other databases and two trials registers. SELECTION CRITERIA Randomised controlled trials of atypical antipsychotics versus placebo in children and youths aged up to and including 18 years, with a diagnosis of disruptive behaviour disorders, including comorbid ADHD. The primary outcomes were aggression, conduct problems and adverse events (i.e. weight gain/changes and metabolic parameters). The secondary outcomes were general functioning, noncompliance, other adverse events, social functioning, family functioning, parent satisfaction and school functioning. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Two review authors (JL and KS) independently collected, evaluated and extracted data. We used the GRADE approach to assess the quality of the evidence. We performed meta-analyses for each of our primary outcomes, except for metabolic parameters, due to inadequate outcome data. MAIN RESULTS We included 10 trials (spanning 2000 to 2014), involving a total of 896 children and youths aged five to 18 years. Bar two trials, all came from an outpatient setting. Eight trials assessed risperidone, one assessed quetiapine and one assessed ziprasidone. Nine trials assessed acute efficacy (over four to 10 weeks); one of which combined treatment with stimulant medication and parent training. One trial was a six-month maintenance trial assessing symptom recurrence.The quality of the evidence ranged from low to moderate. Nine studies had some degree of pharmaceutical support/funding. Primary outcomesUsing the mean difference (MD), we combined data from three studies (238 participants) in a meta-analysis of aggression, as assessed using the Aberrant Behaviour Checklist (ABC) ‒ Irritability subscale. We found that youths treated with risperidone show reduced aggression compared to youths treated with placebo (MD -6.49, 95% confidence interval (CI) -8.79 to -4.19; low-quality evidence). Using the standardised mean difference (SMD), we pooled data from two risperidone trials (190 participants), which used different scales: the Overt Aggression Scale ‒ Modified (OAS-M) Scale and the Antisocial Behaviour Scale (ABS); as the ABS had two subscales that could not be combined (reactive and proactive aggression), we performed two separate analyses. When we combined the ABS Reactive subscale and the OAS-M, the SMD was -1.30 in favour of risperidone (95% CI -2.21 to -0.40, moderate-quality evidence). When we combined the ABS Proactive subscale and OAS-M, the SMD was -1.12 (95% CI -2.30 to 0.06, moderate-quality evidence), suggesting uncertainty about the estimate of effect, as the confidence intervals overlapped the null value. In summary, there was some evidence that aggression could be reduced by risperidone. Data were lacking on other atypical antipsychotics, like quetiapine and ziprasidone, with regard to their effects on aggression.We pooled data from two risperidone trials (225 participants) in a meta-analysis of conduct problems, as assessed using the Nisonger Child Behaviour Rating Form ‒ Conduct Problem subscale (NCBRF-CP). This yielded a final mean score that was 8.61 points lower in the risperidone group compared to the placebo group (95% CI -11.49 to -5.74; moderate-quality evidence).We investigated the effect on weight by performing two meta-analyses. We wanted to distinguish between the effects of antipsychotic medication only and the combined effect with stimulants, since the latter can have a counteracting effect on weight gain due to appetite suppression. Pooling two trials with risperidone only (138 participants), we found that participants on risperidone gained 2.37 kilograms (kg) more (95% CI 0.26 to 4.49; moderate-quality evidence) than those on placebo. When we added a trial where all participants received a combination of risperidone and stimulants, we found that those on the combined treatment gained 2.14 kg more (95% CI 1.04 to 3.23; 3 studies; 305 participants; low-quality evidence) than those on placebo. Secondary outcomesOut of the 10 included trials, three examined general functioning, social functioning and parent satisfaction. No trials examined family or school functioning. Data on non-compliance/attrition rate and other adverse events were available from all 10 trials. AUTHORS' CONCLUSIONS There is some evidence that in the short term risperidone may reduce aggression and conduct problems in children and youths with disruptive behaviour disorders There is also evidence that this intervention is associated with significant weight gain.For aggression, the difference in scores of 6.49 points on the ABC ‒ Irritability subscale (range 0 to 45) may be clinically significant. It is challenging to interpret the clinical significance of the differential findings on two different ABS subscales as it may be difficult to distinguish between reactive and proactive aggression in clinical practice. For conduct problems, the difference in scores of 8.61 points on the NCBRF-CP (range 0 to 48) is likely to be clinically significant. Weight gain remains a concern.Caution is required in interpreting the results due to the limitations of current evidence and the small number of high-quality trials. There is a lack of evidence to support the use of quetiapine, ziprasidone or any other atypical antipsychotic for disruptive behaviour disorders in children and youths and no evidence for children under five years of age. It is uncertain to what degree the efficacy found in clinical trials will translate into real-life clinical practice. Given the effectiveness of parent-training interventions in the management of these disorders, and the somewhat equivocal evidence on the efficacy of medication, it is important not to use medication alone. This is consistent with current clinical guidelines.
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Affiliation(s)
- Jik H Loy
- Waikato DHBChild and Adolescent Mental Health206 Colllingwood StreetHamiltonNew Zealand
| | - Sally N Merry
- University of AucklandDepartment of Psychological MedicinePrivate Bag 92019AucklandNew Zealand1142
| | - Sarah E Hetrick
- Orygen, The National Centre of Excellence in Youth Mental Health and The Centre of Youth Mental Health, University of Melbourne35 Poplar RoadParkvilleMelbourneVictoriaAustralia3054
| | - Karolina Stasiak
- University of AucklandDepartment of Psychological MedicinePrivate Bag 92019AucklandNew Zealand1142
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Rice TR. Commentary: Executive functioning-a key construct for understanding developmental psychopathology or a 'catch-all' term in need of some rethinking? Front Neurosci 2017; 11:130. [PMID: 28367111 PMCID: PMC5355419 DOI: 10.3389/fnins.2017.00130] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 03/03/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Timothy R. Rice
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, Icahn School of Medicine at Mount SinaiNew York, NY, USA
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Irritability in child and adolescent psychopathology: An integrative review for ICD-11. Clin Psychol Rev 2017; 53:29-45. [PMID: 28192774 DOI: 10.1016/j.cpr.2017.01.004] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 01/02/2017] [Accepted: 01/16/2017] [Indexed: 12/13/2022]
Abstract
In preparation for the World Health Organization's development of the Eleventh Revision of the International Classification of Diseases and Related Health Problems (ICD-11) chapter on Mental and Behavioral Disorders, this article reviews the literature pertaining to severe irritability in child and adolescent psychopathology. First, research on severe mood dysregulation suggests that youth with irritability and temper outbursts, among other features of hyperactivity and arousal, demonstrate cross-sectional correlates and developmental outcomes that distinguish them from youth with bipolar disorder. Second, other evidence points to an irritable dimension of Oppositional Defiant Disorder symptomatology, which is uniquely associated with concurrent and subsequent internalizing problems. In contrast to the Diagnostic and Statistical Manual of Mental Disorders' (5th ed.) Disruptive Mood Dysregulation Disorder, our review of the literature supports a different solution: a subtype, Oppositional Defiant Disorder with chronic irritability/anger (proposal included in Appendix). This solution is more consistent with the available evidence and is a better fit with global public health considerations such as harm/benefit potential, clinical utility, and cross-cultural applicability. Implications for assessment, treatment, and research are discussed.
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