Disruptive Disorders Research Articles

A Delphi consensus among experts on assessment and treatment of disruptive mood dysregulation disorder.

The aim of this study was to explore consensus among clinicians and researchers on how to assess and treat Disruptive Mood Dysregulation Disorder (DMDD). The Delphi method was used to organize data collected from an initial sample of 23 child psychiatrists and psychologists. Three rounds of closed/open questions were needed to achieve the objective. Fifteen experts in the field completed the whole study. Finally, 122 proposals were validated and 5 were rejected. Globally, consensus was more easily reached on items regarding assessment than on those regarding treatment. Specifically, experts agreed that intensity, frequency, and impact of DMDD symptoms needed to be measured across settings, including with parents, siblings, peers, and teachers. While a low level of consensus emerged regarding optimal pharmacological treatment, the use of psychoeducation, behavior-focused therapies (e.g., dialectical behavior therapy, chain analysis, exposure, relaxation), and systemic approaches (parent management training, family therapy, parent-child interaction therapy) met with a high degree of consensus. This study presents recommendations that reached a certain degree of consensus among researchers and clinicians regarding the assessment and treatment of youths with DMDD. These findings may be useful to clinicians working with this population and to researchers since they also highlight non-consensual areas that need to be further investigated.

Impulsivity across psychiatric disorders in young adults

PurposeImpulsivity is a common cognitive issue across several psychiatric illnesses but is most frequently associated with the DSM-5 Disruptive, Impulse Control and Conduct Disorders, ADHD, and addictive disorders. We hypothesized that a wide range of psychiatric disorders would be associated with elevated impulsivity, not just those commonly linked to impulsiveness. This study aimed to explore the relationship between impulsivity and various psychiatric disorders in young adults. Procedures700 non-treatment seeking participants (aged 18–29 years) were enrolled from the general community, provided demographic information, and underwent a psychiatric evaluation to screen for various psychiatric disorders. Each participant then completed the Barratt Impulsiveness Scale (BIS), a self-report measure of impulsivity, followed by the Stop Signal Task (SST), a computerized stop-attention task that measures impulse control. Impulsivity levels across psychiatric disorders were examined by analyzing z-scores relative to controls. Main findingsPatients with bulimia nervosa, comorbid panic disorder with agoraphobia, and borderline personality disorder showed the highest levels of attentional, motor, and non-planning impulsivity, respectively. The effect size of the difference in total BIS impulsivity was large (d > 0.8) for several conditions including eating, personality, addictive, and mood disorders. The effect size of the difference in impulsivity was not large for any of the measures of ADHD. As compared to other psychiatric disorders analyzed, trichotillomania showed the greatest levels of impulsivity as measured by SST. Principal conclusionsThis data indicates that a wide range of psychiatric disorders exhibit heightened impulsivity with findings differing across various cognitive domains. Comorbidity resulted in unique findings of elevated impulsivity. This may suggest utility in viewing impulsivity as a transdiagnostic factor for a broad range of psychiatric disorders. Future studies should analyze comorbidities and whether patient psychiatric medication impacts these findings.

Comparison of the Effectiveness of Unified Transdiagnostic Therapy and Reality Therapy on Social Information Processing and Emotion Regulation in Students with Disruptive Mood Dysregulation Disorder

Objective: Disruptive mood dysregulation disorder (DMDD), classified under depressive disorders, leads to functional impairments across various domains and a reduction in mental health during adulthood. The current study aimed to compare the effectiveness of unified transdiagnostic therapy and reality therapy on social information processing and emotion regulation among students with disruptive mood dysregulation disorder. Methods and Materials: The research employed a quasi-experimental design with pre-test, post-test, and follow-up assessments, including a control group. The sample consisted of all 8 to 11-year-old boys diagnosed with DMDD in Isfahan, along with their mothers, who visited the Superior Counseling Center and the Child and Adolescent Home affiliated with the Isfahan Municipal Cultural, Social, and Sports Organization in Spring 2022. Forty-five participants were selected through purposive sampling and then randomly assigned into three groups of fifteen (two experimental and one control group). Research Tools: The research instruments included the Disruptive Mood Dysregulation Diagnostic Scale – Parent Form (DMDDS) (Shahmohammadi et al., 2021), Social Stories (Turkospa & Bryan, 1994), and the Cognitive Emotion Regulation Questionnaire (Garnefski, 2007). The experimental groups received separate interventions (unified transdiagnostic therapy and reality therapy), each consisting of ten 60-minute sessions for the students and thirty-minute sessions for the parents, while the control group received no intervention. Data Analysis: The data were analyzed using SPSS version 23 and repeated measures analysis of variance. Findings: The results indicated that both unified transdiagnostic therapy and reality therapy significantly improved social information processing and both positive and negative emotion regulation in students with DMDD at post-test (p < .01), and these effects were maintained at follow-up (p < .001). No significant difference was found between the two therapeutic methods in this regard. Only the goal clarification aspect of unified transdiagnostic therapy was effective at post-test, showing greater efficacy than reality therapy, though the effectiveness of both therapies was not significant at follow-up. Conclusion: Given the effectiveness of unified transdiagnostic therapy and reality therapy on social information processing and emotion regulation in students with disruptive mood dysregulation disorder, both therapies can be utilized in clinics and specialized counseling centers to improve outcomes for students with this disorder.

Pharmacologic Restraint Use During Mental Health Admissions to Children's Hospitals.

Primary mental health admissions are increasing across US children's hospitals. These patients may experience agitation requiring pharmacologic restraint. This study characterized pharmacologic restraint use in medical inpatient units by primary mental health diagnosis. This retrospective, cross-sectional study used the Pediatric Health Information System database. The study included children aged 5 to 17 years admitted with a primary mental health diagnosis between 2016 and 2021. Rates of pharmacologic restraint use per 1000 patient days were determined for 13 mental health diagnoses and trended over time with Poisson regression. Of 91 898 hospitalizations across 43 hospitals, 3% of admissions and 1.3% of patient days involved pharmacologic restraint. Trends in the rate of pharmacologic restraint use remained stable (95% confidence interval [CI], 0.7-2.1), whereas the incidence increased by 141%. Diagnoses with the highest rates of pharmacologic restraint days per 1000 patient days included autism (79.4; 95% CI, 56.2-112.3), substance-related disorders (45.0; 95% CI, 35.9-56.4), and disruptive disorders (44.8; 95% CI, 25.1-79.8). The restraint rate significantly increased in disruptive disorders (rate ratio [RR], 1.4; 95% CI, 1.1-1.6), bipolar disorders (RR, 2.0; 95% CI, 1.4-3.0), eating disorders (RR, 2.4; 95% CI, 1.5-3.9), and somatic disorders (RR, 4.2; 95% CI, 1.9-9.1). The rate significantly decreased for autism (RR, 0.8; 95% CI, 0.6-1.0) and anxiety disorders (RR, 0.3; 95% CI, 0.2-0.6). Pharmacologic restraint use among children hospitalized with a primary mental health diagnosis increased in incidence and varied by diagnosis. Characterizing restraint rates and trends by diagnosis may help identify at-risk patients and guide targeted interventions to improve pharmacologic restraint utilization.

Differential Effects of Disruptive Mood Dysregulation Disorder Comorbidity in Attention Deficit Hyperactivity Disorder on Social Cognition and Empathy

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.

TEACHERS' PERCEPTIONS OF ELEMENTARY SCHOOL STUDENTS' BEHAVIORS: a discussion in relation to the signs of conduct disorder

CIDD is a significant mental health problem in children and adolescents worldwide, with a global prevalence of approximately 3.2% among children and adolescents. Dysfunctional behaviors in children are frequently manifested in the school environment and may be associated with CIDD, causing serious interference in the teaching and learning process. The research aims to identify the prevalence of diagnostic indicators of Disruptive Impulse Control and Conduct Disorder (DICTD) in elementary school students in the public school system of Patos de Minas - MG. For data collection, an online questionnaire was made available to public school teachers in the municipality, in order to record their observations about the behavior currently displayed by elementary school children. The research seeks to contribute to a better understanding of the relationship between TDCIC and the school environment, as well as to the development of effective intervention strategies. The analysis of the teachers participating in this study reveals worrying indicators of maladaptive behaviors among students, indicating the possible presence of Conduct Disorder. The results highlight manifestations of disruptive disorders, such as angry mood, impulsivity and challenges to authority, which present significant barriers for educators. The challenges faced not only complicate the pedagogical dynamics, but also have the potential to generate psychological distress in teachers. Given this, the underlying implication points to the need to implement measures and strategies aimed at understanding and addressing the emotional and behavioral needs of these students. Such an approach may include specific pedagogical disciplines, specialized psychological support, improvement of social and emotional development programs, as well as close collaboration with families.

A New Behavioral Paradigm for Frustrative Nonreward in Juvenile Mice

BackgroundIrritability, defined as proneness to anger, can reach a pathological extent. It is a defining symptom of disruptive mood dysregulation disorder and one of the most common reasons youths present for psychiatric evaluation and care. Aberrant responses to frustrative nonreward (FNR), the response to omission of expected reward, are central to the pathophysiology of irritability. FNR is a translational construct to study irritability across species. The development of preclinical FNR models would advance mechanistic studies of the important and relatively understudied clinical phenomenon of irritability. MethodsWe used FNR as a conceptual framework to develop a novel mouse behavioral paradigm named alternate poking reward omission. Juvenile mice were exposed to alternate poking reward omission and then examined with a battery of behavioral tests to determine the behavioral effect of FNR. ResultsFNR increased locomotion and aggression regardless of sex. These behavioral changes elicited by FNR resemble the symptoms observed in youth with severe irritability. FNR had no effect on anxiety-like, depression-like, or nonaggressive social behaviors. ConclusionsOur alternate poking reward omission paradigm effectively elevated aggression and locomotion in juvenile mice. These frustration effects are directly related to behavioral symptoms of youth with severe irritability. Our novel behavioral paradigm lays the groundwork for further mechanistic studies of frustration and irritability in rodents.

Emotion Regulation Training on Irritability, Alexithymia, and Interpersonal Problems of Adolescents With Disruptive Mood Dysregulation Disorder

Background: Difficulty regulating emotion has been identified as a trans-diagnostic factor common to various psychiatric diagnoses and behavior problems. This study aims to implement emotion regulation training techniques on adolescents with a disruptive mood disorder, emphasizing the irritability, alexithymia, and interpersonal issues in adolescents with disruptive mood dysregulation disorder. Methods: This quasi-experimental research used a pre-test and post-test design on 30 disruptive mood disorders in Tehran City, Iran, from 2022 to 2023. The participants were selected via simple purposive sampling. They were randomly assigned to two 15-member groups (experimental and control). The intervention group received self-regulation training over two months through eight 90-min group therapy sessions, whereas the control group received no treatment. The data were collected using the Barratt impulsiveness scale (BIS-11), Toronto alexithymia scale (TAS-20), and the inventory of interpersonal problems short-version. The data were analyzed by the SPSS software, version 25, and the multivariate analysis of covariance. Results: As indicated by the results, a significant difference was detected between the groups in terms of irritability (F=26.45, P=0.001, η=0.695), alexithymia (F=38.91, P=0.001, η=0.781), and interpersonal problems (F=31.27, P=0.001, η=0.734). Moreover, according to the alexithymia’s largest effect size (0.781), emotion regulation training had more effect on alexithymia. Conclusion: Based on the results, emotion regulation training can be implemented effectively in clinics and psychological treatment centers. Also, because of using emotion regulation training, it is possible to improve these people’s psychological characteristics and social relations. It is also suggested that relevant organizations train specialists and school counselors accordingly.

Characteristic Similarities of Irritability Between Autism and Disruptive Mood Dysregulation Disorder.

Objective: Irritability in children with autism spectrum disorder (ASD) is prominent and often leads to distress to both autistic children and their families. However, the nature of irritability in autism and the difference from nonautistic children have rarely been examined. This study aimed to investigate the clinical characteristics of irritability in autism, and to compare the symptom profiles with those of disruptive mood dysregulation disorder (DMDD) in nonautistic children. Methods: Fifty-six children aged 7-17 years (mean age 10.36 ± 3.05) were recruited into this study (21 with DMDD, 21 with high-functioning autism [hfASD], and 14 healthy volunteers [HV]). Their parents completed the Aberrant Behavior Checklist-Irritability (ABC-I) subscale and the Strengths and Difficulties Questionnaire (SDQ) parent report form. The ABC-I subscale was analyzed as a whole and broken into subsets (ABC-I-Irritability, ABC-I-Agitation, and ABC-I-Crying). The symptom profiles of irritability and the association with psychosocial difficulties were compared between groups. Results: The ABC-I-Irritability scores of children with hfASD closely matched to those of children with DMDD. In addition, both DMDD and hfASD groups could be differentiated from HV group in five of the six items except "depressed mood." However, in the ABC-I-Agitation scale, children with DMDD, but not hfASD, had higher scores in "Aggressive to other patients and staff" and "Stamps feet while banging objects or slamming doors" than HV. Regarding psychosocial outcomes, irritability in children with DMDD and hfASD were associated with emotional problems as measured by the SDQ. Moreover, irritability in DMDD was associated with conduct problems, and the hfASD group exhibited the similar trend. Conclusions: Symptom profiles of irritability and the associated emotional and conduct problems in children with hfASD were similar to those of DMDD in the nonautistic population. Future studies are warranted to explore the underlying neurophysiological mechanisms of irritability between autistic and nonautistic children for further insight into the nature of irritability in autism.

A cross-sectional analysis of the relationships between anxiety sensitivity and youth irritability: the mediated roles of insomnia and selective attention for threat

BackgroundIrritability is common in multiple psychiatric disorders and is hallmark of disruptive mood dysregulation disorder. Child irritability is associated with higher risk of suicide and adulthood mental health problems. However, the psychological mechanisms of irritability are understudied. This study examined the relationship between anxiety sensitivity and irritability among youth, and further explored three possible mediated factors: selective attention for threat, delayed reward discounting, and insomnia.MethodsParticipants were 1417 students (51.7% male; mean age 13.83 years, SD = 1.48) recruited from one high school in Hunan province, China. Self-report questionnaires were used to measure irritability (The Affective Reactivity Index and The Brief Irritability Test), anxiety sensitivity (The Childhood Anxiety Sensitivity Index), selective attention for threat (The Davos Assessment of Cognitive Biases Scale-attention for threat bias subscale), insomnia (The Youth Self-Rating Insomnia Scale), and delayed reward discounting (The 27-item Monetary Choice Questionnaire). Structural equation modal (SEM) was performed to examine mediated relations.ResultsAnxiety sensitivity was modestly related to irritability and insomnia (r from 0.25 to 0.54) and slightly correlated with selective attention for threat (r from 0.12 to 0.28). However, there is no significant relationship of delayed rewards discounting with anxiety sensitivity and irritability. The results of SEM showed that selective attention for threat (indirect effect estimate = 0.04) and insomnia (indirect effect estimate = 0.20) partially mediate the relationship between anxiety sensitivity and irritability, which explained 34% variation.ConclusionsAnxiety sensitivity is an important susceptibility factor for irritability. Selective attention for threat and insomnia are two mediated mechanisms to understand the relationship between anxiety sensitivity and irritability.

3.30 Obesity and Asthma as Risk Factors for Disruptive Psychiatric Disorders Among Youth in an Inpatient and a National Youth Sample

3.30 Obesity and Asthma as Risk Factors for Disruptive Psychiatric Disorders Among Youth in an Inpatient and a National Youth Sample

Transdiagnostic risk of mental disorders in offspring of affected parents: a meta-analysis of family high-risk and registry studies.

The offspring of parents with mental disorders are at increased risk for developing mental disorders themselves. The risk to offspring may extend transdiagnostically to disorders other than those present in the parents. The literature on this topic is vast but mixed. To inform targeted prevention and genetic counseling, we performed a comprehensive, PRISMA 2020-compliant meta-analysis. We systematically searched the literature published up to September 2022 to retrieve original family high-risk and registry studies reporting on the risk of mental disorders in offspring of parents with any type of mental disorder. We performed random-effects meta-analyses of the relative risk (risk ratio, RR) and absolute risk (lifetime, up to the age at assessment) of mental disorders, defined according to the ICD or DSM. Cumulative incidence by offspring age was determined using meta-analytic Kaplan-Meier curves. We measured heterogeneity with the I2 statistic, and risk of bias with the Quality In Prognosis Studies (QUIPS) tool. Sensitivity analyses addressed the impact of study design (family high-risk vs. registry) and specific vs. transdiagnostic risks. Transdiagnosticity was appraised with the TRANSD criteria. We identified 211 independent studies that reported data on 3,172,115 offspring of parents with psychotic, bipolar, depressive, disruptive, attention-deficit/hyperactivity, anxiety, substance use, eating, obsessive-compulsive, and borderline personality disorders, and 20,428,575 control offspring. The RR and lifetime risk of developing any mental disorder were 3.0 and 55% in offspring of parents with anxiety disorders; 2.6 and 17% in offspring of those with psychosis; 2.1 and 55% in offspring of those with bipolar disorder; 1.9 and 51% in offspring of those with depressive disorders; and 1.5 and 38% in offspring of those with substance use disorders. The offspring's RR and lifetime risk of developing the same mental disorder diagnosed in their parent were 8.4 and 32% for attention-deficit/hyperactivity disorder; 5.8 and 8% for psychosis; 5.1 and 5% for bipolar disorder; 2.8 and 9% for substance use disorders; 2.3 and 14% for depressive disorders; 2.3 and 1% for eating disorders; and 2.2 and 31% for anxiety disorders. There were 37 significant transdiagnostic associations between parental mental disorders and the RR of developing a different mental disorder in the offspring. In offspring of parents with psychosis, bipolar and depressive disorder, the risk of the same disorder onset emerged at 16, 5 and 6 years, and cumulated to 3%, 19% and 24% by age 18; and to 8%, 36% and 46% by age 28. Heterogeneity ranged from 0 to 0.98, and 96% of studies were at high risk of bias. Sensitivity analyses restricted to prospective family high-risk studies confirmed the pattern of findings with similar RR, but with greater absolute risks compared to analyses of all study types. This study demonstrates at a global, meta-analytic level that offspring of affected parents have strongly elevated RR and lifetime risk of developing any mental disorder as well as the same mental disorder diagnosed in the parent. The transdiagnostic risks suggest that offspring of parents with a range of mental disorders should be considered as candidates for targeted primary prevention.

Irritability, Negative Life Events, and the Course of Anxiety and Depressive Symptoms in a Clinical Sample of Youth: A Longitudinal Study

Irritability, the tendency to react with anger, and the experience of negative life events (NLE) have independently been associated with the emergence of anxiety and depression. Here, we investigate how irritability and cumulative effects of NLE interactively predict the course of anxiety and depression in the context of common psychiatric disorders. 432 youth with no psychiatric diagnosis, or a diagnosis of an anxiety disorder, Attention-Deficit/ Hyperactivity Disorder (ADHD), or Disruptive Mood Dysregulation Disorder (DMDD), participated in this study. At baseline, we assessed NLE, parent and youth reports of irritability and anxiety, and youth reports of depression. Symptoms were annually reassessed for up to four years. In youth without psychiatric diagnoses but with elevated baseline irritability, the presence of NLE predicted decreasing anxiety, while the absence of NLE predicted increasing anxiety. In youth with an anxiety disorder, elevated baseline irritability predicted decreasing anxiety independent of NLE, while a large cumulative effect of NLE predicted increasing depression. NLE predicted persisting mild anxiety in ADHD and persisting mild depressive symptoms in DMDD. Our findings suggest that, particularly in non-referred samples, NLE might moderate the relationship between irritability and future anxiety such that irritability/ anger in the context of NLE can positively affect the course of anxiety. Future work replicating this finding while repeatedly measuring NLE and rigorously controlling for potentially confounding effects of treatment, is warranted.

Characteristics of Patients Associated With Restraint Use at a Midwest Children's Hospital.

Restraint use is associated with negative mental health outcomes, injury risk, and known disparities in use. Improved understanding of restraint use among hospitalized children is critical given the increased frequency of hospitalized children with complex and/or acute mental health needs. Our objective is to describe the demographic and clinical features of children associated with mechanical restraint. In a single-center retrospective cohort study of patients hospitalized from 2017 to 2021, restraint encounters were identified from electronic health records. Odds of restraint was modeled as a function of patient demographic and clinical characteristics, as well as hospitalization characteristics using logistic regression modeling adjusted for clustering of hospitalizations within patients and for varying lengths of stay. Among 29 808 children (46 302 encounters), 225 patients (275 encounters) had associated restraint use. In regression modeling, odds of restraint were higher with restraint at the preceding hospitalization (adjusted odds ratio [aOR] 8.6, 95% confidence interval [CI] 4.8-15.5), diagnosis of MH conditions such as psychotic disorders (aOR 5.4, 95% CI 2.7-10.4) and disruptive disorders (aOR 4.7, 95% CI 2.8-7.8), male sex (aOR 1.9, 95% CI 1.5-2.5), and Black race (aOR relative to White patients 1.9, 95% CI 1.4-2.6). Our results suggest racial inequities in restraint use for hospitalized children. This finding mirrors inequities in restraint use in the emergency department and adult settings. Understanding the behavioral needs of such patients may help in reducing restraint use and improving health equity.

Estimated Prevalence of Depressive Disorders in Children From 2004 to 2019

Depression during childhood (ie, age <13 years) poses a major health burden. Recent changes in environmental and lifestyle factors may increase children's risk of mental health problems. This has been reported for anxiety disorders, but it is unclear whether this occurs for depressive disorders. To provide prevalence estimates for the depressive disorders (ie, major depressive disorder [MDD], dysthymia, disruptive mood dysregulation disorder [DMDD], and overall) in children, and whether they have changed over time. The MEDLINE, PsycINFO, Embase, Scopus, and Web of Science databases were searched using terms related to depressive disorders, children, and prevalence. This was supplemented by a systematic gray literature search. Studies were required to provide population prevalence estimates of depressive disorder diagnoses (according to an established taxonomy and standardized interviews) for children younger than 13 years, information about participants' year of birth, and be published in English. Data extraction was compliant with the Meta-Analysis of Observational Studies in Epidemiology guidelines. A total of 12 985 nonduplicate records were retrieved, and 154 full texts were reviewed. Data were analyzed from 2004 (the upper limit of a previous review) to May 27, 2023. Multiple proportional random-effects meta-analytic and mixed-effects meta-regression models were fit. Pooled prevalence rates of depressive disorders, prevalence rate differences between males vs females and high-income countries (HICs) vs low-and middle-income countries (LMICs), and moderating effects of time or birth cohort. A total of 41 studies were found to meet the inclusion criteria. Pooled prevalence estimates were obtained for 1.07% (95% CI, 0.62%-1.63%) for depressive disorders overall, 0.71% (95% CI, 0.48%-0.99%) for MDD, 0.30% (95% CI, 0.08%-0.62%) for dysthymia, and 1.60% (95% CI, 0.28%-3.90%) for DMDD. The meta-regressions found no significant evidence of an association with birth cohort, and prevalence rates did not differ significantly between males and females or between HICs and LMICs. There was a low risk of bias overall, except for DMDD, which was hindered by a lack of studies. In this systematic review and meta-analysis, depression in children was uncommon and did not increase substantially between 2004 and 2019. Future epidemiologic studies using standardized interviews will be necessary to determine whether this trend will continue into and beyond the COVID-19 pandemic.

Gastroschisis and Related Disruptive Disorders Associated with Amyoplasia: Implications for Decreased Maternal Age Effects, Increasing Rates, and Pathogenetic Heterogeneity

Gastroschisis and Related Disruptive Disorders Associated with Amyoplasia: Implications for Decreased Maternal Age Effects, Increasing Rates, and Pathogenetic Heterogeneity

Predisposing Variables in Children with Risk of Disruptive Mood: A Clinical Case–Control Study

ABSTRACT Disruptive mood dysregulation disorder (DMDD) is defined in the DSM-V as frequent, severe temper outbursts that significantly impair functioning in different environments. This was a second-stage of follow-up study, conducted to screen the frequency of DMDD in an elementary school. In the first-stage of our study, 453 children between ages 7–11 were evaluated in terms of DMDD high-risk with Children Behavior Check List (CBCL). Of the children, 30 high-risk and 30 low-risk children for DMDD according to CBCL agreed to participate this clinical case–control study. Diagnoses of anxiety disorder, attention deficit and hyperactivity disorder (ADHD), and oppositional defiant disorder were more common among children in the high-risk group than the control group. Symptom Checklist-90-Revised (SCL-90-R) mothers’ interpersonal, anger, and paranoid subscale scores were higher in the DMDD high-risk group than the control group. Children in the DMDD high-risk group scored higher than the control group in all SRS subscales. In the Diagnostic Analysis of Nonverbal Accuracy (DANVA) test, the DMDD high-risk group had higher error rates for fearful and intense facial expressions. Multiple linear regression analysis showed that having a diagnosis of ADHD, high maternal SCL-90-R anger score, and presence of a paternal psychiatric diagnosis increased the high-risk of DMDD.

Excessive hair cortisol concentration as an indicator of psychological disorders in children

Cortisol in hair is a new biomarker assessing long-term hypothalamic-pituitary-adrenal (HPA) axis activity, which is related to emotion regulation. We compare hair cortisol concentrations (HCC), in clinically referred children with disruptive mood dysregulation disorder (DMDD) (n = 19), children with other types of psychological disorders (n = 48), and healthy subjects (n = 36). We also investigate the association between HCC and irritability, age, and sex. Our results show that children with DMDD or other types of psychological disorders have higher HCC than healthy subjects, p < .001, ηp2 = .39. No difference between children with DMDD and those with other types of psychological disorders was found, p = .91, nor an association between HCC and irritability in the clinical sample, p = .32. We found a significant negative correlation between HCC and age in those with DMDD, r = −0.54, p < .05, but not in the normative sample, r = −0.20, p = .25. No differences in HCC between girls and boys were found in the normative sample, p = .49. Children in need of psychological treatment, including those with DMDD, seem to have dysregulated HPA-axis activity over time. Excessive accumulated cortisol concentrations in hair could be an indicator of a psychological disorder in children.

Neurodevelopmental risk and adaptation as a model for comorbidity among internalizing and externalizing disorders: genomics and cell-specific expression enriched morphometric study

BackgroundComorbidity is the rule rather than the exception for childhood and adolescent onset mental disorders, but we cannot predict its occurrence and do not know the neural mechanisms underlying comorbidity. We investigate if the effects of comorbid internalizing and externalizing disorders on anatomical differences represent a simple aggregate of the effects on each disorder and if these comorbidity-associated cortical surface differences relate to a distinct genetic underpinning.MethodsWe studied the cortical surface area (SA) and thickness (CT) of 11,878 preadolescents (9–10 years) from the Adolescent Brain and Cognitive Development Study. Linear mixed models were implemented in comparative and association analyses among internalizing (dysthymia, major depressive disorder, disruptive mood dysregulation disorder, agoraphobia, panic disorder, specific phobia, separation anxiety disorder, social anxiety disorder, generalized anxiety disorder, post-traumatic stress disorder), externalizing (attention-deficit/hyperactivity disorder, oppositional defiant disorder, conduct disorder) diagnostic groups, a group with comorbidity of the two and a healthy control group. Genome-wide association analysis (GWAS) and cell type specificity analysis were performed on 4468 unrelated European participants from this cohort.ResultsSmaller cortical surface area but higher thickness was noted across patient groups when compared to controls. Children with comorbid internalizing and externalizing disorders had more pronounced areal reduction than those without comorbidity, indicating an additive burden. In contrast, cortical thickness had a non-linear effect with comorbidity: the comorbid group had no significant CT differences, while those patient groups without comorbidity had significantly higher thickness compare to healthy controls. Distinct biological pathways were implicated in regional SA and CT differences. Specifically, CT differences were associated with immune-related processes implicating astrocytes and oligodendrocytes, while SA-related differences related mainly to inhibitory neurons.ConclusionThe emergence of comorbidity across distinct clusters of psychopathology is unlikely to be due to a simple additive neurobiological effect alone. Distinct developmental risk moderated by immune-related adaptation processes, with unique genetic and cell-specific factors, may contribute to underlying SA and CT differences. Children with the highest risk but lowest resilience, both captured in their developmental morphometry, may develop a comorbid illness pattern.

Disruptive Mood Dysregulation Disorder and its Ayurvedic Management - A Case Report

Disruptive Mood Dysregulation Disorder (DMDD) is a condition in which children or adolescents experience ongoing irritability, anger, and frequent, intense temper outbursts. The symptoms of DMDD go beyond a “bad mood.” DMDD symptoms are severe. Youth who have DMDD experience significant problems at home, school, and often with peers. They also tend to have high rates of health care service use, hospitalization, and school suspension, and are more likely to develop other mood disorders. The present case of a 13 year old girl has worsening of mood characterized by irritability, anger, harming parent, crying spells, poor self care, social withdrawal for 12 months. The symptoms were increasing progressively and which badly affected her daily routine activities and school life. Here had never been a distinct period lasting more than one day during which the full symptom criteria, for a manic, hypomanic or a depressive episode had been met. In Ayurveda, the condition was diagnosed as Vathaja Unmada with Pithanubandha based on the symptoms of irritability anger etc. The treatment protocol including Snehapana, Virechana, Vasthi and Nasya was administered. During the treatment period family therapy methods also administered. After the intervention the symptoms were improved.