Disruptive Disorders Research Articles

Risk factors for disruptive behaviours: protocol for a systematic review and meta-analysis of quasi-experimental evidence.

IntroductionDisruptive behaviour disorders, including oppositional defiant disorder and conduct disorder, are a common set of diagnoses in childhood and adolescence, with global estimates of 5.7%, 3.6% and 2.1% for any disruptive disorder, oppositional defiant disorder and conduct disorder, respectively. There are high economic and social costs associated with disruptive behaviours and the prevalence of these disorders has increased in recent years. As such, disruptive behaviours represent an escalating major public health concern and it is important to understand what factors may influence the risk of these behaviours. Such research would inform interventions that aim to prevent the development of disruptive behaviours. The current review will identify the most stringent evidence of putative risk factors for disruptive behaviour from quasi-experimental studies, which enable stronger causal inference.Methods and analysisThe review will be carried out according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An electronic search of references published between 1 January 1980 and 1 March 2020 will be conducted using Medline, Embase, PsycINFO and Web of Science. Initial abstract and title screening, full-text screening and data extraction will be completed independently by two reviewers using Evidence for Policy and Practice Information (EPPI)-Reviewer 4 software. Quasi-experimental studies in the English language examining the association between any putative risk factor and a clearly defined measure of disruptive behaviour (eg, a validated questionnaire measure) will be included. We will conduct meta-analyses if we can pool a minimum of three similar studies with the same or similar exposures and outcomes.Ethics and disseminationThe proposed review does not require ethical approval. The results will help to identify risk factors for which there is strong evidence of causal effects on disruptive behaviours and also highlight potential risk factors that require further research. The findings will be disseminated via publication in a peer-reviewed scientific journal and through presentations at international meetings and conferences.PROSPERO registration numberCRD42020169313.

Estilos parentales en el proceso de crianza de niños con trastornos disruptivos

Estilos parentales en el proceso de crianza de niños con trastornos disruptivos

¿Los hijos de pacientes con trastorno bipolar tienen una peor percepción de la calidad de sueño?

IntroductionThe offspring of bipolar parents (BO) is a high-risk population for inheriting the bipolar disorder (BD) and other early clinical manifestations, such as sleep disturbances. ObjectiveTo compare the presence of psychiatric disorders and sleep disturbances of BO versus offspring of control parents (OCP). MethodsA cross-sectional analytical study was conducted that compared BO versus OCP. The participants were assessed using valid tools to determine the presence of psychiatric symptoms or disorders. The “Sleep Evaluation Questionnaire” and “School Sleep Habits Survey” were used to determine sleep characteristics and associated factors. Sleep records (7-21 days) were also obtained by using an actigraphy watch. ResultsA sample of 42 participants (18 BO and 24 OCP) was recruited. Differences were found in the presentation of the psychiatric disorder. The BO group showed a higher frequency of major depression disorder (MDD; P=.04) and Disruptive Mood Dysregulation Disorder (DMDD; P=.04). The OCP group showed a higher frequency of Attention Deficit and Hyperactivity Disorder (ADHD; P=.65), and Separation Anxiety Disorder (SAD; P=.46). Differences were also found in sleep by using subjective measurements. Compared to the OCP group, BO had a worse perception of quality of sleep (P=.02), a higher frequency of nightmares (P=.01), a shorter total sleep time, and a higher sleep latency. Nevertheless, no differences were found between groups in the actigraphy measurements. ConclusionsThe BO group had a higher frequency of Mood Disorders, and at the same time a higher number of sleep disturbances in the subjective measurements. It is possible that there is an association between mood symptoms, sleep disturbances, and coffee intake. No differences were found in the sleep profile by using actigraphy.

Suicide Attempts Among French and Brazilian Adolescents Admitted to an Emergency Room. A Comparative Study of Risk and Protective Factors.

BackgroundSuicide is the second most common cause of preventable mortality among Brazilian and French adolescents. The aim of the current study was to compare the main risk and protective factors associated with a suicide attempt (SA) and to highlight differences based on geographical characteristics.MethodWe compared a Brazilian sample (N = 45) of adolescents admitted to the emergency room of a public hospital in São Paulo for SA to a French sample (N = 320) of adolescents hospitalized for SA across 5 paediatric departments. Then, we ran several multivariate models to examine how each selected variable was related to geographic origin and to the other selected variables linked to geographic origin.ResultsThe two samples presented no significant differences regarding gender, age or schooling. Both samples had high rates of depressive disorders, anxiety disorders, substance use, disruptive disorders, borderline psychopathology, and lifetime SAs. However, the Brazilian sample presented significantly higher levels of psychopathology and had more insecure attachment relationships (fearful and detached), whereas the French sample had a more secure attachment style. Brazilian adolescents had more recourse to spiritual beliefs and spiritual support, whereas the French adolescents had higher scores on the Reasons for Living Inventory and used more help-seeking strategies from their social network, mainly close friends. Multivariate models showed that two productive coping strategies (seeking spiritual support and social action) and the dependence score were significantly associated with membership in the Brazilian cohort, whereas a secure attachment style and depression severity (evaluated by the Beck Depression Inventory) were significantly associated with membership in the French cohort.ConclusionDespite presenting similar psychopathologies, Brazilian adolescents presented a more insecure attachment style and used the religious kind of coping more commonly than their French counterparts. We hypothesize that religion may compensate for the social vulnerabilities present in a middle-income country such as Brazil. More transcultural studies may help to elucidate this phenomenon.

Domestic Violence Against Men-Prevalence and Risk Factors.

According to the World Health Organization (WHO), intimate partner violence is among the major risks to women's health around the world. Men, too, can be victims of domestic violence; like female victims, they tend to present initially with their injuries to a family physician or an emergency room. Domestic violence against men is thus a relevant issue for physicians of all specialties. This review is based on publications retrieved by a comprehensive, selective search in the PubMed database and with the Google Scholar search service, as well as on a retrospective analysis of data on the injured persons, the aggressors, and the nature of the violence that was experienced and the injuries that were sustained. The studies identified by the search yielded prevalence rates of 3.4% to 20.3% for domestic physical violence against men. Most of the affected men had been violent toward their partners themselves. 10.6-40% of them reported having been abused or maltreated as children. Alcohol abuse, jealousy, mental illness, physical impairment, and short relationship duration are all associated with a higher risk of being a victim of domestic violence. The reported consequences of violence include mostly minor physical injuries, impaired physical health, mental health problems such as anxiety or a disruptive disorder, and increased consumption of alcohol and/or illegal drugs. The prevalence of violence against men and the risk factors for it have been little studied to date. It would be desirable for preventive measures to be further developed and for special help to be made available to the affected men.

Prevalence of Psychiatric Disorders in Children with Chronic Kidney Disease in Zagazig University Hospitals

Background: Psychiatric manifestations as depression, periods of adjustment, low self-Esteem, cognitive dysfunction, anxiety, and attention deficit disorders occur with chronic kidney disease (CKD). Objective: The aim of the work was to assess the association between psychiatric disorders and chronic kidney disease in Pediatric Nephrology Unit, Zagazig University Children's Hospital. Patients and Methods: This cross-sectional study included a total of 156 patients with Chronic Kidney Disease, attending at Pediatric Nephrology Unit, Zagazig University Children's Hospital. All patients were subjected to complete history taking and psychiatric assessment of children that was based on the Semi Structured Clinical Interview for Children and Adolescents AGES 6-18 PROTOCOL FORM (SCICA) and the diagnostic and statistical manual of mental disorders 5th edition (DSM-5). Results: Among CKD children the prevalence of anxiety was 37.2%, prevalence of eating disorder was 15.4%, prevalence of elimination disorder was 19.2% and prevalence of attention deficit was 43.6%. Prevalence of depression among CKD children was 30.8%. CKD patients on dialysis were more likely to be depressed than the pre-dialysis patients. Prevalence of psychiatric disorders among CKD children was 64.7 %. This study showed that, CKD patients on dialysis were more likely to had psychiatric disorders than the pre-dialysis patients. Conclusion: Psychiatric disorders were significantly higher in CKD patients. The most common psychiatric comorbidity in CKD patients was attention deficit (43.6%), followed by disruptive disorder (40.4%) and depression (30.8%). Patients with dialysis are significantly more prone to develop psychiatric disorders.

Use of Antipsychotics: The Experiences, Views, and Monitoring Practices of Child and Adolescent Psychiatrists in Turkey

Objectives: The aim of this study is to evaluate the antipsychotics prescribed by child psychiatrists and their applications on the follow-up of these drugs. Methods: The universe of this research included consultant physicians and child psychiatry residents working in the field. A questionnaire has been created that assesses the use of antipsychotics and follow-up processes of physicians. The survey involved 19 questions. Contents of the survey were sociodemographic data, short-term and long-term follow-up of antipsychotic drugs, side-effect intervention strategies, and diagnoses of the most commonly preferred antipsychotic medications. The survey was delivered via e-mail and sent as a message to the child and adolescent psychiatrists in Turkey. Results: One hundred sixty-one physicians working in the field of child and adolescent psychiatry participated in the study. Aripiprazole (32.2%), risperidone (30.4%), and quetiapine (14.9%) were three most commonly prescribed antipsychotics. Disruptive behavior-related disorders (28.9%), behavior problems related to autism spectrum disorder (20.7%), behavior problems related to intellectual disability (14.5%), and attention-deficit/hyperactivity disorder (12.4%) were the most common diagnoses requiring antipsychotics medications. Before starting antipsychotic treatment, the most commonly evaluated parameters were body mass index (BMI) (47.2%), waist circumference (10.5%), blood pressure (28.5%), lipid profile (37%), and blood glucose level (41.6%). When the evaluations made at least in a year after starting antipsychotic drug therapy were examined, 80.2% of physicians reported blood glucose, 79.6% lipid profile, 65.7% BMI, 59.1% blood pressure, and 26.6% waist circumference measurement almost always done. Conclusions: The results showed that the adherence to recommendations in guidelines for the screening of antipsychotic-related side effects was low. This study suggests that interventions should be made about antipsychotic monitoring training to physicians.

Toward a Developmental Nosology for Disruptive Mood Dysregulation Disorder in Early Childhood

Disruptive mood dysregulation disorder (DMDD) in DSM, characterized by severe, chronic irritability, currently excludes children<6 years of age. However, capitalizing on a burgeoning developmental science base to differentiate clinically salient irritability in young children may enable earlier identification. The objective of this study was to advance an empirically derived framework for early childhood DMDD (EC-DMDD) by modeling and validating DMDD patterns in early childhood and generating clinically informative, optimized behaviors with thresholds. Data (N= 425) were from 3 longitudinal assessments of the MAPS Study, spanning preschool (means= 4.7 and 5.5 years) to early school age (mean= 6.8 years). The Multidimensional Assessment Profile of Disruptive Behavior (MAP-DB) Temper Loss scale captured irritability, the Family Life Impairment Scale (FLIS) assessed cross-domain impairment at the preschool time points and the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS) was used to assess clinical status at early school age. Latent transition analyses differentiated children with EC-DMDD from children with low, transient, or nonimpairing irritability. Developmental patterning of irritability proved important for normal:abnormal differentiation. Of children, 27% had initially high irritability, but only two-thirds of these were persistently highly irritable. Thus, "false positives" based on a single screen would be substantial. Yet, "false negatives" are low, as<1% of children with baseline low irritability demonstrated later high irritability. Based on the sequential preschool-age time points, 6.7% of children were identified with EC-DMDD, characterized by persistent irritability with pervasive impairment, similar to prevalence at older ages. Specific behaviors included low frustration tolerance; dysregulated, developmentally unexpectable tantrums; and sustained irritable mood, all of which sensitively (0.85-0.96) and specifically (0.80-0.91) identified EC-DMDD. EC-DMDD predicted irritability-related syndromes (DMDD, oppositional defiant disorder) at early school age better than downward extension of DSM DMDD criteria to preschool age. These findings provide empirical thresholds for preschool-age clinical identification of DMDD patterns. The results lay the foundation for validation of DMDD in early childhood and inform revision of DSM criteria.

Context-dependent irritability in Attention Deficit/Hyperactivity Disorder: correlates and stability of family-restricted versus cross-situational temper outbursts.

Impairing irritability is highly prevalent in children with attention deficit/hyperactivity disorder (ADHD), although manifestations of irritability are not necessarily present in all settings (home, school, with peers). At the moment, little is known about the relative prevalence, stability, and etiologies of contextual versus cross-situational manifestations of irritability in ADHD. In this study, levels of dysfunctional parenting practices and sleep problems were compared in irritable versus nonirritable children with ADHD, in cases of family-restricted versus cross-situational irritability, and examined as predictors of irritability levels over a one-year interval. Stability of irritability manifestations over time was investigated, and prevalence of cross-situational disruptive mood dysregulation disorder (DMDD) versus 'family-restricted' DMDD was compared. One hundred and seventy children with ADHD (age 6-11) were examined. Parents completed a semi-structured interview and questionnaire to assess irritability, and parent-report questionnaires were used to evaluate parenting practices and sleep problems. Questionnaires were completed for a second time after a one-year interval. Parenting practices were more dysfunctional in the irritable group compared to the nonirritable group, while sleep problems did not differ between these two groups. Levels of parenting practices and sleep problems did not predict later irritability after correction for multiple comparison nor did they differ between the family-restricted and cross-situational irritable groups. Finally, family-restricted irritability was as prevalent and as stable over time as cross-situational irritability and family-restricted DMDD as prevalent as cross-situational DMDD. Factors associated with contextual versus cross-situational manifestations of irritability in ADHD remain elusive. More subtle measures of parenting practices should be considered, including psychological control or accommodation, and other constructs such as social inhibition. Despite not being captured by current nosography, severe forms of family-restricted irritability may be as prevalent as severe forms of cross-situational irritability.

S20. LIFETIME PSYCHOPATHOLOGY IN CHILD AND ADOLESCENT OFFSPRING OF PARENTS DIAGNOSED WITH SCHIZOPHRENIA OR BIPOLAR DISORDER

BackgroundHaving one parent diagnosed with a severe mental disorder is considered one of the main risk factors for developing that disorder in adulthood and it also increases the risk of a wide range of mental disorders in the offspring from early childhood and adolescence. The aim of this study is to analyze the prevalence of several psychopathological diagnoses, the presence of prodromal symptoms and global functioning in schizophrenia offspring (SZoff) or bipolar offspring (BDoff) compared to community control offspring (CCoff) at baseline and 2-year follow-up.Methods41 SZoff, 97 BDoff and 107 CCoff between 7 and 17 years were included. Clinical assessment consisted of a clinical evaluation using the following instruments: structured interview KSADS-PL or SCID-I, semi-structured Interview for Prodromal Syndromes (SIPS) and the Children’s Global Assessment Scale (CGAS). To test between-group differences in DSM-IV diagnoses multilevel mixed-effect logistic regression models (categorical variables) or linear (continuous variables) regression models were conducted with group (SZoff, BDoff and CCoff), time (baseline or 2-year follow-up), interaction time x group, age, gender and socio-economic status as fixed variables.ResultsSignificant differences between groups were found in any lifetime axis I disorder (F=8.720; p<0.001), mood disorders (F=4.774; p=0.009), anxiety disorders (F=4.368; p=0.013), ADHD (F=21.593; p<0.001), disruptive behavioral disorders (F=10.788; p<0.001) and comorbidity (F=5.588; P=0.004). Significant differences between groups were also found in the positive (F=6.088; p=0.003), negative (F=4.423; p=0.015), disorganized (F=3.866; p=0.024) and total (F=6.394; p= 0.002) sub-scales of the SOPS and CGAS (F=11.613;p<0.001). Interestingly, mood disorders were more prevalent in BDoff and disruptive disorders were more prevalent in SZoff. Prodromal symptoms were higher in SZoff compared to CCoff, while the BPoff group showed an intermediate pattern. Finally, global functioning was lower in the SZoff group compared to BDoff and CCoff.DiscussionScreening patients’ children is clinically relevant since, as a group, they have an elevated risk of developing a psychiatric disorder and of experiencing their first symptoms during childhood and adolescence.

The μ-opioid receptor gene A118G polymorphism is associated with insecure attachment in children with disruptive mood regulation disorder and their mothers.

BackgroundThe A118G single nucleotide polymorphism (SNP) of the μ‐opioid receptor gene, with high expression of the A allele and low expression of the G allele, has been associated with emotional/behavioral dysregulation and depressive disorders and is recognized as a mediator of affiliative behavior. No study has thus far investigated this SNP in school‐age children with disruptive mood regulation disorder (DMDD). This study compared a sample of healthy children and their mothers with a sample of children with DMDD and their mothers, evaluating whether insecure attachment and psychopathological symptoms are associated with A allele‐ or G allele‐carrying mothers and children and whether caregiving capacities are associated with A allele‐ or G allele‐carrying mothers.MethodsFor evaluation of their psychopathological symptoms and attachment styles, mothers filled out the CBCL/6‐18, the SCL‐90‐R, and the ECR. To evaluate the types of relationship children were experiencing with their mothers, children filled out the ECR‐revised child version and the PBI. Genotypic analyses were conducted on DNA samples obtained by buccal swabbing from children and mothers.ResultsAn insecure attachment style was more frequent in mothers and children carrying the G allele (G/G + A/G genotypes). In the clinical sample, G allele‐carrying children scored higher than homozygous A/A ones on the subscales of Withdrawal and Conduct Problems. G‐carrying mothers showed higher interpersonal sensitivity, depression, hostility, and paranoid ideation and provided less care than A/A mothers.ConclusionsThis study offers new insights into the associations between the A118G SNP of the μ‐opioid receptor gene and emotional/behavioral functioning, attachment style in children, and psychopathology and caregiving ability in mothers.

Diagnostic classification of irritability and oppositionality in youth: a global field study comparing ICD-11 with ICD-10 and DSM-5.

Severe irritability has become an important topic in child and adolescent mental health. Based on the available evidence and on public health considerations, WHO classified chronic irritability within oppositional defiant disorder (ODD) in ICD-11, a solution markedly different from DSM-5's (i.e. the new childhood mood diagnosis, disruptive mood dysregulation disorder [DMDD]) and from ICD-10's (i.e. ODD as one of several conduct disorders without attention to irritability). In this study, we tested the accuracy with which a global, multilingual, multidisciplinary sample of clinicians were able to use the ICD-11 classification of chronic irritabilityand oppositionality as compared to the ICD-10 and DSM-5 approaches. Clinicians (N=196) from 48 countries participated in an Internet-based field study in English, Spanish, or Japanese and were randomized to review and use one of the three diagnostic systems. Through experimental manipulation of validated clinical vignettes, we evaluated how well clinicians in each condition could identify chronic irritability versus nonirritable oppositionality, episodic bipolar disorder, dysthymic depression, and normative irritability. Compared to ICD-10 and DSM-5, ICD-11 led to more accurate identification of severe irritability and better differentiation from boundary presentations. Participants using DSM-5 largely failed to apply the DMDD diagnosis when it was appropriate, and they more often applied psychopathological diagnoses to developmentally normative irritability. The formulation of irritability and oppositionality put forth in ICD-11 shows evidence of clinical utility, supporting accurate diagnosis. Global mental health clinicians can readily identify ODD both with and without chronic irritability.

Feasibility and acceptability of a brief cognitive-behavioral group intervention for chronic irritability in youth.

Chronic irritability is a core feature of oppositional defiant disorder (ODD) and disruptive mood dysregulation disorder (DMDD), but few irritability-specific interventions have been tested. Existing evidence-based treatments for disruptive behavior problems offer a strong template. This pilot study was conducted to develop and evaluate a brief irritability-specific module of a validated cognitive-behavioral group intervention for children (Stop Now And Plan (SNAP) Program). Stop now and plan for irritability (I-SNAP) retained core elements of SNAP in a shortened 6-week format. Community families with irritable children (M = 8.44 years, SD = 1.42) were recruited for parent and child emotion regulation skills groups. Of 18 children enrolled (72% male), 14 completed (78%). Half of children attended all six sessions, though homework compliance was lower. All parents reported favorable impressions and would recommend I-SNAP to others. Significant improvements were seen from pre- to post-treatment across parent-reported irritability, ODD symptoms, emotion regulation, and disciplinary effectiveness. This pilot study provides initial support suggesting I-SNAP may be feasible to implement and acceptable to parents. In addition, pilot analyses demonstrated that this brief group intervention was associated with positive outcomes consistent with treatment targets. This preliminary evidence supports the need for further research to assess I-SNAP's effects on irritability relative to control groups.

The effectiveness of mood regulation skills training on the anxiety and irritability of students with disruptive mood disregulation disorder

The effectiveness of mood regulation skills training on the anxiety and irritability of students with disruptive mood disregulation disorder

Sensory Processing Difficulties in Youths With Disruptive Mood Dysregulation Disorder.

Difficulty modulating sensory information has been described in children with developmental disorders. However, the relation of sensory processing difficulties (SPD) to emotional regulation problems remains poorly understood. The aim of this study is to determine the rate and patterns of SPD in youth with disruptive mood dysregulation disorder (DMDD). Participants were DMDD patients aged 6–16 years presenting at a university hospital in outpatient or inpatient facilities (n = 30). For each participant, the parent-reported Sensory Profile, the Affective Lability Scale, the Beck Depression Inventory-Second Edition, the Child Behavior Checklist/4–18, and the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children–Present and Lifetime Version were completed. The scores of the Sensory Profile of the DMDD youths were compared to those obtained in a clinical control group and to the manual scores for same-age typically developing youths. SPD were reported in 53% of the subjects in the DMDD group compared to 33% in the clinical control group (p = 0.405). Youths with DMDD showed a significant difference on almost all items of the Sensory Profile compared to typically developing youth. The Sensory Profile was found to discriminate best between the participants with DMDD and those in the clinical control group with regard to the category “Behavioral outcomes of sensory processing” and the factor “Fine motor/perceptual behavior.” All types of sensory processing patterns were reported in the DMDD youths: sensation avoiding (40%), low registration (27%), sensory sensitivity (20%), and sensation seeking (10%). As a group, youths with DMDD have significantly more SPD when compared to typical youths. Therefore, SPD could be an important factor to consider in youths with DMDD when providing comprehensive assessment and therapeutic interventions.

The Diagnostic Infant Preschool Assessment-Likert Version: Preparation, Concurrent Construct Validation, and Test-Retest Reliability.

Objective: The Diagnostic Infant and Preschool Assessment was revised to include Likert ratings (DIPA-L) to give a broader range of severity ratings that may have greater utility for clinical and research purposes. In addition, the instrument was updated for Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5), and two types of Likert ratings-frequency versus problem intensity-were explored for posttraumatic stress disorder (PTSD) symptoms. Concurrent construct validation and test-retest reliability were examined for the five most common disorders seen in very young children in outpatient clinics: PTSD, attention-deficit/hyperactivity disorder, oppositional defiant disorder, separation anxiety disorder, and generalized anxiety disorder (GAD). A sixth disorder, disruptive mood dysregulation disorder (DMDD), which was created in DSM-5, was tested for the first time. Functional impairment was also examined. Methods: The caregivers of 58 two- through six-year-old children (57 mothers and 1 father) were recruited from an outpatient clinic. They were interviewed at Time 1, and 52 were reinterviewed at Time 2 by research assistants (children's age M 4.7 years, standard deviation 1.2). Results: Few differences were found between the ratings of frequency versus problem intensity for PTSD symptoms. Tests of concurrent criterion validation were acceptable for all disorders when compared against disorder-specific questionnaires; the range of Pearson correlation coefficients was 0.56-0.94. A trend for attenuation of diagnoses from Time 1 to Time 2 was evident, but not statistically significant. Test-retest reliabilities were strong when examined with continuous Likert scores, except for GAD (the range of intraclass correlation coefficients values was 0.29-0.91, but were less consistent for categorical disorder-level status [the range of Cohen's κs was 0.35-0.79]). The range of internal consistencies was 0.78-0.95, excluding DMDD, which could not be calculated. Conclusions: The updated and revised DIPA-L demonstrated many acceptable features of a valid and reliable instrument for the assessment of very young children. While the findings are tentative given the small sample size, the DIPA-L is the only diagnostic instrument for young children with a replication, tested in clinic populations, updated for DSM-5, with psychometrics for functional impairment, and has Likert ratings.

Lifetime psychopathology in child and adolescent offspring of parents diagnosed with schizophrenia or bipolar disorder: a 2-year follow-up study.

Having one parent diagnosed with a severe mental disorder is considered one of the main risk factors for developing that disorder in adulthood, and it also increases the risk of a wide range of mental disorders in the offspring. The aim of this study is to compare the prevalence of several psychopathological diagnoses, the presence of prodromal symptoms, and global functioning in offspring of parents with schizophrenia or bipolar disorder and in offspring of controls at baseline and 2-year follow-up. This study included 41 offspring of parents with schizophrenia, 90 offspring of parents with bipolar disorder, and 107 offspring of controls (mean age 11.7 ± 3.2 at baseline and 13.9 ± 3.2 at follow-up). The prevalence of psychopathology and comorbidity was higher in offspring of parents with schizophrenia and offspring of parents with bipolar disorder than in offspring of controls at baseline and at 2-year follow-up. Interestingly, mood disorders were more prevalent in offspring of parents with bipolar disorder and disruptive disorders were more prevalent in offspring of parents with schizophrenia. Prodromal symptoms were more frequent in offspring of parents with schizophrenia than in offspring of controls, while the offspring of parents with bipolar disorder showed an intermediate pattern. Finally, global functioning was lower in the offspring of parents with schizophrenia than the offspring of parents with bipolar disorder and the offspring of controls. Screening patients' children is clinically relevant, since, as a group, they have an elevated risk of developing a psychiatric disorder and of experiencing their first symptoms during childhood and adolescence.

Defense Style of Children and Adolescents: Differences and Ability to Discriminate Among Clinical Categories.

This study assessed the defense style of children referred to an outpatient clinic and examined what this style contributes to discriminating among various disorder categories, beyond internalizing and externalizing symptoms. A sample of 433 children and adolescents were grouped into four disorder categories: disruptive, depressive, anxiety, and attention deficit hyperactivity disorder. Their parents completed the Comprehensive Assessment of Defense Style (CADS: mature, self-oriented, and other-oriented) and the Child Behavior Checklist (CBCL: internalizing and externalizing symptoms). The disorder categories differed in the use of other-oriented defenses (e.g., acting-out, projection), whereas the CADS helped in properly discriminating most diagnostic categories beyond the CBCL. Information provided by the children themselves was missing, as was a subsample of nonclinical participants; these sources could strengthen the conclusions of the study. Assessing children's defense style together with their symptoms may result in better statistical discrimination among diagnostic categories.

Follow up study on Attention Deficit Hyperactivity Disorder patients with and without comorbid mood disorders receiving Non Stimulant medication

Abstract Article Outline Abstract Introduction Patients and methods Procedure Statistical analysis Results Discussion Conclusion References Background Irritability is common in Attention deficit hyperactivity disorder (ADHD) which is sometimes associated with Mood symptoms. Results from community samples suggest that 4.3–23.5% of those with ADHD meet Disruptive mood dysregulation disorder diagnostic criteria. The Aim of this study: To compare the prognostic outcome of ADHD symptoms in ADHD children with comorbid mood disorders compared to those without comorbid mood disorders receiving non-stimulant medication. Patients and Methods This is An observational prognostic prospective study in which two groups of ADHD patients were included in the study, group 1 includes 40 ADHD patients without comorbid mood disorders and group 2 includes 40 ADHD patients with comorbid mood disorders, they were assessed using; The Kiddie Schedule for Affective Disorder and Schizophrenia for School Age Children Rating scales as Conners’ Parent Rating Scale-Revised Long Version, Pediatric behavior rating scale and Children Depression Inventory. Results ADHD symptoms (hyperactivity and inattention) were found to be improved regarding the hyperactivity in a statistically significant way in the mood group after 1 week of receiving non stimulant medications, while there was no significant change in the non-mood group, Also there was significant improvement of the inattention symptoms among the two groups after receiving non stimulant medication. Meanwhile severity of depressive symptoms showed an improvement in the mood group while there was no change in severity in the non-mood group. As regards the irritability symptoms it showed insignificant change in both groups among the two follow-ups. Conclusion There is a more significant decrease in inattention symptoms in ADHD children with comorbid mood disorder who received non-stimulant treatment for one week more than the children without comorbid mood disorder. Moreover the depressive symptoms decreases among patients with ADHD and mood disorders after one week of receiving non-stimulant treatment.

Treatment Efficacy of Internet Gaming Disorder With Attention Deficit Hyperactivity Disorder and Emotional Dysregulaton.

BackgroundRecent youth with Attention Deficit Hyperactivity Disorder (ADHD) noticed emotional dysregulation if they had Internet Gaming Disorder (IGD). This study aims to understand the treatment efficacy of IGD with ADHD and emotional dysregulaton.MethodA total of 101 ADHD youths were recruited. We used the Chen Internet Addiction Scale and IGD criteria of the diagnotsic statistical manual (DSM)-5 to confirm IGD. The Swanson, Nolan, and Pelham questionnaire Version IV was used for symptoms of ADHD and oppositional defiant disorder. Disruptive mood dysregulation disorder was assessed by psychiatrist.ResultsThere is a new phenomenon that emotional dysregulation has been frequently noticed in severely gaming-addicted ADHD youth. Treatment efficacy of IGD is good when the underlying symptom of ADHD is controlled. Symptom scores of disruptive mood dysregulation (DMDD) were significantly reduced by 71.9%, 74.8%, and 84.4% at week 2, 3, and 4, respectively (P ≤ .001) after adjusting baseline symptom severity.ConclusionIGD may strongly arouse emotional dysregulation. Future DSM criteria could consider these gaming-addicted youth as a specific subclass of ADHD.