Disruptive Mood Dysregulation Disorder Research Articles

Pediatric Bipolar Disorder.

The diagnosis of bipolar disorder (BD) in youth is confusing and controversial. Controversy notwithstanding, youth diagnosed with BD have high behavioral health needs and are at elevated risk for problematic long-term psychosocial functioning and complex psychiatric medication regimens. Pediatricians and other primary care providers (PCPs) can play an important role in the assessment and treatment of youth diagnosed with BD and the recently created and also controversial diagnosis of disruptive mood dysregulation disorder (DMDD). This article provides information on the definitions, background, and presentation of pediatric bipolar disorder (PBD), how to differentiate PBD from other psychiatric disorders, effective psychiatric and psychosocial interventions for PBD, potential roles for PCPs, and what is known about DMDD. [Pediatr Ann. 2016;45(10):e362-e366.].

3.32 DISRUPTIVE MOOD DYSREGULATION DISORDER IN JUVENILE JUSTICE

Disruptive mood dysregulation disorder (DMDD) is a new diagnosis for children and adolescents in the DSM-5 categorized under depressive disorders. Our primary goal is to compare children with DMDD to clarify their differences. Our secondary goals are to investigate differential contributors to DMDD versus mood and DMDD versus disruptive behavior disorders among youth in the juvenile justice system.

Disruptive Mood Dysregulation Disorder and Other Psychopathology: Present and Future

Disruptive Mood Dysregulation Disorder and Other Psychopathology: Present and Future

8.1 Disruptive Mood Dysregulation Disorder in Children With Autism Spectrum Disorder

8.1 Disruptive Mood Dysregulation Disorder in Children With Autism Spectrum Disorder

5.23 PREVALENCE OF AND COMORBIDITIES WITH DISRUPTIVE MOOD DYSREGULATION DISORDER IN AN INPATIENT SETTING

Disruptive Mood Dysregulation Disorder (DMDD) is a new disorder in DSM-5. This condition requires developmentally inappropriate temper outbursts and chronic irritability. Concern has been raised that this disorder may be too easily diagnosed in children with serious problems. To investigate this possibility this study looked at the prevalence of and co-morbidities for DMDD in a consecutively discharged sample of 100 6-12 year old inpatients in a psychiatric hospital.

6.98 IDENTIFYING DIFFERENCES IN EMOTIONAL IDENTIFICATION ACCURACY IN DYSREGULATED CHILDREN

The purpose of this research is to investigate the differences in emotion identification accuracy between children with the Childhood Behavior Checklist Dysregulation Profile (CBCL-DP), those diagnosed with Disruptive Mood Dysregulation Disorder (DMDD) or Severe Mood Dysregulation (SMD), and controls.

8.3 Stability and Predictors of Disruptive Mood Dysregulation Disorder in Young Children

8.3 Stability and Predictors of Disruptive Mood Dysregulation Disorder in Young Children

Proper Emotion Recognition, Dysfunctional Emotion Regulation

A considerable number of adolescents exhibit severe self-regulation deficits in affect and behavior, which are referred to as affective dysregulation (AD). AD may be conceptualized as a dimensional trait that, in its extreme form, resembles the diagnostic categories of severe mood dysregulation (SMD) or disruptive mood dysregulation disorder (DMDD). Assuming a shared pathway of psychopathology in AD and SMD, similar underlying dysfunctional mechanisms in emotion processing, particularly emotion recognition (RECOG) and regulation (REGUL), may be postulated. Adolescent inpatients with AD (CAD, N = 35), without AD (CCG, N = 28), and nonclinical controls (NCG; N = 28) were administered a morphed facial recognition task (RECOG). REGUL abilities, levels of irritability as well as depressive symptoms were also assessed. We found no significant group differences in accuracy and thresholds for RECOG abilities. Patients with AD reported more dysfunctional REGUL strategies than did CCG and NCG. Both depression and AD, but not irritability, influenced the overall degree of maladaptive REGUL. The broad phenotype of AD does not involve the deficits in RECOG reported for adolescents with a narrow phenotype (SMD); regarding REGUL strategies, AD seems to be associated with specific impairments.

Cognitive-Behavioral Therapy for a 9-Year-Old Girl With Disruptive Mood Dysregulation Disorder.

Disruptive mood dysregulation disorder (DMDD) is a relatively new diagnosis in the field of childhood onset disorders. Characterized by both behavior and mood disruption, DMDD is a purportedly unique clinical presentation with few relevant treatment studies to date. The current case study presents the application of cognitive-behavioral therapy (CBT) for anger and aggression in a 9-year-old girl with DMDD, co-occurring attention deficit hyperactivity disorder (ADHD), and a history of unspecified anxiety disorder. At the time of intake evaluation, she demonstrated three to four temper outbursts and two to three episodes of aggressive behavior per week, in addition to prolonged displays of non-episodic irritability lasting hours or days at a time. A total of 12 CBT sessions were conducted over 12 weeks and 5 follow-up booster sessions were completed over a subsequent 3-month period. Irritability-related material was specially designed to target the DMDD clinical presentation. Post-treatment and 3-month follow-up assessments, including independent evaluation, demonstrated significant decreases in the target symptoms of anger, aggression, and irritability. Although the complexities of diagnosing and treating DMDD warrant extensive research inquiry, the current case study suggests CBT for anger and aggression as a viable treatment for affected youth.

Evidence-based treatments for youths with severely dysregulated mood: a qualitative systematic review of trials for SMD and DMDD.

The aim of this literature review was to examine the evidence for psychotherapeutic and pharmacological treatments in subjects with severely dysregulated mood and to identify potential areas for improvements in research designs. A literature search was conducted using several databases for published (PubMed, PsycINFO) and ongoing (clinical trial registries) studies conducted in youths who met NIMH's criteria for Severe Mood Dysregulation (SMD) or the DSM-5 diagnosis of Disruptive Mood Dysregulation Disorder (DMDD). Eight completed studies were identified: three randomized trials, four open pilot studies and one case report. Seven ongoing studies were found in trial registries. The available evidence suggests potential efficacy of psychotherapies which have previously been developed for internalizing and externalizing disorders. The two main pharmacological strategies tested are, first, a monotherapy of psychostimulant or atypical antipsychotic such as risperidone, already used in the treatment of severe irritability in youths with developmental disorders; and second, the use of a serotonergic antidepressant as an add-on therapy in youths treated with psychostimulant. Ongoing studies will further clarify the effectiveness of psychotherapeutic interventions for DMDD individuals and whether they should be given alone or in conjunction with other treatments. The short duration of the trials for a chronic disorder, the low number of studies, the lack of placebo or active comparator arm, and restrictive inclusion criteria in most of the controlled trials dramatically limit the interpretation of the results. Finally, future research should be conducted across multiple sites, with standardized procedures to measure DMDD symptoms reduction, and include a run-in period to limit placebo effect.

Comparing Brain Morphometry Across Multiple Childhood Psychiatric Disorders

In both children and adults, psychiatric illnessis associated with structural brain alterations, particularly in the prefrontal cortex (PFC). However, moststudies compare gray matter volume (GMV) in healthy volunteers (HVs) to one psychiatric group. We compared GMV among youth with anxiety disorders, bipolardisorder (BD), disruptive mood dysregulation disorder (DMDD), attention-deficit/hyperactivity disorder (ADHD), and HVs. 3-Tesla T1-weighted magnetic resonance imaging scans were acquired in 184 youths (39 anxious, 20 BD, 52 DMDD, 20 ADHD, and 53 HV). Voxel-based morphometry analyses were conducted. One-way analysis of variance tested GMV differences with whole-brain familywise error (p< .05) correction; secondary, exploratory whole-brain analyses used a threshold of p<.001,≥200 voxels. Given recent frameworks advocating dimensional approaches in psychopathology research, we also tested GMV associations with continuous anxiety, irritability, and inattention symptoms. Specificity emerged in the left dorsolateral PFC (dlPFC), which differed among youth with BD, anxiety, and HVs; GMV was increased in youth with anxiety, but decreased in BD, relative to HVs. Secondary analyses revealed BD-specific GMV decreases in the right lateral PFC, right dlPFC, and dorsomedial PFC, and also anxiety-specific GMV increases in the left dlPFC, right ventrolateral PFC, frontal pole, and right parahippocampal gyrus/lingual gyrus. Both BD and DMDD showed decreased GMV relative to HVs in the right dlPFC/superior frontal gyrus. GMV was not associated with dimensional measures of anxiety, irritability, or ADHD symptoms. Both disorder-specific and shared GMV differences manifest in pediatric psychopathology. Some differences were specific to anxiety disorders, others specific to BD, and others shared between BD and DMDD. Further developmental research might map commonalities and differences of structure and function in diverse pediatric psychopathologies.

Demographic Differences in Disruptive Mood Dysregulation Disorder Symptoms in ADHD, Autism, and General Population Samples

Objective: Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) disruptive mood dysregulation disorder (DMDD) is a controversial new diagnosis. No studies have investigated DMDD symptoms (irritable-angry mood and temper outbursts) and demographics in general population and psychiatric samples. Method: Maternal ratings of DMDD symptoms and diagnoses, age, gender, IQ, race, and parent occupation were analyzed in general population (n = 665, 6-12 years) and psychiatric samples (n = 2,256, 2-16 years). Results: Percentage of school-age children with DMDD symptoms were 9% general population, 12% ADHD-I, 39% ADHD-C, and 43% autism. Male, nonprofessional parent, and autism with IQ > 80 were associated with increasing DMDD symptoms, but demographics together explained only 2% to 3% of the DMDD score variance. Conclusion: Demographics contributed little to the presence of DMDD symptoms in all groups, whereas oppositional defiant disorder (ODD) explained most of the variance. Almost all children with DMDD symptoms had ODD suggesting that DMDD may not be distinct from ODD.

Increased Serum Levels of Oxytocin in 'Treatment Resistant Depression in Adolescents (TRDIA)' Group.

Objective‘Treatment-resistant depression’ is depression that does not respond to an adequate regimen of evidence-based treatment. Treatment-resistant depression frequently becomes chronic. Children with treatment-resistant depression might also develop bipolar disorder (BD). The objective of this study was to determine whether serum levels of oxytocin (OXT) in treatment-resistant depression in adolescents (TRDIA) differ from non-treatment-resistant depression in adolescents (non-TRDIA) or controls. We also investigated the relationships between serum OXT levels and the clinical symptoms, severity, and familial histories of adolescent depressive patients.MethodsWe measured serum OXT levels: TRDIA (n = 10), non-TRDIA (n = 27), and age- and sex- matched, neurotypical controls (n = 25). Patients were evaluated using the Children’s Depression Rating Scale-Revised (CDRS-R) and the Depression Self-Rating Scale for Children-Japanese Version (DSRS-C-J). The patients were also assessed retrospectively using the following variables: familial history of major depressive disorder and BD (1st degree or 2nd degree), history of disruptive mood dysregulation disorder, recurrent depressive disorder (RDD), history of antidepressant activation.ResultsSerum levels of OXT among the TRDIA and non-TRDIA patients and controls differed significantly. Interestingly, the rates of a family history of BD (1st or 2nd degree), RDD and a history of antidepressant activation in our TRDIA group were significantly higher than those of the non-TRDIA group.ConclusionsSerum levels of OXT may play a role in the pathophysiology of TRDIA.

Temper Loss and Persistent Irritability in Preschoolers: Implications for Diagnosing Disruptive Mood Dysregulation Disorder in Early Childhood.

Disruptive Mood Dysregulation Disorder (DMDD) is a new and controversial child psychiatric disorder characterized by persistent irritability and frequent temper loss. Among the controversies surrounding DMDD is whether the age of onset criterion-that DMDD may not be diagnosed before age 6years-is justified. This study examined DMDD symptoms and associated patterns of psychiatric comorbidity, behavioral, and family functioning in a sample of 139 preschoolers (ages 4-0 to 5-11years) admitted to an early childhood psychiatric day treatment program. DMDD symptoms were common in this acute clinical sample, with 63 children (45.3%) presenting with frequent temper outbursts and chronic irritability. As compared to children who did not present with DMDD symptoms, these children demonstrated more aggression and emotional reactivity and lower receptive language skills, with high rates of comorbidity with the disruptive behavior disorders. Findings contribute to an emerging literature on preschool DMDD, with implications for early childhood psychiatric assessment and clinical interventions.

Disruptive mood dysregulation disorder: current insights.

Disruptive mood dysregulation disorder (DMDD) was introduced as a new diagnostic entity under the category of depressive disorders in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). It was included in DSM-5 primarily to address concerns about the misdiagnosis and consequent overtreatment of bipolar disorder in children and adolescents. DMDD does provide a home for a large percentage of referred children with severe persistent irritability that did not fit well into any DSM, Fourth Edition (DSM-IV) diagnostic category. However, it has been a controversial addition to the DSM-5 due to lack of published validity studies, leading to questions about its validity as a distinct disorder. In this article, the authors discuss the diagnostic criteria, assessment, epidemiology, criticism of the diagnosis, and pathophysiology, as well as treatment and future directions for DMDD. They also review the literature on severe mood dysregulation, as described by the National Institute of Mental Health, as the scientific support for DMDD is based primarily on studies of severe mood dysregulation.

Distinguishing disruptive mood dysregulation disorder from pediatric bipolar disorder.

This article outlines diagnostic criteria and features of the newly established diagnosis disruptive mood dysregulation disorder (DMDD), and discusses how this disorder differs from bipolar disorder in childhood. The chronic, severe, nonepisodic irritability seen in patients with DMDD contrasts with the characteristic episodic mood swing symptoms of bipolar disorder. Differentiating between the two diagnoses is important in regard to prognostic and treatment considerations, as children with DMDD are more likely to develop a mood disorder later in life rather than to develop classic bipolar disorder. Research is needed to establish clear treatment guidelines for DMDD.

Functional consequences of attention-deficit hyperactivity disorder on children and their families.

Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder with core symptoms that include hyperactivity, impulsiveness, and inattention, and it is the most common psychiatric disorder among children and adolescents. These core symptoms are continuously recognized throughout the day from childhood to adulthood. Furthermore, children with ADHD from childhood to adulthood might also have various comorbid psychiatric disorders. Recently, bipolar disorder and disruptive mood dysregulation disorder, a new clinical issue, have been discussed as comorbid disorders or differential disorders associated with ADHD. Furthermore, comorbid disorders of ADHD are related to quality of life and family burden. Children with ADHD have poorer long-term outcomes than controls with respect to: academic achievement and attainment, occupational rank and job performance, risky sexual practices and early unwanted pregnancies, substance use, relationship difficulties, marital problems, traffic violations, and car accidents. Irritability of children with ADHD has been a key symptom that clinicians and researchers have used to evaluate the developmental condition of children with ADHD. ADHD is sometimes a chronic disorder that occurs over a long period, increasing the family burden of these children (including health-care costs), which will increase with aging for unremitted children with ADHD. Therefore, clinicians should evaluate not only the mental condition of the child but also the family burden. Children with ADHD should be treated during childhood to reduce their clinical symptoms and family burden.

DMDD: Few teens have it, and perhaps it should be eliminated or modified

As clinicians get accustomed to a new diagnosis in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM‐5) — disruptive mood dysregulation disorder (DMDD) — there are still questions about the utility and clinical picture of the children it is supposed to describe. However, a recent study shows that very few adolescents have it, and that it should be modified or perhaps eliminated in the next DSM.

Depression and Inflammatory Periodontal Disease Considerations-An Interdisciplinary Approach.

Periodontal disease, a bacterially mediated inflammatory disease of the gingival and adjacent periodontal attachment apparatus, represents, after dental caries, the leading cause of tooth loss among adults in developed countries due to the destruction of the periodontal ligament and the loss of the adjacent supporting bone, the tissues which support the teeth (Pihlstrom et al., 2005). Depressive disorders, the most commonly diagnosed conditions in psychiatry (Ustun et al., 2004; Kessler and Bromet, 2013), include, according to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5): disruptive mood dysregulation disorder, major depressive disorder (including major depressive episode) an extensive prevalent disorder ranked third among the primary causes of global illness (Mathers and Loncar, 2006), persistent depressive disorder (dysthymia), premenstrual dysphoric disorder, substance/medication-induced depressive disorder, depressive disorder due to another medical condition, other specified depressive disorder, and unspecified depressive disorder (American Psychiatric Association, 2013; Patten, 2013). The aim of this article is to summarize the current knowledge about the periodontal disease—depression relationship and to discuss the plausible mechanisms underlying this possible bidirectional association, by which each disease may contribute to the other (Figure ​(Figure11). Open in a separate window Figure 1 Review of reported results related to the biological and psychosocial mechanisms underlying the depression-periodontal disease bidirectional connection.

Correction to "The Effectiveness and Tolerability of Central Nervous System Stimulants in School-Age Children with Attention-Deficit/Hyperactivity Disorder and Disruptive Mood Dysregulation Disorder across Home and School".

Correction to "The Effectiveness and Tolerability of Central Nervous System Stimulants in School-Age Children with Attention-Deficit/Hyperactivity Disorder and Disruptive Mood Dysregulation Disorder across Home and School".