Neural Mechanisms of Frustration in Chronically Irritable Children

National Institute of Mental Health (NIMH), 베서스다, Maryland, United States
American Journal of Psychiatry (Impact Factor: 13.56). 06/2013; 170(10). DOI: 10.1176/appi.ajp.2013.12070917
Source: PubMed

ABSTRACT OBJECTIVE Irritability is common in children and adolescents and is the cardinal symptom of disruptive mood dysregulation disorder, a new DSM-5 disorder, yet its neural correlates remain largely unexplored. The authors conducted a functional MRI study to examine neural responses to frustration in children with severe mood dysregulation. METHOD The authors compared emotional responses, behavior, and neural activity between 19 severely irritable children (operationalized using criteria for severe mood dysregulation) and 23 healthy comparison children during a cued-attention task completed under nonfrustrating and frustrating conditions. RESULTS Children in both the severe mood dysregulation and the healthy comparison groups reported increased frustration and exhibited decreased ability to shift spatial attention during the frustration condition relative to the nonfrustration condition. However, these effects of frustration were more marked in the severe mood dysregulation group than in the comparison group. During the frustration condition, participants in the severe mood dysregulation group exhibited deactivation of the left amygdala, the left and right striatum, the parietal cortex, and the posterior cingulate on negative feedback trials, relative to the comparison group (i.e., between-group effect) and to the severe mood dysregulation group's responses on positive feedback trials (i.e., within-group effect). In contrast, neural response to positive feedback during the frustration condition did not differ between groups. CONCLUSIONS In response to negative feedback received in the context of frustration, children with severe, chronic irritability showed abnormally reduced activation in regions implicated in emotion, attention, and reward processing. Frustration appears to reduce attention flexibility, particularly in severely irritable children, which may contribute to emotion regulation deficits in this population. Further research is needed to relate these findings to irritability specifically, rather than to other clinical features of severe mood dysregulation.

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    • "RSC may additionally be more ecologically valid, allowing observation of mind wandering, a commonly occurring activity in the daily lives of youth. In addition, by focusing on neural regions shown to be important in fMRI task-related analyses [such as the amygdala (Altshuler et al., 2005; Foland et al., 2008), striatum (Deveney et al., 2013), prefrontal cortical (Pavuluri et al., 2008; Kalmar et al., 2009; Passarotti et al., 2010; Ladouceur et al., 2011) and anterior cingulate cortical (Gogtay et al., 2007; Kalmar et al., 2009) regions, and an insula-centered neural network supporting salience, interoception, and emotion perception (Rubia et al., 2009; Taylor et al., 2009; Kurth et al., 2010; Cauda et al., 2012; Cloutman et al., 2012)], RSC studies may increase our understanding of pathophysiologic processes in behaviorally and emotionally dysregulated youth. "
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    • "Here, we extend those findings by demonstrating that such between-group differences in neural activity are present even when the faces are processed outside awareness. Data in the current experiment are consistent with previous neuroimaging and clinical studies, which conclude that severe, nonepisodic irritability does not appear to be a developmental presentation of BD (Brotman et al., 2006, 2010; Rich et al., 2007; Adleman et al., 2011; Deveney et al., 2012; Thomas et al., 2012, 2013). Further, our data indicate that patients and healthy subjects may differ in their neural responses to emotional stimuli, even when they are not aware of those stimuli. "
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