Neural Mechanisms of Frustration in Chronically Irritable Children
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.
- SourceAvailable from: Michele Bertocci
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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. "
ABSTRACT: The Research Domain Criteria (RDoC) adopts a dimensional approach for examining pathophysiological processes underlying categorically defined psychiatric diagnoses. We used this framework to examine relationships among symptom dimensions, diagnostic categories, and resting state connectivity in behaviorally and emotionally dysregulated youth selected from the Longitudinal Assessment of Manic Symptoms study (n=42) and healthy control youth (n=18). Region of interest analyses examined relationships among resting state connectivity, symptom dimensions (behavioral and emotional dysregulation measured with the Parent General Behavior Inventory-10 Item Mania Scale [PGBI-10M]; dimensional severity measures of mania, depression, anxiety), and diagnostic categories (Bipolar Spectrum Disorders, Attention Deficit Hyperactivity Disorder, Anxiety Disorders, and Disruptive Behavior Disorders). After adjusting for demographic variables, two dimensional measures showed significant inverse relationships with resting state connectivity, regardless of diagnosis: 1) PGBI-10M with amygdala-left posterior insula/bilateral putamen; and 2) depressive symptoms with amygdala-right posterior insula connectivity. Diagnostic categories showed no significant relationships with resting state connectivity. Resting state connectivity between amygdala and posterior insula decreased with increasing severity of behavioral and emotional dysregulation and depression; this suggests an intrinsic functional uncoupling of key neural regions supporting emotion processing and regulation. These findings support the RDoC dimensional approach for characterizing pathophysiologic processes that cut across different psychiatric disorders. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.Psychiatry Research: Neuroimaging 11/2014; 231(1). DOI:10.1016/j.pscychresns.2014.10.015 · 2.83 Impact Factor
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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. "
ABSTRACT: Youth with bipolar disorder (BD) and those with severe, non-episodic irritability (severe mood dysregulation, SMD) show face-emotion labeling deficits. These groups differ from healthy volunteers (HV) in neural responses to emotional faces. It is unknown whether awareness is required to elicit these differences. We compared activation in BD (N=20), SMD (N=18), and HV (N=22) during "Aware" and "Non-aware" priming of shapes by emotional faces. Subjects rated how much they liked the shape. In aware, a face (angry, fearful, happy, neutral, blank oval) appeared (187ms) before the shape. In non-aware, a face appeared (17ms), followed by a mask (170ms), and shape. A Diagnosis-by-Awareness-by-Emotion ANOVA was not significant. There were significant Diagnosis-by-Awareness interactions in occipital regions. BD and SMD showed increased activity for non-aware vs. aware; HV showed the reverse pattern. When subjects viewed angry or neutral faces, there were Emotion-by-Diagnosis interactions in face-emotion processing regions, including the L precentral gyrus, R posterior cingulate, R superior temporal gyrus, R middle occipital gyrus, and L medial frontal gyrus. Regardless of awareness, BD and SMD differ in activation patterns from HV and each other in multiple brain regions, suggesting that BD and SMD are distinct developmental mood disorders.04/2014; 8:110-120. DOI:10.1016/j.dcn.2013.09.007
- American Journal of Psychiatry 10/2013; 170(10):1093-1096. DOI:10.1176/appi.ajp.2013.13070934 · 13.56 Impact Factor