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.
American Journal of Psychiatry 06/2014; 171(6):607-610. DOI:10.1176/appi.ajp.2014.14030385 · 13.56 Impact Factor
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ABSTRACT: Disruptive mood dysregulation disorder (DMDD) is a new DSM 5 diagnosis specifically addressing children and adolescents. DMDD belongs to the category of mood disorders and has been created to improve recognition of a condition characterized by both mood and behavioral symptoms and to avoid a diagnosis of bipolar disorder in children and adolescents with severe chronic irritability and temper tantrums. Its validity and possible overlap with disruptive behavior disorders such as oppositional defiant disorder or conduct disorder and neurodevelopmental disorder such as attention deficit hyperactivity disorder – especially in children with severe emotional liability or comorbidities – are still subject to debate. This review addresses the background of DMDD, diagnosis and neuropsychological correlates.Annales Médico-psychologiques revue psychiatrique 10/2014; DOI:10.1016/j.amp.2014.08.009 · 0.15 Impact Factor
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ABSTRACT: Pediatric onset bipolar disorder (BD) is a challenging diagnosis with potentially debilitating outcomes. This review aims to critically evaluate recently published literature relevant to the diagnosis of BD in youth, emphasizing interesting and important new findings characterizing pediatric BD and reporting updates in the diagnostic and statistical manual relevant to this disorder in youth. Challenges regarding the diagnosis of BD will be discussed, in addition to important distinctions with other childhood disorders, including other bipolar spectrum disorders; major depressive disorder; dysthymia; disruptive mood dysregulation disorder (DMDD); attention-deficit/hyperactivity disorder (ADHD) and other disruptive behavioral disorders; anxiety disorders, including post-traumatic stress disorder (PTSD); psychotic disorders; autism spectrum disorders; substance use disorders; and borderline personality disorder. The review concludes with a comment on past research limitations and future directions in the field.Current Psychiatry Reports 12/2014; 16(12):516. DOI:10.1007/s11920-014-0516-2 · 3.05 Impact Factor