Pediatric Mental Health Care Dysfunction Disorder?

Hastings Center, Garrison, NY, USA.
New England Journal of Medicine (Impact Factor: 55.87). 05/2010; 362(20):1853-5. DOI: 10.1056/NEJMp1003175
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    • "and MDD, attention deficit/hyperactivity disorder (ADHD), and anxiety disorders are reported to be the most common comorbid diagnoses (American Psychiatric Association 2013). The diagnosis of DMDD is criticized because of its potential to pathologize physiological behavior (i.e., temper tantrums) with a consequent elevation in use of psychotropic medications, paucity of empirical evidence supporting the validity of diagnosis, low test– retest reliability and supporting studies focusing at selected centers, and a not entirely overlapping diagnosis (i.e., SMDD) (Parens et al. 2010; Regier et al. 2013; McGough 2014). On the other hand, there are also studies supporting its validity as a distinct diagnosis (Copeland et al. 2013; Deveney et al. 2013; Copeland et al. 2014; Dougherty et al. 2014). "
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    ABSTRACT: Objective: Disruptive mood dysregulation disorder (DMDD) is a novel diagnosis listed in Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5) to encompass chronic and impairing irritability in youth, and to help its differentiation from bipolar disorders. Because it is a new entity, treatment guidelines, as well as its sociodemographic and clinical features among diverse populations, are still not elucidated. Here, DMDD cases from three centers in Turkey are reported and the implications are discussed. Methods: The study was conducted at the Abant Izzet Baysal University Medical Faculty Department of Child and Adolescent Psychiatry (Bolu), and American Hospital and Bengi Semerci Institute (Istanbul) between August 2014 and October 2014. Records of patients were reviewed and features of patients who fulfilled criteria for DMDD were recorded. Data were analyzed with SPS Version 17.0 for Windows. Descriptive analyses, χ(2) test, and Mann-Whitney U test were used for analyses. Diagnostic consensus was determined via Cohen's κ constants. p was set at 0.01. Results: Thirty-six patients (77.8 % male) fulfilled criteria for DMDD. κ value for consensus between clinicians was 0.68 (p = 0.00). Mean age of patients was 9.0 years (S.D. = 2.5) whereas the mean age of onset for DMDD symptoms was 4.9 years (S.D. = 2.2). Irritability, temper tantrums, verbal rages, and physical aggression toward family members were the most common presenting complaints. Conclusions: Diagnostic consensus could not be reached for almost one fourth of cases. Most common reasons for lack of consensus were problems in clarification of moods of patients in between episodes, problems in differentiation of normality and pathology (i.e., symptoms mainly reported in one setting vs. pervasiveness), and inability to fulfill frequency criterion for tantrums.
    Journal of child and adolescent psychopharmacology 10/2015; DOI:10.1089/cap.2015.0004 · 2.93 Impact Factor
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    • "Mood-stabilizing and antipsychotic medications have been used for pediatric BP (Delbello, Schwiers, Rosenberg, & Strakowski, 2002; Findling et al., 2009; Tohen et al., 2007) and increasingly are used off-label to treat irritability and aggression. It has been proposed that the lack of evidencebased interventions for SMD has contributed to the high rates of polypharmacy in children, especially among those with ADHD (Comer et al., 2010; Olfson, Crystal, Huang, & Gerhard, 2010; Parens et al., 2010). There has been little systematic research documenting their effectiveness in youth with SMD who do not have a formal mood disorder (IMS Health, 2011). "
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    ABSTRACT: Objective: No psychosocial treatments have been developed for children with ADHD and severe mood dysregulation (SMD) despite the significant prevalence and morbidity of this combination. Therefore, the authors developed a novel treatment program for children with ADHD and SMD. Method: The novel therapy program integrates components of cognitive-behavioral therapies for affect regulation with a parent-training intervention for managing recurrent defiant behaviors. It consists of nine 105-min child and parent groups run in unison. A pilot trial was conducted with seven participants with ADHD and SMD ages 7 to 12 who were on a stable stimulant regimen. Results: Six of the seven (86%) families completed the program. Participants showed large improvements in depressive symptoms, mood lability, and global functioning. Milder improvements in externalizing behaviors were observed. Conclusion: Results suggest the feasibility and potential efficacy of the therapy program for children with ADHD and SMD and warrant a larger controlled trial. (J. of Att. Dis. 2012; XX(X) 1-XX).
    Journal of Attention Disorders 02/2012; 17(6). DOI:10.1177/1087054711433423 · 3.78 Impact Factor
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    • "The changes in the definition of PBD have raised substantial debate [4]. The current DSM-V task group is attempting to address the surge in diagnoses of PBD with the introduction of a new category, Temper Dysregulation Disorder with Dysphoria, which is also controversial [5]. "
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    ABSTRACT: Eleven previous reports have shown potential benefit of a 36-ingredient micronutrient formula (known as EMPowerplus) for the treatment of psychiatric symptoms. The current study asked whether children (7-18 years) with pediatric bipolar disorder (PBD) benefited from this same micronutrient formula; the impact of Attention-Deficit/Hyperactivity Disorder (ADHD) on their response was also evaluated. Data were available from an existing database for 120 children whose parents reported a diagnosis of PBD; 79% were taking psychiatric medications that are used to treat mood disorders; 24% were also reported as ADHD. Using Last Observation Carried Forward (LOCF), data were analyzed from 3 to 6 months of micronutrient use. At LOCF, mean symptom severity of bipolar symptoms was 46% lower than baseline (effect size (ES) = 0.78) (p < 0.001). In terms of responder status, 46% experienced >50% improvement at LOCF, with 38% still taking psychiatric medication (52% drop from baseline) but at much lower levels (74% reduction in number of medications being used from baseline). The results were similar for those with both ADHD and PBD: a 43% decline in PBD symptoms (ES = 0.72) and 40% in ADHD symptoms (ES = 0.62). An alternative sample of children with just ADHD symptoms (n = 41) showed a 47% reduction in symptoms from baseline to LOCF (ES = 1.04). The duration of reductions in symptom severity suggests that benefits were not attributable to placebo/expectancy effects. Similar findings were found for younger and older children and for both sexes. The data are limited by the open label nature of the study, the lack of a control group, and the inherent self-selection bias. While these data cannot establish efficacy, the results are consistent with a growing body of research suggesting that micronutrients appear to have therapeutic benefit for children with PBD with or without ADHD in the absence of significant side effects and may allow for a reduction in psychiatric medications while improving symptoms. The consistent reporting of positive changes across multiple sites and countries are substantial enough to warrant a call for randomized clinical trials using micronutrients.
    BMC Psychiatry 09/2010; 10(1):74. DOI:10.1186/1471-244X-10-74 · 2.21 Impact Factor
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