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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- "Only the PAPA specifically asks about tantrums and measures whether theyare non-destructive (actions against property) or destructive (against people or objects) as well as asking about frequency. The new DSM-5 condition of disruptive mood dysregulation disorder (DMDD), although controversial (Parens et al., 2010) has resulted in an increased focus on both irritability (Leibenluft & Stoddard, 2013;Stringaris et al., 2012b) and the outbursts themselves (). The defining feature of DMDD is frequently occurring verbal or physical outbursts greatly out of proportion to the precipitant, with mood between the outbursts being persistently irritable and angry and noticeable by others. "
ABSTRACT: Background: This study explores the relationship of irritability to tantrums and loss of temper in a community and clinical sample. Methods: The community sample, recruited via commercial mailing lists, consisted of 462 6-year-olds whose parents completed the Child Behavior Checklist (CBCL), and Preschool Age Psychiatric Assessment (PAPA). Tantrums were assessed in the oppositional defiant disorder (ODD) section of the PAPA. Irritability was assessed in the depression section to identify persistently irritable and/or angry mood. The clinic sample, drawn from a child psychiatry clinic, included 229 consecutively referred 6-year-olds from 2005 through 2014 whose parents completed the CBCL and Child and Adolescent Symptom Inventory (CASI). Temper loss and irritability items came from the ODD and depression sections of the CASI, and tantrum description was taken from an irritability inventory. Children's Global Assessment Scale (CGAS) and the CBCL Dysregulation Profile were examined in both samples. Logistic and multiple regression were used to compare rates of diagnosis, CBCL subscales, CGAS, and tantrum quality between children with tantrums only and tantrums with irritability. Results: Almost half (45.9%) of clinic children had severe tantrums; only 23.8% of those were said to be irritable. In the community, 11% of children had tantrums, but 78.4% of those were called irritable. However, irritability in the clinic, although less common, was associated with aggressive tantrums and substantial impairment. In contrast, irritability was associated with only a relatively small increase in impairment in the community sample. Conclusions: Irritability may have different implications in community versus clinic samples, and tantrums assessed in the community may be qualitatively different from those seen in clinics.
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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). "
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.
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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). "
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).