Different Psychophysiological and Behavioral Responses Elicited by Frustration in Pediatric Bipolar Disorder and Severe Mood Dysregulation

Department of Psychology, George Mason University, 페어팩스, Virginia, United States
American Journal of Psychiatry (Impact Factor: 12.3). 03/2007; 164(2):309-17. DOI: 10.1176/appi.ajp.164.2.309
Source: PubMed


Researchers disagree as to whether irritability is a diagnostic indicator for pediatric mania in bipolar disorder. The authors compared the behavioral and psychophysiological correlates of irritability among children with severe mood dysregulation (i.e., nonepisodic irritability and hyperarousal without episodes of euphoric mood) and narrow-phenotype bipolar disorder (i.e., a history of at least one manic or hypomanic episode with euphoric mood) as well as those with no diagnosis (i.e., healthy comparison children).
Subjects with severe mood dysregulation (N=21) or narrow-phenotype bipolar disorder (N=35) and comparison subjects (N=26) completed the affective Posner task, an attentional task that manipulated emotional demands and induced frustration. Mood response, behavior (reaction time and accuracy), and brain activity (event-related potentials) were measured.
The severe mood dysregulation and narrow-phenotype bipolar disorder groups both reported significantly more arousal than comparison subjects during frustration, but behavioral and psychophysiological performance differed between the patient groups. In the frustration condition, children with narrow-phenotype bipolar disorder had lower P3 amplitude than children with severe mood dysregulation or comparison subjects, reflecting impairments in executive attention. Regardless of emotional context, children with severe mood dysregulation had lower N1 event-related potential amplitude than comparison subjects or children with narrow-phenotype bipolar disorder, reflecting impairments in the initial stages of attention. Post hoc analyses demonstrated that the N1 deficit in children with severe mood dysregulation is associated with oppositional defiant disorder symptom severity.
Results indicate that while irritability is an important feature of severe mood dysregulation and narrow-phenotype bipolar disorder, the pathophysiology of irritability may differ among the groups and is influenced by oppositional defiant disorder severity.

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    • "Frustration is widely noted in the individual differences literature (Abler et al., 2005; Campbell, 1995; Rich et al., 2011) and clinical community (Fergus et al., 2003; Leibenluft et al., 2003) as the most commonly observed precipitant for temper outbursts in highly irritable children. Frustration is often induced while collecting neural data though paradigms that increase in difficulty (Lewis et al., 2006; Moadab et al., 2010; Perlman and Pelphrey, 2010) or involve an unsolvable task (Pawliczek et al., 2013), which blocks a desired goal, or deceives participants into believing that failing performance will decrease the likelihood of an expected reward (Deveney et al., 2013; Rich et al., 2007). The fMRI studies cited above have found neural activation changes in the context of frustration induction within three main regions: the anterior cingulate cortex (ACC), amygdala, and striatum, all of which are relevant to cognitive and emotional dysfunction in irritability. "
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    ABSTRACT: Irritability is an aspect of the negative affectivity domain of temperament, but in severe and dysregulated forms is a symptom of a range of psychopathologies. Better understanding of the neural underpinnings of irritability, outside the context of specific disorders, can help to understand normative variation but also characterize its clinical salience in psychopathology diagnosis. This study assessed brain activation during reward and frustration, domains of behavioral deficits in childhood irritability. Children (age 6-9) presenting in mental health clinics for extreme and impairing irritability (n=26) were compared to healthy children (n=28). Using developmentally sensitive methods, neural activation was measured via a negative mood induction paradigm during fMRI scanning. The clinical group displayed more activation of the anterior cingulate and middle frontal gyrus during reward, but less activation during frustration, than healthy comparison children. The opposite pattern was found in the posterior cingulate. Further, in clinical subjects, parent report of irritability was dimensionally related to decreased activation of the anterior cingulate and striatum during frustration. The results of this study indicate neural dysfunction within brain regions related to reward processing, error monitoring, and emotion regulation underlying clinically impairing irritability. Results are discussed in the context of a growing field of neuroimaging research investigating irritable children. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.
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    • "J. Psychophysiol. (2015), reported a context-specific effect of frustration on P3b amplitude during an attention task that was not present in typically developing children, or those with other mood disorders (Rich et al., 2007). Additional studies focusing on externalizing and internalizing symptoms have been conducted with go/no-go paradigms embedded into an affective block design containing blocks of reward and non-reward trials (Lewis et al., 2006; Stieben et al., 2007). "
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    ABSTRACT: Frustration is a normative affective response with adaptive value in motivating behavior. However, excessive anger in response to frustration characterizes multiple forms of externalizing psychopathology. How a given trait subserves both normative and pathological behavioral profiles is not entirely clear. One hypothesis is that the magnitude of response to frustration differentiates normative versus maladaptive reactivity. Disproportionate increases in arousal in response to frustration may exceed normal regulatory capacity, thus precipitating aggressive or antisocial responses. Alternatively, pathology may arise when reactivity to frustration interferes with other cognitive systems, impairing the individual's ability to respond to frustration adaptively. In this paper we examine these two hypotheses in a sample of kindergarten children. First we examine whether children with conduct problems (CP; n = 105) are differentiated from comparison children (n = 135) with regard to magnitude of autonomic reactivity (cardiac and electrodermal) across a task that includes a frustrative non-reward block flanked by two reward blocks. Second we examine whether cognitive processing, as reflected by magnitude of the P3b brain response, is disrupted in the context of frustrative non-reward. Results indicate no differences in skin conductance, but a greater increase in heart rate during the frustration block among children in the CP group. Additionally, the CP group was characterized by a pronounced decrement in P3b amplitude during the frustration condition compared with both reward conditions. No interaction between cardiac and P3b measures was observed, suggesting that each system independently reflects a greater sensitivity to frustration in association with externalizing symptom severity. Copyright © 2015. Published by Elsevier B.V.
    No preview · Article · Apr 2015 · International journal of psychophysiology: official journal of the International Organization of Psychophysiology
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    • "In addition, there are at least mild symptoms (distractibility, intrusiveness) in a second setting 6. The symptoms are due to the direct physiological effects of a drug of abuse, or to a general medical or neurological condition Adapted from Rich et al. (2007). Fig. 1. (A) In the non-aware condition, a face or blank oval was presented for 17 ms, followed by a scrambled face mask for 170 ms and then by the abstract shape. "

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