Disruptive Mood Dysregulation Disorder and Chronic Irritability in Youth at Familial Risk for Bipolar Disorder

Sparks, Garrett; Axelson, David; Yu, Haifeng; Ha, Wonho; Ballester, Javier; Diler, Rasim Somer; Goldstein, Benjamin I.; Goldstein, Tina R.; Hickey, Mary Beth; Ladouceur, Cecile D.; Monk, Kelly; Sakolsky, Dara; Birmaher, Boris

doi:10.1016/j.jaac.2013.12.026

Cited by 51 publications

(45 citation statements)

References 45 publications

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“…It was associated with poorer functioning across multiple domains but many relationships attenuated when adjusting for common comorbidities; however, DMDD was independently associated with some aspects of poorer social functioning and poorer family quality of life even when comorbidities were taken into account. Similar to a number of previous studies [7,[9][10][11], we found a very high co-occurrence between ODD and DMDD (90 %) in this sample of children with ADHD. These findings have raised questions about whether ODD and DMDD are truly independent.…”

Section: Discussionsupporting

confidence: 91%

“…However, research to date has generally disregarded this rule in order to examine the diagnostic overlap between these conditions. ODD is the most common comorbidity in children with DMDD with 57-96 % also meeting criteria for ODD [7,[9][10][11], raising questions about the validity of DMDD as a separate diagnostic category. While most children with DMDD meet criteria for ODD, only 20-40 % of children with ODD meet criteria for DMDD [7].…”

Section: Disruptive Mood Dysregulation Disorder: Definition Prevalenmentioning

confidence: 99%

“…DMDD has been associated with poor parent mental health [9,11], low levels of parental support [8], and high levels of parental hostility [8]. Children with DMDD are reported to be severely impaired, and receive low ratings of social and global functioning [5,7,8].…”

Section: Disruptive Mood Dysregulation Disorder: Definition Prevalenmentioning

confidence: 99%

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Comorbidity and correlates of disruptive mood dysregulation disorder in 6–8-year-old children with ADHD

Mulraney

Schilpzand

Hazell³

et al. 2015

Eur Child Adolesc Psychiatry

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This study aimed to characterize the nature and impact of disruptive mood dysregulation disorder (DMDD) in children with attention-deficit/hyperactivity disorder (ADHD) including its co-occurrence with other comorbidities and its independent influence on daily functioning. Children with ADHD (6-8 years) were recruited through 43 Melbourne schools, using a 2-stage screening (parent and teacher Conners 3 ADHD index) and case-confirmation (Diagnostic Interview Schedule for Children, Version IV; [DISC-IV]) procedure. Proxy DMDD diagnosis was confirmed via items from the oppositional defiant disorder (ODD) and major depressive disorder modules of the DISC-IV. Outcome domains included comorbid mental health disorders, academic functioning, social functioning, child and family quality of life, parent mental health, and parenting behaviors. Unadjusted and adjusted linear and logistic regression were used to compare children with comorbid ADHD and DMDD and children with ADHD without DMDD. Thirty-nine out of 179 children (21.8 %) with ADHD had comorbid DMDD. Children with ADHD and DMDD had a high prevalence of ODD (89.7 %) and any anxiety disorder (41.0 %). Children with ADHD and DMDD had poorer self-control and elevated bullying behaviors than children with ADHD without DMDD. Children with ADHD and DMDD were similar to children with ADHD in the other domains measured when taking into account other comorbidities including ODD. One in five children with ADHD in their second year of formal schooling met criteria for DMDD. There was a very high diagnostic overlap with ODD; however, the use of a proxy DMDD diagnosis containing items from the ODD module of the DISC-IV may have artificially inflated the comorbidity rates. DMDD added to the burden of ADHD particularly in the area of social functioning.

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Section: Discussionsupporting

confidence: 91%

Section: Disruptive Mood Dysregulation Disorder: Definition Prevalenmentioning

confidence: 99%

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Comorbidity and correlates of disruptive mood dysregulation disorder in 6–8-year-old children with ADHD

Mulraney

Schilpzand

Hazell³

et al. 2015

Eur Child Adolesc Psychiatry

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“…Based on retrospective studies of both adults and children, sleep disturbances, anxiety, depressive symptoms, affective lability, subthreshold hypomanic symptoms, behavioral dyscontrol, and irritability have been reported to precede bipolar disorder (3,7–9). Many of these characteristics have also been identified in youth at genetic risk for bipolar disorder (10–18). …”

mentioning

confidence: 99%

Toward the Definition of a Bipolar Prodrome: Dimensional Predictors of Bipolar Spectrum Disorders in At-Risk Youths

Hafeman¹,

Merranko²,

Axelson³

et al. 2016

AJP

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176

199

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Objective We aimed to assess dimensional symptomatic predictors of new-onset bipolar spectrum disorder in youth at familial risk of bipolar disorder (“at-risk” youth). Method Offspring aged 6–18 of parents with bipolar-I/II disorder (n=391) and offspring of community controls (n=248) were recruited without regard to non-bipolar psychopathology. At baseline, 8.4% (33/391) of offspring of bipolar parents had bipolar spectrum; 14.7% (44/299) of offspring with follow-up developed new-onset bipolar spectrum (15 with bipolar-I/II) over eight years. Scales collected at baseline and follow-up were reduced using factor analyses; factors (both at baseline and visit proximal to conversion or last contact) were then assessed as predictors of new-onset bipolar spectrum. Results Relative to community control offspring, at-risk and bipolar offspring had higher baseline levels of anxiety/depression, inattention/disinhibition, externalizing, subsydromal manic, and affective lability symptoms (p<.05). The strongest predictors of new-onset bipolar spectrum were: baseline anxiety/depression, baseline and proximal affective lability, and proximal subsyndromal manic symptoms (p<.05). While affective lability and anxiety/depression were elevated throughout follow-up in those who later developed bipolar spectrum, manic symptoms increased up to the point of conversion. A path analysis supported the hypothesized model that affective lability at baseline predicted new-onset bipolar spectrum, in part, through increased manic symptoms at the visit prior to conversion; earlier parental age of mood disorder onset also significantly increased risk of conversion (p<.001). While youth without anxiety/depression, affective lability, and mania (and with a parent with older age of mood disorder onset) had a 2% predicted chance of conversion to bipolar spectrum, those with all risk factors had a 49% predicted chance of conversion. Conclusions Dimensional measures of anxiety/depression, affective lability, and mania are important predictors of new-onset bipolar spectrum in this population of at-risk youth. These symptoms emerged from among numerous other candidates, underscoring the potential clinical and research utility of these findings.

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“…In fact, as Vidal-Ribas et al note, heritability of irritability overlaps with depression, and there is a significant relation between maternal depression and offspring irritability. Moreover, significantly more offspring of parents with bipolar disorder (BD) had a proxy diagnosis of DMDD than offspring of controls, 12 and DMDD offspring of parents with BD were at higher risk of developing BD than those without DMDD (Axelson et al, unpublished data).…”

mentioning

confidence: 99%

The Risks of Persistent Irritability

Birmaher

2016

Journal of the American Academy of Child & Adolescent Psych

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Disruptive Mood Dysregulation Disorder and Chronic Irritability in Youth at Familial Risk for Bipolar Disorder

Cited by 51 publications

References 45 publications

Comorbidity and correlates of disruptive mood dysregulation disorder in 6–8-year-old children with ADHD

Comorbidity and correlates of disruptive mood dysregulation disorder in 6–8-year-old children with ADHD

Toward the Definition of a Bipolar Prodrome: Dimensional Predictors of Bipolar Spectrum Disorders in At-Risk Youths

The Risks of Persistent Irritability

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