Mood regulation in youth

Abstract

Purpose of review-Mood regulation problems, such as severe chronic irritability or short episodes of mania like symptoms are common, impairing and a topic of intense recent interest to clinicians, researchers and the DSM-5 process. Here we review the most recent findings about these two presentations and discuss approaches to their treatment.Recent findings-Longitudinal and genetic findings suggest that chronic irritability should be regarded as a mood problem that is distinct from bipolar disorder.A proportion of children with short (less than 4 days) episodes of mania like symptoms seem to progress to classical (Type I or II) bipolar disorder over time in US clinic samples. In a UK sample, such episodes were independently associated with psychosocial impairment.The evidence base for the treatment of either irritability or short-lived episodes to mania-like symptoms is still small. Clinicians should be cautious with extrapolating treatments from classical bipolar disorder to these mood regulation problems. CBT-based approaches targeting general mood regulation processes may be effective for cases with severe irritability or short episodes of mania like symptoms.Summary-There is increasing research evidence for the importance of mood regulation problems in the form of either irritability or short episodes of mania like symptoms in youth. The evidence base for their drug treatment has yet to be developed. CBT-based interventions to modify processes of mood regulation may be a useful and safe intervention for patients with these presentations.

Manic Symptoms in Youth: Dimensions, Latent Classes, and Associations With Parental Psychopathology

“…1,2 The lack of a clear definition of BD in youth may be partially responsible for the sharp rise in the rate at which pediatric BD is being diagnosed in the United States. 3 Over-diagnosis of BD in youth is a concern; so too is underdiagnosis.…”

A Prospective Study of Rumination and Irritability in Youth

“…For example, adolescents may be given psychoeducation about the unhelpful effects of angry rumination as an emotion regulation strategy, and encouraged to look out for warning signs and triggers for when it occurs. They may be trained to use more adaptive coping strategies, such as mindfulness (Wright et al 2009 ), directed imagery, and active problem-solving (Watkins 2015 ) that they can then engage in as an alternative to rumination (Leigh et al 2012 ).…”

The “ins” and “outs” of the depressive disorders section of DSM‐5.

“…Given that these symptoms can be indicative of any of a number of psychiatric illnesses-including depression, anxiety, bipolar disorder, and oppositional defiant disorder-accurate diagnosis has been difficult. Indeed, there is increasing concern that children and adolescents are frequently misdiagnosed as having bipolar disorder (Leibenluft, 2011;Leigh, Smith, Malavic, & Stringaris, 2012) and, consequently, that they are being overtreated with potent medications, such as mood stabilizers and antipsychotics, that may have harmful and long-term side effects (Wakefield, 2012). More recently, however, researchers have posited that this heightened degree of persistent irritability and extreme anger reflects a unique disorder that is distinguishable from the less severe symptoms of irritability that are common to many disorders.…”