Systematic review and meta-analysis: Pharmacological and nonpharmacological interventions for disruptive mood dysregulation disorder

Abstract

Background Disruptive mood dysregulation disorder (DMDD) is a relatively new diagnostic approach that focuses on describing severe, non-episodic irritability and recurrent outbursts of emotional instability in adolescents. Methods This meta-analysis examined the efficacy of the available pharmacological and nonpharmacological interventions for DMDD. Literature searches were conducted in July 2023. To determine relevant papers, 330 abstracts were reviewed, and 39 articles were identified for full review. A random-effects model was used for the meta-analysis, and a subgroup analysis was used to assess the effects of study design and intervention type. Eleven studies were included (six pharmacological and five nonpharmacological). Results Despite high heterogeneity in effects (I²=85%), we showed statistically significant improvement to irritability symptoms following intervention (standardized mean difference = 0.78, 95% confidence interval = 0.21–1.36, Z = 2.68, P༜0.05). The subgroup analysis showed that, compared with randomized controlled trials (RCTs), participants in open trials showed significant improvement in irritability. Additionally, drug intervention significantly improved irritability compared to non-drug interventions. Atomoxetine, optimized stimulants, or stimulants combined with other drugs and behavioral therapy effectively improved irritability. However, large-sample RCTs are needed to explore DMDD treatment without potential influencing factors. Conclusion In conclusion, treatment strategies for persistent non-periodic irritability in youths with DMDD are diverse, and because of DMDD symptoms and its intersection with other diseases, it is necessary to combine multiple treatment strategies.