An Open-Label Trial of Risperidone in Children and Adolescents with Severe Mood Dysregulation

Krieger, Fernanda Valle; Pheula, Gabriel Ferreira; Coelho, Roberta Paula Schell; Zeni, Thamis; Tramontina, Silzá; Zeni, Cristian Patrick; Rohde, Luis Augusto

doi:10.1089/cap.2010.0123

Cited by 52 publications

(21 citation statements)

References 45 publications

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“…A small study of lithium (n=14) vs. placebo (n=11) was ineffective for treatment of SMD 47 , while a small (n=21) open-label trial showed that risperidone reduced irritability in SMD 48 . The diagnostic stability of DMDD is not known in youth at risk for BD, and optimal treatment approaches may differ in this population.…”

Section: Discussionmentioning

confidence: 99%

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

Sparks

Axelson

et al. 2014

Journal of the American Academy of Child & Adolescent Psych

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Objective Disruptive mood dysregulation disorder (DMDD) is a new diagnosis in the DSM-5. Youth with a family history of BD are at increased risk for BD and non-bipolar psychopathology. No studies to date have examined rates of DMDD among offspring of parents with BD. This study examines the risk for DMDD in offspring of parents with BD compared to community controls and considers rates of chronic irritability (independent of a DMDD diagnosis) across diagnoses in youth with parents with BD. Method Modified DMDD criteria were applied post hoc to 375 offspring of parents with BD and 241 offspring of community control parents aged 6–17. We calculated odds ratios using generalized linear mixed models. Additionally, we explored associations with a severe chronic irritability phenotype and various diagnoses in the high risk cohort. Results Offspring of parents with BD were more likely to meet criteria for DMDD than the offspring of community control parents (OR=8.3, 6.7% vs 0.8%), even when controlling for demographic variables and comorbid parental diagnoses (OR 5.4). They also had higher rates of chronic irritability compared to community controls (12.5% vs. 2.5%, χ 2=18.8, p<0.005). Within the offspring of parents with BD, the chronic irritability phenotype was frequently present in offspring with diagnoses of BD, depression, ADHD, and DBD. Conclusions Like other non-BD diagnoses, family history of BD increases the risk for DMDD. Severe chronic irritability and temper tantrums are the core features of DMDD and are associated with mood and behavioral disorders in youth at risk for BD.

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Section: Discussionmentioning

confidence: 99%

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

Sparks

Axelson

et al. 2014

Journal of the American Academy of Child & Adolescent Psych

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“…49 An open label trial using low doses (mean 1.2±0.5 mg) of risperidone in children and adolescents with SMD showed significant reductions in irritability scores (Aberrant Behavior Checklist-Irritability at baseline 25.89, standard error [SE] 2.7, and at week 8 11.28, SE 3.06, p < 0.001). 50 Risperidone was also effective in reducing duration of rage outbursts in inpatient settings (baseline 44±20 min, last dose 25±12 min). 51 Indeed, risperidone is FDA approved for the treatment of irritability in patients with autism spectrum disorders, although irritability in autism may not be the same as the one found in typically developing children.…”

Section: Therapeutic Strategies For Chronic Irritabilitymentioning

confidence: 96%

Irritability in children and adolescents: past concepts, current debates, and future opportunities

Krieger

Leibenluft²,

Stringaris

et al. 2013

Rev. Bras. Psiquiatr.

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Irritability is defined as a low threshold to experience anger in response to frustration. It is one of the most common symptoms in youth and is part of the clinical presentation of several disorders. Irritability can present early in life and is a predictor of long-term psychopathology; yet, the diagnostic status of irritability is a matter of intense debate. In the present article, we address two main components of the debate regarding irritability in youth: the misdiagnosis of chronic irritability as pediatric bipolar disorder, and the proposal of a new diagnosis in the DSM-5, disruptive mood dysregulation disorder, whose defining symptoms are chronic irritability and temper outbursts.

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“…However, we are only beginning to systematically evaluate the efficacy of this practice. An open-label trial of risperidone (mean dose = 1.28 mg) in youth with SMD showed significant reduction in irritability scores 70. In a randomized, controlled trial, augmenting psychostimulant and parent training with risperidone versus placebo in children with ADHD and severe aggression led to moderate but variable improvement in aggressive behaviors over 9 weeks.…”

Section: Treatmentmentioning

confidence: 99%

Disruptive mood dysregulation disorder: current insights

Baweja¹,

Mayes²,

Hameed³

et al. 2016

NDT

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Disruptive mood dysregulation disorder (DMDD) was introduced as a new diagnostic entity under the category of depressive disorders in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). It was included in DSM-5 primarily to address concerns about the misdiagnosis and consequent overtreatment of bipolar disorder in children and adolescents. DMDD does provide a home for a large percentage of referred children with severe persistent irritability that did not fit well into any DSM, Fourth Edition (DSM-IV) diagnostic category. However, it has been a controversial addition to the DSM-5 due to lack of published validity studies, leading to questions about its validity as a distinct disorder. In this article, the authors discuss the diagnostic criteria, assessment, epidemiology, criticism of the diagnosis, and pathophysiology, as well as treatment and future directions for DMDD. They also review the literature on severe mood dysregulation, as described by the National Institute of Mental Health, as the scientific support for DMDD is based primarily on studies of severe mood dysregulation.

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An Open-Label Trial of Risperidone in Children and Adolescents with Severe Mood Dysregulation

Abstract: Risperidone was effective in reducing irritability in SMD youth. To the best of our knowledge, this is the first psychopharmacological trial in this group of patients with positive results. Further randomized, controlled studies are needed.

Cited by 52 publications

References 45 publications

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

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

Irritability in children and adolescents: past concepts, current debates, and future opportunities

Disruptive mood dysregulation disorder: current insights

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