Evidence-based treatments for youths with severely dysregulated mood: a qualitative systematic review of trials for SMD and DMDD

Benarous, Xavier; Consoli, Angèle; Guilé, Jean-Marc; Rivière, Sébastien; Cohen, Doron; Olliac, Bertrand

doi:10.1007/s00787-016-0907-5

Cited by 32 publications

(17 citation statements)

References 58 publications

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“…7 Yet, there is a paucity of clinical trials for DMDD. 2,8 In this article, we present the results of a randomized controlled trial (RCT) of citalopram (CTP) versus placebo (PBO) as addons to open-label stimulant optimization for the treatment of irritability in severe mood dysregulation (SMD), which became the basis for the DSM-5 DMDD.…”

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confidence: 99%

A Double-Blind Randomized Placebo-Controlled Trial of Citalopram Adjunctive to Stimulant Medication in Youth With Chronic Severe Irritability

Towbin

Vidal‐Ribas

Brotman

et al. 2020

Journal of the American Academy of Child & Adolescent Psych

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Drs. Towbin and Vidal-Ribas contributed equally to this research. Objective: Despite the clinical importance of chronic and severe irritability, there is a paucity of controlled trials for its pharmacological treatment. Here, we examine the effects of adding citalopram (CTP) to methylphenidate (MPH) in the treatment of chronic severe irritability in youth using a double-blind randomized placebo-controlled design. Method: After a lead-in phase of open treatment with stimulant, 53 youth meeting criteria for severe mood dysregulation (SMD) were randomly assigned to receive CTP or placebo (PBO) for 8 weeks. A total of 49 participants, 48 of them (98%) meeting disruptive mood dysregulation disorder (DMDD) criteria, were included in the intent-to-treat analysis. The primary outcome measure was the proportion of response based on improvements of irritability at the week 8 of the trial. Results: At the end of the trial, a significantly higher proportion of response was seen in those participants randomly assigned to CTPþMPH compared to PBOþMPH (35% CTPþMPH versus 6% PBOþMPH; odds ratio ¼ 11.70, 95% CI ¼ 2.00À68.16, p ¼ 0.006). However, there were no differences in functional impairment between groups at the end of the trial. No differences were found in any adverse effect between treatment groups, and no trial participant exhibited hypomanic or manic symptoms. Conclusion: Adjunctive CTP might be efficacious in the treatment of chronic severe irritability in youth resistant to stimulant treatment alone. Clinical trial registration information: A Controlled Trial of Serotonin Reuptake Inhibitors Added to Stimulant Medication in Youth With Severe Mood Dysregulation; https://clinicaltrials.gov; NCT00794040.

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confidence: 99%

A Double-Blind Randomized Placebo-Controlled Trial of Citalopram Adjunctive to Stimulant Medication in Youth With Chronic Severe Irritability

Towbin

Vidal‐Ribas

Brotman

et al. 2020

Journal of the American Academy of Child & Adolescent Psych

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“…Die Wirksamkeit verschiedener Substanzgruppen bei der Behandlung der affektiven Dysregulation wird gerade in Studien überprüft. So untersuchte eine aktuelle Metaanalyse [19]…”

Section: Merkeunclassified

Disruptive Stimmungsdysregulationsstörung

Witt¹,

Fegert²,

Kölch³

2020

Pädiatrie up2date

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“…In another article in the current ECAP, Benarous et al [10] reviewed treatments for youths with severely dysregulated mood. It was found that nearly all the studies were limited by a lack of standardized evidence-based assessment of treatment effects.…”

Section: Research Applicationsmentioning

confidence: 99%

The need for evidence-based intake, progress, and outcomes assessment

Achenbach

2016

Eur Child Adolesc Psychiatry

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standardized data on problems and strengths manifested by the child and parents. Parallel self-report and collateralreport instruments for developmentally appropriate assessment of child and parent functioning can give clinicians a comprehensive picture of areas in which children and parents may need help [3]. To qualify as evidence-based, assessment instruments should be supported by published standardization, reliability, validity, and normative data [4]. Multi-informant dimensional assessment of children and their parentsAssessment instruments that are scored on developmentally normed dimensional scales document the problems and strengths that can then be compared with subsequent reassessments to measure the progress and outcomes of treatment. If clinicians deem it appropriate, they can show parents bar graphs of dimensional scales that are scored from ratings of their child's functioning, their partner's functioning, and their own functioning. Bar graphs of data from multiple informants can help parents understand how views of their child's functioning and of their own functioning may differ. For example, a child's teachers may report more attention problems than reported by the child or parents. On the other hand, a child may report more depression than reported by the child's parents or teachers. One parent may report that the other parent displays much more aggressive behavior than that parent reports. Graphs of normed dimensional scores derived from each informant's reports provide clinicians and parents with concrete pictures of problems for which help may be needed. Graphs also reveal differences between informants' reports that can help parents understand variations in how their child functions in different contexts and in how their child is seen by different informants.Mental health clinicians are under increasing pressure to provide evidence for the effectiveness of their services. Many kinds of treatment are being promoted as "evidence based," with randomized controlled trials (RCTs) serving as gold standards for evidence-based treatments. Despite the importance of RCTs for evaluating treatments, it has been found that therapeutic benefits achieved in RCTs often shrink markedly when the treatments are applied to children in community mental health services [1,2].One possible reason for the shrinkage of benefits is that children seen in community services are not recruited for having the specific problems targeted by particular evidence-based treatments. A second possible reason for shrinkage is that community clinicians are not trained to provide all the relevant evidence-based treatments. And a third possible reason is that parents in community services may not collaborate as effectively as parents participating in RCTs. Whether to treat, what to treat, whom to treat?To benefit from RCT findings, clinicians need to have a clear basis for determining whether particular children need treatment. If treatment is indicated, clinicians also need a clear basis for determining what should be treated and w...

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Evidence-based treatments for youths with severely dysregulated mood: a qualitative systematic review of trials for SMD and DMDD

Cited by 32 publications

References 58 publications

A Double-Blind Randomized Placebo-Controlled Trial of Citalopram Adjunctive to Stimulant Medication in Youth With Chronic Severe Irritability

A Double-Blind Randomized Placebo-Controlled Trial of Citalopram Adjunctive to Stimulant Medication in Youth With Chronic Severe Irritability

Disruptive Stimmungsdysregulationsstörung

The need for evidence-based intake, progress, and outcomes assessment

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