Improvements in Irritability with Open-Label Methylphenidate Treatment in Youth with Comorbid Attention Deficit/Hyperactivity Disorder and Disruptive Mood Dysregulation Disorder

Winters, Drew E.; Fukui, Sadaaki; Leibenluft, Ellen; Hulvershorn, Leslie A.

doi:10.1089/cap.2017.0124

Cited by 38 publications

(27 citation statements)

References 58 publications

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“…The following terms are prominent in the literature: Irritability refers to a heightened propensity or vulnerability to feeling angry, and has been defined as an emotional state in which an individual is “easily annoyed and provoked to anger” (Safer 2009; American Psychiatric Association 2013). It is the main characteristic of the newly developed diagnosis category, DMDD, but is present in several other disorders (American Psychiatric Association 2013; Winters et al 2018). Like irritability, the term anger refers to an emotion.…”

Section: Aggression and Aggression-related Emotional Constructsmentioning

confidence: 99%

“…Although aggression was historically recognized as a way of expressing depressed mood, our understanding of mood disorders has expanded to view aggression as a co-occurring feature of the primary mood disorder. Irritability has long been seen as a symptom of depressive episodes, including the diagnosis of DMDD (Winters et al 2018). However, aggressive behaviors—such as temper tantrums, destruction of property, and assaultive behavior—have also been observed in mixed and manic states in children with bipolar disorder (Weisbrot and Ettinger 2002; Connor et al 2017).…”

Section: Clinical Diagnoses Associated With Iamentioning

confidence: 99%

“…Since the last comprehensive child psychiatry reviews of aggression were published, there have been several new developments in the field (Connor et al 2006; Jensen et al 2007). First, within child psychiatry literature, discussion of aggression has largely been supplanted by research on irritability (Pagliaccio et al 2018; Winters et al 2018) and classified as DMDD in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (American Psychiatric Association 2013). Next, IA has been identified as a treatable indication and an unmet pharmacotherapy need (Robb et al 2019).…”

Section: Introductionmentioning

confidence: 99%

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Maladaptive Aggression: With a Focus on Impulsive Aggression in Children and Adolescents

Connor

Newcorn

Saylor³

et al. 2019

Journal of Child and Adolescent Psychopharmacology

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Objective: Aggressive behavior is among the most common reasons for referral to psychiatric clinics and confers significant burden on individuals. Aggression remains poorly defined; there is currently no consensus on the best ways to recognize, diagnose, and treat aggression in clinical settings. In this review, we synthesize the available literature on aggression in children and adolescents and propose the concept of impulsive aggression (IA) as an important construct associated with diverse and enduring psychopathology. Methods: Articles were identified and screened from online repositories, including PubMed, PsychInfo, the Cochrane Database, EMBase, and relevant book chapters, using combinations of search terms such as ''aggression,'' ''aggressive behavio(u)r,'' ''maladaptive aggression,'' ''juvenile,'' and ''developmental trajectory.'' These were evaluated for quality of research before being incorporated into the article. The final report references 142 sources, published from 1987 to 2019. Results: Aggression can be either adaptive or maladaptive in nature, and the latter may require psychosocial and biomedical interventions when it occurs in the context of central nervous system psychopathology. Aggression can be categorized into various subtypes, including reactive/proactive, overt/covert, relational, and IA. IA in psychiatric or neurological disorders is reviewed along with current treatments, and an algorithm for systematic evaluation of aggression in the clinical setting is proposed. Conclusions: IA is a treatable form of maladaptive aggression that is distinct from other aggression subtypes. It occurs across diverse psychiatric and neurological diagnoses and affects a substantial subpopulation. IA can serve as an important construct in clinical practice and has considerable potential to advance research.

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Section: Aggression and Aggression-related Emotional Constructsmentioning

confidence: 99%

Section: Clinical Diagnoses Associated With Iamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Maladaptive Aggression: With a Focus on Impulsive Aggression in Children and Adolescents

Connor

Newcorn

Saylor³

et al. 2019

Journal of Child and Adolescent Psychopharmacology

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“…27 In addition, a recent small open-label trial (N ¼ 22) has demonstrated reductions in irritability with medium to large effect sizes in these children following stimulant monotherapy. 28 Nevertheless, a significant proportion (w50%) of those with aggression and ADHD remain refractory to stimulant medication even when combined with parent training/behavioral treatments. 25,29 Focusing on the related construct of aggression, the Treatment of Severe Childhood Aggression (TOSCA) study group found that add-on risperidone and placebo were no different from each other when combined with parent training plus stimulant medication in children with ADHD 30 ; similar results were obtained for the 12-week follow up of this study.…”

mentioning

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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“…Its effect on irritability is mixed. It improved irritability in 71%, but worsened it in 19%, and caused no change in 10% of the patients 5…”

Section: Introductionmentioning

confidence: 95%

<p>The effect of stimulants on irritability in autism comorbid with ADHD: a systematic review</p>

Ghanizadeh¹,

Molla²,

Olango³

2019

NDT

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Introduction: While there is a very high rate of comorbidity of autism and ADHD, there are controversies about prescribing stimulants in children with autism. This is a systematic review about the effect of stimulants on irritability in children with both autism and ADHD. Methods: A systematic review was conducted to study the possible effect of stimulants on irritability in autism and ADHD using the databases of PubMed, Scopus, EMBASE, and ScienceDirect in September 2018. Eligible clinical trials of stimulants in the treatment of Autism and ADHD without restriction of language were included. The primary outcome was irritability score. The full texts of relevant articles were studied, and their references were scanned for any possible related article. Results: Out of 1,315 citations, there were 26 relevant articles. Of the relevant articles, 16 were not interventional studies and were excluded. There were 10 interventional studies. None of them considered irritability as a main outcome. Also, none of them studied the effect of stimulants on irritability in autism plus ADHD. Current uncontrolled evidence about the association of stimulants with irritability is controversial. Conclusion: The current evidence is not enough to support or discourage the effect of stimulants on irritability in children and adolescents with both autism and ADHD. Well-designed controlled clinical trials need to be conducted for this ignored research area.

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Improvements in Irritability with Open-Label Methylphenidate Treatment in Youth with Comorbid Attention Deficit/Hyperactivity Disorder and Disruptive Mood Dysregulation Disorder

Cited by 38 publications

References 58 publications

Maladaptive Aggression: With a Focus on Impulsive Aggression in Children and Adolescents

Maladaptive Aggression: With a Focus on Impulsive Aggression in Children and Adolescents

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

<p>The effect of stimulants on irritability in autism comorbid with ADHD: a systematic review</p>

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