Neural Correlates of Irritability in Disruptive Mood Dysregulation and Bipolar Disorders

Wiggins, Jillian Lee; Brotman, Melissa A.; Adleman, Nancy E.; Kim, Pilyoung; Oakes, Allison H.; Reynolds, Richard C.; Chen, Gang; Pine, Daniel S.; Leibenluft, Ellen

doi:10.1176/appi.ajp.2015.15060833

Cited by 109 publications

(109 citation statements)

References 26 publications

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“…The NIMH research group and others have used versions of the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Aged Children or similar interviews to diagnose DMDD 19,29,31,32. None of these interviews have been adapted for widespread clinical use and their administration time is a potential barrier for use in busy clinical services.…”

Section: Assessment Methods For Dmddmentioning

confidence: 99%

“…In the ventral visual stream, associations between neural activity and irritability were found more consistently in the DMDD group than in the bipolar disorder group, especially in response to ambiguous angry faces. Authors suggested diagnostic specificity in the neural correlates of irritability and the need to evaluate different approaches to treat irritability in the two disorders 32. Differences in functional connectivity between the left basolateral amygdala, the frontal lobes, and the cingulate have also been reported between SMD and bipolar disorder, with hyperconnectivity seen only in youth with bipolar disorder 56.…”

Section: Pathophysiologymentioning

confidence: 99%

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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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Section: Assessment Methods For Dmddmentioning

confidence: 99%

Section: Pathophysiologymentioning

confidence: 99%

Disruptive mood dysregulation disorder: current insights

Baweja¹,

Mayes²,

Hameed³

et al. 2016

NDT

View full text Add to dashboard Cite

show abstract

“…They also judge neutral faces as more hostile than do healthy youth, whether the stimulus duration is brief (i.e., 200 ms) [29] or not (i.e., 4000 ms) [30]. Irritable youth show amygdala, ventral visual stream, and association cortex dysfunction during explicit face processing [30–32], although the nature of the amygdala dysfunction (hypo- vs. hyperactivation) varies across tasks.…”

Section: Social Information Processing In Irritable Youthmentioning

confidence: 99%

Pediatric Irritability: A Systems Neuroscience Approach

Leibenluft

2017

Trends in Cognitive Sciences

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148

129

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Irritability, defined as an increased propensity to exhibit increased anger relative to one’s peers, is a common clinical problem in youth. Irritability can be conceptualized as aberrant responses to frustration (where frustration is the emotional response to blocked goal attainment) and/or aberrant “approach” responses to threat. Irritable youth show hyper-reactivity to threat mediated by dysfunction in amygdala, medial prefrontal cortex, ACC, insula, striatum, and association cortex. Irritable youth also show abnormalities in reward learning, cognitive control, and responses to frustration. These abnormalities are mediated by circuitry that includes the inferior frontal gyrus, striatum, anterior cingulate and parietal cortices. Effective treatments for irritability are lacking; pathophysiological research can lead to more precisely targeted interventions.

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“…More specifically, many of these children were being diagnosed with Bipolar Disorder despite the chronic, versus episodic, nature of their symptoms and evidence for distinct pathophysiology. (Brotman et al, 2010; Wiggins et al, 2016; Adleman et al, 2011; Thomas et al, 2012; Deveney et al, 2012) The challenge is that these symptoms are observed across multiple mood and disruptive behavior disorders (Barlow, 1991); the establishment of DMDD aimed to address this issue. However, researchers have questioned the validity of DMDD as a distinct diagnosis (Stringaris, 2011; Axelson et al, 2012; Roy, Lopes, & Klein, 2014; Lochman et al, 2015).…”

mentioning

confidence: 99%

“…Studies of other disorders (i.e., mood and anxiety disorders) were considered only if they included findings specifically related to symptoms of chronic irritability and temper outbursts. We do not include studies that focus exclusively on pediatric BD since the pathophysiology is believed to be distinct from that of DMDD as indicated above (Brotman et al, 2010; Adleman et al, 2011; Thomas et al, 2012; Deveney et al, 2012; Wiggins et al, 2016). Second, behavioral and neuroimaging protocols are typically complex and may involve multiple RDoC constructs.…”

mentioning

confidence: 99%

Disruptive Mood Dysregulation Disorder (DMDD): An RDoC perspective

Meyers

DeSerisy

Roy

2017

Journal of Affective Disorders

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In recent years, there has been much debate regarding the most appropriate diagnostic classification of children exhibiting emotion dysregulation in the form of irritability and severe temper outbursts. Most recently, this has resulted in the addition of a new diagnosis, Disruptive Mood Dysregulation Disorder (DMDD) in the DSM 5. The impetus for including this new disorder was to reduce the number of diagnoses that these children would typically receive; however, there is concern that it has only complicated matters rather than simplifying them. For example, a recent epidemiologic study shows that DMDD cannot be differentiated from oppositional defiant disorder (ODD) based on symptoms alone. Thus, these children are an ideal population in which to apply RDoC constructs in order to obtain greater clarity in terms of underlying processes and ultimately, inform nosology and appropriate interventions. The aim of this article is to provide a foundation for future research by examining extant theoretical and empirical evidence for the role of four key RDoC constructs in DMDD.

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Neural Correlates of Irritability in Disruptive Mood Dysregulation and Bipolar Disorders

Abstract: These results suggest diagnostic specificity in the neural correlates of irritability, a symptom of both DMDD and bipolar disorder. Such evidence of distinct neural correlates suggests the need to evaluate different approaches to treating irritability in the two disorders.

Cited by 109 publications

References 26 publications

Disruptive mood dysregulation disorder: current insights

Disruptive mood dysregulation disorder: current insights

Pediatric Irritability: A Systems Neuroscience Approach

Disruptive Mood Dysregulation Disorder (DMDD): An RDoC perspective

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