Argyris Stringaris1, Pablo Vidal-Ribas1,2, Melissa A Brotman3, Ellen Leibenluft3. 1. Mood Brain and Development Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA. 2. Institute of Psychiatry, Psychology and Neuroscience, Department of Child and Adolescent Psychiatry, King's College London, London, UK. 3. Section on Mood Dysregulation and Neuroscience, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA.
Abstract
BACKGROUND: Irritability is one of the most common reasons for referral to child and adolescent mental health services and is the main characteristic of the new diagnosis of disruptive mood dysregulation disorder (DMDD). However, the recognition and management of irritability presents a major challenge in clinical practice and may be partly responsible for the dramatic increase in antipsychotic prescribing in recent years. METHODS: In this review, we provide up-to-date information on the definition and mechanisms underlying irritability, and its assessment in clinical practice. We aim to discuss the latest research on DMDD, and the presence of severe irritability in the context of other disorders, as well as to recommend a treatment algorithm. RESULTS: Severe irritability is associated with aberrant reward processing and bias toward threatening stimuli. Several measures are available to easily assess irritability. The recent diagnosis of DMDD captures children whose main problem is severe irritability and differ from those with bipolar disorder in longitudinal outcomes, family history, and behavioral and neural correlates. Treatment of irritability might depend on the context it appears. Indirect evidence suggests that parent management training (PMT) and cognitive behavioral therapy (CBT) are the most supported psychological treatments for irritability. CONCLUSIONS: Irritability, recognized as a mood problem rather than a purely behavioral manifestation, is a common condition for young people. Practitioners should not ignore irritability as it is associated with substantial morbidity and impairment. Although there are no trials with irritability as main outcome, clinicians can apply several existing pharmacological and psychological interventions for its treatment. Also, new promising approaches relying on pathophysiological findings, such as exposure-based cognitive behavioral therapy techniques and interpretation bias training (IBT), are being currently investigated.
BACKGROUND:Irritability is one of the most common reasons for referral to child and adolescent mental health services and is the main characteristic of the new diagnosis of disruptive mood dysregulation disorder (DMDD). However, the recognition and management of irritability presents a major challenge in clinical practice and may be partly responsible for the dramatic increase in antipsychotic prescribing in recent years. METHODS: In this review, we provide up-to-date information on the definition and mechanisms underlying irritability, and its assessment in clinical practice. We aim to discuss the latest research on DMDD, and the presence of severe irritability in the context of other disorders, as well as to recommend a treatment algorithm. RESULTS: Severe irritability is associated with aberrant reward processing and bias toward threatening stimuli. Several measures are available to easily assess irritability. The recent diagnosis of DMDD captures children whose main problem is severe irritability and differ from those with bipolar disorder in longitudinal outcomes, family history, and behavioral and neural correlates. Treatment of irritability might depend on the context it appears. Indirect evidence suggests that parent management training (PMT) and cognitive behavioral therapy (CBT) are the most supported psychological treatments for irritability. CONCLUSIONS:Irritability, recognized as a mood problem rather than a purely behavioral manifestation, is a common condition for young people. Practitioners should not ignore irritability as it is associated with substantial morbidity and impairment. Although there are no trials with irritability as main outcome, clinicians can apply several existing pharmacological and psychological interventions for its treatment. Also, new promising approaches relying on pathophysiological findings, such as exposure-based cognitive behavioral therapy techniques and interpretation bias training (IBT), are being currently investigated.
Authors: Jennifer B Dwyer; Argyris Stringaris; David A Brent; Michael H Bloch Journal: J Child Psychol Psychiatry Date: 2020-02-04 Impact factor: 8.982
Authors: Katharina Kircanski; Michelle G Craske; Bruno B Averbeck; Daniel S Pine; Ellen Leibenluft; Melissa A Brotman Journal: Behav Res Ther Date: 2019-04-22
Authors: Emily L Dennis; Kathryn L Humphreys; Lucy S King; Paul M Thompson; Ian H Gotlib Journal: Soc Cogn Affect Neurosci Date: 2019-07-31 Impact factor: 3.436
Authors: Ashlee A Moore; Dana M Lapato; Melissa A Brotman; Ellen Leibenluft; Steven H Aggen; John M Hettema; Timothy P York; Judy L Silberg; Roxann Roberson-Nay Journal: J Child Psychol Psychiatry Date: 2019-04-17 Impact factor: 8.982
Authors: Wan-Ling Tseng; Christen M Deveney; Joel Stoddard; Katharina Kircanski; Anna E Frackman; Jennifer Y Yi; Derek Hsu; Elizabeth Moroney; Laura Machlin; Laura Donahue; Alexandra Roule; Gretchen Perhamus; Richard C Reynolds; Roxann Roberson-Nay; John M Hettema; Kenneth E Towbin; Argyris Stringaris; Daniel S Pine; Melissa A Brotman; Ellen Leibenluft Journal: Am J Psychiatry Date: 2018-10-19 Impact factor: 18.112
Authors: Lucy Riglin; Olga Eyre; Ajay K Thapar; Argyris Stringaris; Ellen Leibenluft; Daniel S Pine; Kate Tilling; George Davey Smith; Michael C O'Donovan; Anita Thapar Journal: Am J Psychiatry Date: 2019-07-01 Impact factor: 18.112