ABSTRACT
Objectives:
Severe and chronic irritability, which causes impaired functionality, often leads children and adolescents to apply to psychiatry clinics. Irritability is associated with many childhood psychiatric disorders; however, it is particularly one of the diagnostic criteria of disruptive mood dysregulation disorder (DMDD). The aim of this review is to evaluate the studies which provide the developmental mechanisms of irritability in DMDD and which show the differences of irritability in different psychiatric disorders.
Materials and Methods:
“Disruptive Mood Dysregulation Disorder” and “irritability” key words were used to determine relevant studies for review and total of 59 articles in Turkish and English language were included.
Results:
Studies showed that the irritability characteristics of children with DMDD were different from those with other psychiatric disorders and it has been shown that children perceive neutral facial expressions even as threatening.
Conclusion:
It is essential to determine whether irritability is chronic or not while assessing irritability. Explaining the characteristics of irritability specific to a case is important for diagnosis and treatment.
References
1American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (5th ed). Washington, DC; American Psychiatric Association, 2013.
2Leibenluft E, Charney DS, Towbin KE, Bhangoo RK, Pine DS. Defining clinical phenotypes of juvenile mania. Am J Psychiatry. 2003;160:430-437.
3McGough JJ. Chronic non-episodic irritability in childhood: Current and future challenges. Am J Psychiatry. 2014;171:607-610.
4Ochsner KN. The social-emotional processing stream: five core constructs and their translational potential for schizophrenia and beyond. Biol Psychiatry. 2012;64:48-61.
5Stringaris A, Zavos H, Leibenluft E, Maughan B, Eley TC. Adolescent irritability: phenotypic associations and genetic links with depressed mood. Am J Psychiatry. 2012;169:47-54.
6Coccaro EF, Bergeman CS, Kavoussi RJ, Seroczynski AD. Heritability of aggression and ırritability: a twin study of the Buss-Durkee aggression scales in adult male subjects. Biol Psychiatry. 1997;41:273-284.
7Berkowitz L. Aggression: its causes, consequences, and control. McGraw-Hill Book Company, New York; 1993.
8Caprara GV, Cinanni V, D’Imperio G, Passerini S, Renzi P, Travaglia G. Indicators of impulsive aggression: present status of research on irritability and emotional susceptibility scales. Pers Individ Dif. 1985;6:665-674.
9Krieger FV, Leibenluft E, Stringaris A, Polanczyk GV. Irritability in children and adolescents: Past concepts, current debates, and future opportunities. Braz Psychiatry. 2013;35(Suppl 1):32-39.
10Brotman MA, Kassem L, Reising MM, Guyer AE, Dickstein DP, Rich BA, Towbin KE, Pine DS, McMahon FJ, Leibenluft E. Parental diagnosis in youth with narrow phenotype bipolar disorder or severe mood dysregulation. Am J Psychiatry. 2007;164:1238-1241
11Stringaris A, Goodman R. Longitudinal outcome of youth oppositionality: Irritable, headstrong, and hurtful behaviors have distinctive predictions. J Am Acad Child Adolesc Psychiatry. 2009;48:404-412.
12Stringaris A, Goodman R. Three dimensions of oppositionality in youth. J Child Psychol Psychiatry. 2009;50:216-223.
13Vidal-Ribas P, Brotman MA, Valdivieso I, Leibenluft E, Stringaris A. The status of irritability in psychiatry: A conceptual and quantitative review. J Am Acad Child Adolesc Psychiatry. 2016;55:556-570.
14Copeland WE, Shanahan L, Egger H, Angold A, Costello EJ. Adult diagnostic and functional outcomes of DSM-5 disruptive mood dysregulation disorder. Am J Psychiatry. 2014;171:668-674.
15Stringaris A, Cohen P, Pine DS, Leibenluft E. Adult outcomes of youth irritability: A 20-year prospective community-based study. Am J Psychiatry. 2009;166:1048-1054.
16Stringaris A, Taylor E. Disruptive mood. Irritability in children and adolescents. New York; Oxford University Press, 2015.
17Correll CU, Blader JC. Antipsychotic use in youth without psychosis: A double-edged sword. JAMA Psychiatry. 2015;72:859-860.
18Brotman MA, Kircanski K, Stringaris A, Pine DS, Leibenluft E. Irritability in youths: A translational model. Am J Psychiatry. 2017;174:520-532.
19Deveney CM, Connolly ME, Haring CT, Bones BL, Reynolds RC, Kim P, Pine DS, Leibenluft E. Neural mechanisms of frustration in chronically irritable children. Am J Psychiatry. 2013;170:1186-1194.
20Perlman SB, Jones BM, Wakschlag LS, Axelson D, Birmaher B, Phillips ML. Neural substrates of child irritability in typically developing and psychiatric populations. Dev Cogn Neurosci. 2015;14:71-80.
21Fanselow MS. Neural organization of the defensive behavior system responsible for fear. Psychon Bull Rev. 1994;1:429-438.
22LeDoux JE, Pine DS. Using neuroscience to help understand fear and anxiety: A two-system framework. Am J Psychiatry. 2016;173:1083-1093.
23Hommer RE, Meyer A, Stoddard J, Connolly ME, Mogg K, Bradley BP, Pine DS, Leibenluft E, Brotman MA. Attention bias to threat faces in severe mood dysregulation. Depress Anxiety. 2014;31:559-565.
24Salum GA, Mogg K, Bradley BP, Stringaris A, Gadelha A, Pan PM, Rohde LA, Polanczyk GV, Manfro GG, Pine DS, Leibenluft E. Association between irritability and bias in attention orienting to threat in children and adolescents. J Child Psychol Psychiatry. 2017;58:595-602.
25Brotman MA, Rich BA, Guyer AE, Lunsford JR, Horsey SE, Reising MM, Thomas LA, Fromm SJ, Towbin K, Pine DS, Leibenluft E. Amygdala activation during emotion processing of neutral faces in children with severe mood dysregulation versus ADHD or bipolar disorder. Am J Psychiatry. 2010;167:61-69.
26Stoddard J, Sharif-Askary B, Harkins EA, Frank HR, Brotman MA, Penton-Voak IS, Maoz K, Bar-Haim Y, Munafò M, Pine DS, Leibenluft E. An open pilot study of training hostile interpretation bias to treat disruptive mood dysregulation disorder. J Child Adolesc Psychopharmacol. 2016;26:49-57.
27Thomas LA, Brotman MA, Muhrer EJ, Rosen BH, Bones BL, Reynolds RC, Deveney CM, Pine DS, Leibenluft E. Parametric modulation of neural activity by emotion in youth with bipolar disorder, youth with severe mood dysregulation, and healthy volunteers. Arch Gen Psychiatry. 2012;69:1257-1266.
28Leibenluft E. Severe mood dysregulation, irritability, and the diagnostic boundaries of bipolar disorder in youths. Am J Psychiatry. 2011;168:129-42.
29Axelson D, Findling RL, Fristad MA, Kowatch RA, Youngstrom EA, Horwitz SM, Arnold LE, Frazier TW, Ryan N, Demeter C, Gill MK, Hauser-Harrington JC, Depew J, Kennedy SM, Gron BA, Rowles BM, Birmaher B. Examining the proposed disruptive mood dysregulation disorder diagnosis in children in the Longitudinal Assessment of Manic Symptoms studyy. J Clin Psychiatry. 2012;73:1342-1350.
30Regier DA, Narrow WE, Clarke DE, Kraemer HC, Kuramoto SJ, Kuhl EA, Kupfer DJ. DSM-5 field trials in the United States and Canada, Part II: test-retest reliability of selected categorical diagnoses. Am J Psychiatry. 2013;170:59-70.
31Mayes SD, Mathiowetz C, Kokotovich C, Waxmonsky J, Baweja R, Calhoun SL, Bixler EO. Stability of disruptive mood dysregulation disorder symptoms (irritable-angry mood and temper outbursts) throughout childhood and adolescence in a general population sample. J Abnorm Child Psychol. 2015;43:1543-1549.
32Rich BA, Carver FW, Holroyd T, Rosen HR, Mendoza JK, Cornwell BR, Fox NA, Pine DS, Coppola R, Leibenluft E. Different neural pathways to negative affect in youth with pediatric bipolar disorder and severe mood dysregulation. J Psychiatr Res. 2011;45:1283-1294.
33Dougherty LR, Smith VC, Bufferd SJ, Carlson GA, Stringaris A, Leibenluft E, Klein DN. DSM-5 disruptive mood dysregulation disorder: correlates and predictors in young children. Psychol Med. 2014;44:2339-2350.
34Leibenluft E, Stoddard J. The developmental psychopathology of irritability. Dev Psychopathol. 2013;25:1473-1487.
35Guyer AE, McClure EB, Adler AD, Brotman MA, Rich BA, Kimes AS, Pine DS, Ernst M, Leibenluft E. Specificity of facial expres-sion labeling deficits in childhood psychopathology. J Child Psychol Psychiatry. 2007;48:863-871.
36Baweja R, Mayes SD, Hameed U, Waxmonsky JG. Disruptive mood dysregulation disorder: current insights. Neuropsychiatr Dis Treat. 2016;12:2115-2124.
37Kessel EM, Doughtery LR, Kujawa A, Hajcak G, Carlson GA, Klein DN. Longitudinal associations between preschool disruptive mood dysregulation disorder symptoms and neural reactivity to monetary reward during preadolescence. J Child Adolesc Psychopharmacol 2016;26:131-137.
38Martin SE, Hunt JI, Mernick LR, DeMarco M, Hunter HL, Coutinho MT, Boekamp JR. Temper Loss and Persistent Irritability in Preschoolers: Implications for Diagnosing Disruptive Mood Dysregulation Disorder in Early Childhood. Child Psychiatry Hum Dev. 2017;48:498-508.
39Rich BA, Grimley ME, Schmajuk M, Blair KS, Blair RJ, Leibenluft E. Face emotion labeling deficits in children with bipolar disorder and severe mood dysregulation. Dev Psychopathol. 2008;20: 529-546.
40Rich BA, Schmajuk M, Perez-Edgar KE, Fox NA, Pine DS, Leibenluft E. Different psychophysiological and behavioral responses elicited by frustration in pediatric bipolar disorder and severe mood dysregulation. Am J Psychiatry. 2007;164:309-317.
41Waxmonsky JG, Waschbusch DA, Belin P, Li T, Babocsai L, Humphery H, Pariseau ME, Babinski DE, Hoffman MT, Haak JL, Mazzant JR, Fabiano GA, Pettit JW, Fallahazad N, Pelham WE. A randomized clinical trial of an integrative group therapy for children with severe mood dysregulation. J Am Acad Child Adolesc Psychiatry. 2016;55:196-207.
42Stoddard J, Hsu D, Reynolds RC, Brotman MA, Ernst M, Pine DS, Leibenluft E, Dickstein DP. Aberrant amygdala intrinsic functional connectivity distinguishes youths with bipolar disorder from those with severe mood dysregulation. Psychiatry Res. 2015;231:120-125.
