Monday, May 12, 2014

Long-Term Prognosis for Youth With DMDD Is Poor, Study Finds

The long-term outlook for children who have persistent irritability punctuated by frequent temper outbursts—criteria that qualify them for a diagnosis of disruptive mood dysregulation disorder (DMDD)—is characterized by a "bleak prognosis," according to a study published in AJP in Advance. The senior researcher was E. Jane Costello, Ph.D., a professor of psychiatry and behavioral sciences at Duke University.

The study included 1,420 children who were followed into young adulthood. Researchers found that 4 percent of them had had DMDD as youngsters (the diagnosis has been incorporated into DSM-5, published last year). The DMDD group was significantly more likely as young adults to be anxious and depressed and to have multiple health problems, as well as low educational attainment, impoverishment, social isolation, and police contact, than were subjects who as children had had no psychiatric disorders or had psychiatric disorders other than DMDD.

"I think this is a very interesting study," Ellen Leibenluft, M.D., chief of the Section on Bipolar Spectrum Disorders of the National Institute of Mental Health and an expert on DMDD, told Psychiatric News. "The fact that children with DMDD are at risk for anxiety and depression is consistent with research looking at outcomes for irritability generally. But it is helpful to have the finding confirmed in a sample in which the researchers explicitly applied criteria for DMDD."

"The other thing that is particularly interesting about the study is how it demonstrates the severe impairment that children with DMDD experience as adults, even when compared with children with other psychiatric disorders," Liebenluft added. We already knew how impairing the condition was in childhood. Now we know that it continues to have long-term adverse consequences as well."

The challenge now, Leibenluft continued, is to determine whether first-line treatmetns for anxiety or depressive disorders, such as antidepressants or cognitive-behavioral therapy, can help children with DMDD. "We are conducting a clinical trial at NIMH currently to answer this question."

More information about DMDD can be found in the Psychiatric News articles, "Severe Childhood Mood Disorder May Be Unique Syndrome" and "DSM-5 Self-Exam: Depressive Disorders."

(Image: vesna cvorovic/


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