Deveney Christen M, Hommer Rebecca E, Reeves Elizabeth, Stringaris Argyris, Hinton Kendra E, Haring Catherine T, Vidal-Ribas Pablo, Towbin Kenneth, Brotman Melissa A, Leibenluft Ellen
Department of Psychology, Wellesley College, Wellesley, Massachusetts, USA.
Depress Anxiety. 2015 May;32(5):364-72. doi: 10.1002/da.22336. Epub 2014 Dec 12.
Severe, chronic irritability is receiving increased research attention, and is the cardinal symptom of a new diagnostic category, disruptive mood dysregulation disorder (DMDD). Although data from epidemiological community samples suggest that childhood chronic irritability predicts unipolar depression and anxiety in adulthood, whether these symptoms are stable and cause ongoing clinical impairment is unknown. The present study presents 4-year prospective and longitudinal diagnostic and impairment data on a clinical sample of children selected for symptoms of severe irritability (operationalized as severe mood dysregulation [SMD]).
Youth meeting criteria for SMD (n = 200) were evaluated at baseline using standard diagnostic methods. Two-year (n = 78) and 4-year (n = 46) follow-up diagnostic and clinical impairment ratings collected at 6-month intervals were completed with those youths enrolled in the study for a sufficient time.
Although the number of youth meeting strict categorical SMD criteria declined over time (49 and 40% at 2 and 4 years, respectively), many individuals not meeting full criteria continued to display clinically significant irritability symptoms (2 years: 42%; 4 years: 37%). Impairment due to these irritability symptoms remained consistently in the moderate range on the Clinical Global Impressions Scale.
By the 4-year follow-up, only 40% of youths meet strict SMD criteria; however, most continue to display clinically impairing symptoms and significant impairment warranting psychiatric treatment. These findings provide evidence for the course of irritability, with implications for DMDD. Future research with populations meeting DMDD criteria and followed through the ages of high risk for psychiatric diagnoses is necessary.
严重的慢性易激惹正受到越来越多的研究关注，并且是一种新的诊断类别——破坏性心境失调障碍（DMDD）的主要症状。尽管来自流行病学社区样本的数据表明儿童期慢性易激惹可预测成年期的单相抑郁和焦虑，但这些症状是否稳定以及是否会导致持续的临床损害尚不清楚。本研究呈现了对一组因严重易激惹症状（定义为严重情绪失调[SMD]）而入选的儿童临床样本进行的4年前瞻性和纵向诊断及损害数据。
对符合SMD标准的青少年（n = 200）在基线时使用标准诊断方法进行评估。对参与研究足够长时间的青少年，每隔6个月收集一次为期两年（n = 78）和四年（n = 46）的随访诊断及临床损害评分。
尽管随着时间推移，符合严格分类SMD标准的青少年数量有所下降（2年和4年时分别为49%和40%），但许多未达到全部标准的个体仍持续表现出具有临床意义的易激惹症状（2年时：42%；4年时：37%）。在临床总体印象量表上，这些易激惹症状导致的损害一直处于中度范围。
到4年随访时，只有40%的青少年符合严格的SMD标准；然而，大多数人仍持续表现出导致临床损害的症状以及需要精神科治疗的显著损害。这些发现为易激惹的病程提供了证据，对DMDD具有启示意义。未来有必要对符合DMDD标准且随访至精神科诊断高风险年龄阶段的人群进行研究。
