Blader Joseph C, Pliszka Steven R, Kafantaris Vivian, Sauder Colin, Posner Jonathan, Foley Carmel A, Carlson Gabrielle A, Crowell Judith A, Margulies David M
1 Department of Psychiatry, University of Texas Health Science Center at San Antonio , San Antonio, Texas.
2 Department of Psychiatry Research, Zucker Hillside Hospital/North Shore-LIJ Health System , Glen Oaks, New York.
J Child Adolesc Psychopharmacol. 2016 Mar;26(2):164-73. doi: 10.1089/cap.2015.0112. Epub 2016 Jan 8.
Diagnostic criteria for disruptive mood dysregulation disorder (DMDD) require 1) periodic rageful outbursts and 2) disturbed mood (anger or irritability) that persists most of the time in between outbursts. Stimulant monotherapy, methodically titrated, often culminates in remission of severe aggressive behavior, but it is unclear whether those with persistent mood symptoms benefit less.This study examined the association between the presence of persistent mood disturbances and treatment outcomes among children with attention-deficit/hyperactivity disorder (ADHD) and periodic aggressive, rageful outbursts.
Within a cohort of children with ADHD and aggressive behavior (n = 156), the prevalence of persistent mood symptoms was evaluated at baseline and after completion of a treatment protocol that provided stimulant monotherapy and family-based behavioral treatment (duration mean [SD] = 70.04 [37.83] days). The relationship of persistent mood symptoms on posttreatment aggressive behavior was assessed, as well as changes in mood symptoms.
Aggressive behavior and periodic rageful outbursts remitted among 51% of the participants. Persistent mood symptoms at baseline did not affect the odds that aggressive behavior would remit during treatment. Reductions in symptoms of sustained mood disturbance accompanied reductions in periodic outbursts. Children who at baseline had high irritability but low depression ratings showed elevated aggression scores at baseline and after treatment; however, they still displayed large reductions in aggression.
Among aggressive children with ADHD, aggressive behaviors are just as likely to decrease following stimulant monotherapy and behavioral treatment among those with sustained mood symptoms and those without. Improvements in mood problems are evident as well. Therefore, the abnormalities in persistent mood described by DMDD's criteria do not contraindicate stimulant therapy as initial treatment among those with comorbid ADHD. Rather, substantial improvements may be anticipated, and remission of both behavioral and mood symptoms seems achievable for a proportion of patients.
ClinicalTrials.gov (U.S.); IDs: NCT00228046 and NCT00794625; www.clinicaltrials.gov.
破坏性心境失调障碍（DMDD）的诊断标准要求：1）周期性的愤怒爆发；2）在爆发间期大部分时间存在的情绪紊乱（愤怒或易激惹）。系统滴定的兴奋剂单一疗法常常能使严重攻击行为得到缓解，但尚不清楚那些存在持续性情绪症状的患者是否获益较少。本研究调查了注意缺陷多动障碍（ADHD）且有周期性攻击、愤怒爆发的儿童中，持续性情绪紊乱的存在与治疗结果之间的关联。
在一组患有ADHD和攻击行为的儿童（n = 156）中，在基线期以及完成一项提供兴奋剂单一疗法和基于家庭的行为治疗的治疗方案后（持续时间平均[标准差]= 70.04 [37.83]天），评估持续性情绪症状的患病率。评估了持续性情绪症状与治疗后攻击行为的关系，以及情绪症状的变化。
51%的参与者攻击行为和周期性愤怒爆发得到缓解。基线期的持续性情绪症状并不影响治疗期间攻击行为缓解的几率。持续性情绪紊乱症状的减轻伴随着周期性爆发的减少。基线期易怒程度高但抑郁评分低的儿童在基线期和治疗后攻击分数升高；然而，他们的攻击行为仍有大幅减少。
在患有ADHD的攻击性儿童中，在接受兴奋剂单一疗法和行为治疗后，有持续性情绪症状的儿童和没有持续性情绪症状的儿童攻击行为减少的可能性相同。情绪问题也有明显改善。因此，DMDD标准所描述的持续性情绪异常并不妨碍将兴奋剂疗法作为合并ADHD患者的初始治疗方法。相反，可以预期会有显著改善，并且一部分患者的行为和情绪症状似乎都可以得到缓解。
ClinicalTrials.gov（美国）；标识符：NCT00228046和NCT00794625；网址：www.clinicaltrials.gov。
