Mitchell Rachel H B, Timmins Vanessa, Collins Jordan, Scavone Antonette, Iskric Adam, Goldstein Benjamin I
1 Department of Psychiatry, University of Toronto , Toronto, Ontario, Canada .
2 Centre for Youth Bipolar Disorder, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto , Toronto, Ontario, Canada .
J Child Adolesc Psychopharmacol. 2016 Mar;26(2):147-53. doi: 10.1089/cap.2015.0063. Epub 2016 Feb 4.
The purpose of this study was to examine the prevalence and correlates of disruptive mood dysregulation disorder phenotype (DMDDP) in a clinical population of adolescents with bipolar disorder (BD).
DMDD criteria were modified and applied to a sample of 116 adolescents with BD-I (n = 30), BD-II (n = 46) or BD-not otherwise specified (NOS) (n = 40) from a tertiary teaching hospital. Diagnoses were determined via the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Aged Children, Present and Lifetime version (KSADS-PL). Diagnostic and Statistical Manual of Mental Disorders (DSM-5) DMDD Criteria A-G were derived from the KSADS oppositional defiant disorder (ODD) screening interview and supplement, as well as narrative summaries. Chi-square analyses or t tests (p < 0.05) were conducted as appropriate, followed by logistic regression. P values were adjusted using the false discovery rate (FDR) approach.
DMDDP criteria could not be determined for 8 adolescents because of missing data from the ODD supplement. Twenty-five percent of the remainder (27/108) met criteria for DMDDP. DMDDP was not associated with BD subtype or with family history of BD. In univariate analyses, after controlling for age, sex, and race, DMDDP was associated with lower functioning, increased family conflict, assault history, and attention deficit and/or hyperactivity disorder (ADHD) (FDR adjusted p values: <0.0001, < 0.0001, 0.007, and 0.007, respectively). Lifetime substance use disorder and medication use approached significance (adjusted p = 0.05). In logistic regression, DMDDP was independently associated with greater parent-reported family conflict (odds ratio [OR] 1.17; confidence interval [CI- 1.06-1.30; p = 0.001) and greater functional impairment (OR 0.89; CI 0.82-0.97; p = 0.006). DMDDP was also associated with a threefold increase in ADHD, although ADHD was only marginally significant (OR 3.3; CI 0.98-10.94; p = 0.05).
Despite the positioning of DMDD as phenotypically and biologically distinct from BD, these phenotypes commonly overlap in clinical settings. This overlap is not explained by BD-NOS or by nonfamilial BD. The association of ADHD with DMDDP in this sample draws into question whether arousal symptoms should have been retained as originally elaborated in the severe mood dysregulation phenotype. Strategies to mitigate the excessive functional impairment of this comorbidity are warranted.
本研究旨在调查双相情感障碍（BD）青少年临床群体中破坏性行为障碍失调症表型（DMDDP）的患病率及其相关因素。
对来自一家三级教学医院的116名患有I型双相情感障碍（n = 30）、II型双相情感障碍（n = 46）或未另行规定的双相情感障碍（NOS）（n = 40）的青少年样本，修改并应用破坏性行为障碍失调症（DMDD）标准。通过《儿童情感障碍和精神分裂症评定量表（适用于学龄儿童），目前和终生版》（KSADS - PL）确定诊断。《精神疾病诊断与统计手册》（DSM - 5）的DMDD标准A - G源自KSADS对立违抗性障碍（ODD）筛查访谈及补充内容，以及叙述性总结。酌情进行卡方分析或t检验（p < 0.05），随后进行逻辑回归分析。使用错误发现率（FDR）方法调整p值。
由于ODD补充内容数据缺失，8名青少年无法确定DMDDP标准。其余青少年中有25%（27/108）符合DMDDP标准。DMDDP与双相情感障碍亚型或双相情感障碍家族史无关。在单变量分析中，在控制年龄、性别和种族后，DMDDP与功能较低、家庭冲突增加、攻击史以及注意力缺陷和/或多动障碍（ADHD）相关（FDR调整后的p值分别为：<0.0001、<0.0001、0.007和0.007）。终生物质使用障碍和药物使用接近显著水平（调整后的p = 0.05）。在逻辑回归中，DMDDP与父母报告的更大的家庭冲突（优势比[OR] 1.17；置信区间[CI] 1.06 - 1.30；p = 0.001）和更大的功能损害（OR 0.89；CI 0.82 - 0.97；p = 0.006）独立相关。DMDDP还与ADHD增加三倍相关，尽管ADHD仅略微显著（OR 3.3；CI 0.98 - 10.94；p = 0.05）。
尽管DMDD在表型和生物学上被定位为与双相情感障碍不同，但这些表型在临床环境中通常重叠。这种重叠不能用未另行规定的双相情感障碍（BD - NOS）或非家族性双相情感障碍来解释。本样本中ADHD与DMDDP的关联使人质疑唤醒症状是否应如最初在严重情绪失调表型中阐述的那样保留。有必要采取策略减轻这种共病的过度功能损害。
