1 School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.
2 Clinical and Health Psychology Research Initiative (CaHPRI), School of Social Sciences & Psychology, Western Sydney University, Penrith, NSW, Australia.
Aust N Z J Psychiatry. 2017 Dec;51(12):1220-1226. doi: 10.1177/0004867416672727. Epub 2016 Oct 14.
Disruptive mood dysregulation disorder is a newly proposed childhood disorder included in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition to describe children ⩽18 years of age with chronic irritability/temper outbursts. This study aimed to examine the prevalence of disruptive mood dysregulation disorder, severe mood dysregulation and chronic irritability in an Australian study of young people at increased familial risk of developing bipolar disorder ('HR' group) and controls ('CON' group).
A total of 242 12- to 30-year-old HR or CON subjects were administered the severe mood dysregulation module. Of these, 42 were aged ⩽18 years at the time of assessment, with 29 subjects in the HR group and 13 in the CON group.
No subjects ⩽18 years - in either group - fulfilled current or lifetime criteria for disruptive mood dysregulation disorder or severe mood dysregulation, the precursor to disruptive mood dysregulation disorder. Similarly, no subjects in either group endorsed the severe mood dysregulation/disruptive mood dysregulation disorder criteria for irritable mood or marked excessive reactivity. One HR participant endorsed three severe mood dysregulation criteria (distractibility, physical restlessness and intrusiveness), while none of the comparison subjects endorsed any criteria. Exploratory studies of the broader 12- to 30-year-old sample similarly found no subjects with severe mood dysregulation/disruptive mood dysregulation disorder in either the HR or CON group and no increased rates of chronic irritability, although significantly more HR subjects reported at least one severe mood dysregulation/disruptive mood dysregulation disorder criterion (likelihood ratio = 6.17; p = 0.013); most of the reported criteria were severe mood dysregulation 'chronic hyper-arousal' symptoms.
This study comprises one of the few non-US reports on the prevalence of disruptive mood dysregulation disorder and severe mood dysregulation and is the first non-US study of the prevalence of these conditions in a high-risk bipolar disorder sample. The failure to replicate the finding of higher rates of disruptive mood dysregulation disorder and chronic irritability in high-risk offspring suggests that these are not robust precursors of bipolar disorder.
心境恶劣障碍是一种新提出的儿童障碍，被纳入《精神障碍诊断与统计手册》第五版，用于描述 ⩽18 岁的儿童慢性易激惹/情绪爆发。本研究旨在调查心境恶劣障碍、严重心境不稳和慢性易激惹在澳大利亚一项双相障碍高危家族的年轻人研究中的患病率（“HR”组）和对照组（“CON”组）。
共对 242 名 12 至 30 岁的 HR 或 CON 受试者进行了严重心境不稳模块的评估。其中，42 名受试者在评估时年龄 ⩽18 岁，其中 29 名受试者来自 HR 组，13 名来自 CON 组。
无 ⩽18 岁受试者-无论在哪个组-均符合心境恶劣障碍或严重心境不稳的现行或终身标准，即心境恶劣障碍的前驱症状。同样，也没有受试者符合严重心境不稳/心境恶劣障碍的易激惹或明显过度反应的标准。1 名 HR 参与者符合 3 项严重心境不稳标准（注意力分散、身体躁动不安和侵扰性），而无对照受试者符合任何标准。对更广泛的 12 至 30 岁样本的探索性研究也发现，无论是 HR 组还是 CON 组，均无受试者患有严重心境不稳/心境恶劣障碍，也无慢性易激惹率增加的情况，尽管 HR 组的受试者报告有至少一项严重心境不稳/心境恶劣障碍标准的人数显著更多（比值比=6.17；p=0.013）；大多数报告的标准为严重心境不稳的“慢性过度兴奋”症状。
本研究是心境恶劣障碍和严重心境不稳患病率的少数非美国报告之一，也是第一个对高危双相障碍样本中这些疾病患病率的非美国研究。未能复制高危后代心境恶劣障碍和慢性易激惹率较高的发现表明，这些并非双相障碍的可靠前驱症状。
