Winters Drew E, Fukui Sadaaki, Leibenluft Ellen, Hulvershorn Leslie A
1 School of Social Work, Indiana University , Indianapolis, Indiana.
2 Section on Mood Dysregulation and Neuroscience, Intramural Research Program, National Institute of Mental Health, National Institutes of Health , Bethesda, Maryland.
J Child Adolesc Psychopharmacol. 2018 Jun;28(5):298-305. doi: 10.1089/cap.2017.0124. Epub 2018 Apr 30.
The purpose of this open-label study was to examine the effects of long-acting methylphenidate (MPH) treatment on irritability and related emotional symptoms associated with disruptive mood dysregulation disorder (DMDD) in youth with comorbid attention-deficit/hyperactivity disorder (ADHD).
The sample included 22 medication-free male and female subjects (ages 9-15) who met criteria for both DMDD and ADHD. Participants underwent a 4-week trial of long-acting MPH treatment (Concerta), with weekly dosing increases until a therapeutic dose was reached. Repeated measures t-tests were used to compare pre- and posttreatment ratings of primary and secondary measures. The primary outcome was self-report irritability. Secondary outcomes included parent and child ratings of emotional frequency, emotional lability, and negative affect (NA). Multiple regression was used to examine the impact baseline hyperactivity, age, gender, race, socioeconomic status, or comorbid diagnosis had on treatment outcomes.
Significant improvements (medium to large effect sizes) in child-rated irritability as well as parent and child ratings of emotional lability, NA, and anger were found. As anticipated, ADHD symptoms also improved. While a majority of the sample saw improvement in child-rated irritability (71%), symptoms worsened a small proportion (19%), and an even smaller portion experienced no change (10%). No demographics, psychiatric comorbidities, or severity of ADHD symptoms influenced treatment outcomes.
Study findings suggest that MPH treatment significantly improved mood and emotional symptoms associated with DMDD comorbid with ADHD. These findings, coupled with good tolerability in this open-label pilot study supports further research into the use of MPH as a first-line treatment for DMDD. Future work examining MPH treatment of youth with DMDD with and without comorbid ADHD is needed.
本开放标签研究旨在探讨长效哌甲酯（MPH）治疗对患有注意力缺陷/多动障碍（ADHD）合并破坏性行为障碍（DMDD）的青少年的易怒情绪及相关情绪症状的影响。
样本包括22名未服用过药物的男性和女性受试者（年龄9 - 15岁），他们同时符合DMDD和ADHD的标准。参与者接受了为期4周的长效MPH（康纳达）治疗试验，每周增加剂量直至达到治疗剂量。采用重复测量t检验比较治疗前后主要和次要指标的评分。主要结局指标是自我报告的易怒情绪。次要结局指标包括父母和孩子对情绪频率、情绪不稳定及消极情绪（NA）的评分。采用多元回归分析来检验基线多动、年龄、性别、种族、社会经济地位或共病诊断对治疗结局的影响。
发现儿童报告的易怒情绪以及父母和孩子对情绪不稳定、NA和愤怒的评分有显著改善（效应大小为中等至大）。正如预期的那样，ADHD症状也有所改善。虽然大多数样本的儿童报告的易怒情绪有所改善（71%），但一小部分（19%）症状恶化，更小比例（10%）无变化。没有人口统计学特征、精神共病或ADHD症状严重程度影响治疗结局。
研究结果表明，MPH治疗显著改善了与ADHD合并的DMDD相关的情绪和情感症状。这些发现，再加上本开放标签试点研究中的良好耐受性，支持进一步研究将MPH用作DMDD的一线治疗方法。未来需要开展工作，研究MPH对患有和未患有ADHD合并症的DMDD青少年的治疗效果。
