Child and Adolescent Psychopathology Services, Amiens University Hospital, Amiens, France; INSERM Unit U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardy Jules Verne (UPJV), Amiens, France; Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France.
Manulife Centre for Breakthroughs in Teen Depression and Suicide Prevention, Douglas Mental Health University Institute, McGill University, Montreal, Canada; Department of psychiatry, McGill University, Montreal, Canada.
J Affect Disord. 2020 Mar 15;265:207-215. doi: 10.1016/j.jad.2020.01.020. Epub 2020 Jan 8.
Although the disruptive mood dysregulation disorder (DMDD) was included in the depressive disorders (DD) section of the DSM-5, common and distinctive features between DMDD and the pre-existing DD (i.e., major depressive disorder, MDD, and persistent depressive disorder, PDD) received little scrutiny.
Youths consecutively assessed as outpatients at two Canadian mood clinics over four years were included in the study (n = 163; mean age:13.4 ± 0.3; range:7-17). After controlling for inter-rater agreement, data were extracted from medical charts, using previously validated chart-review instruments.
Twenty-two percent of youths were diagnosed with DMDD (compared to 36% for MDD and 25% for PDD), with substantial overlap between the three disorders. Youths with DMDD were more likely to have a comorbid non-depressive psychiatric disorder - particularly attention deficit hyperactivity disorder, odds ratio (OR=3.9), disruptive, impulse-control and conduct disorder (OR=3.0) or trauma- and stressor-related disorder (OR=2.5). Youths with DMDD did not differ with regard to the level of global functioning, but reported more school and peer-relationship difficulties compared to MDD and/or PDD. The vulnerability factors associated with mood disorders (i.e., history of parental depression and adverse life events) were found at a comparable frequency across the three groups.
The retrospective design and the selection bias for mood disordered patients restricted the generalizability of the results.
Youths with DMDD share several clinical features with youths with MDD and PDD. Further studies are required to determine the developmental trajectories and the benefits of expanding pharmacotherapy for DD to DMDD.
尽管 DSM-5 将破坏性心境失调障碍（DMDD）纳入了心境障碍（DD）部分，但 DMDD 与之前存在的 DD（即重度抑郁症，MDD 和持续性抑郁障碍，PDD）之间的共同和独特特征并未受到太多关注。
本研究纳入了在加拿大两家情绪诊所连续四年接受门诊评估的青少年（n=163；平均年龄：13.4±0.3；范围：7-17 岁）。在控制了评分者间的一致性后，使用先前验证的图表审查工具从病历中提取数据。
22%的青少年被诊断为 DMDD（相比之下，MDD 为 36%，PDD 为 25%），三种疾病之间存在大量重叠。DMDD 青少年更有可能患有共病非抑郁性精神障碍——特别是注意力缺陷多动障碍，优势比（OR）为 3.9，破坏性、冲动控制和行为障碍（OR）为 3.0 或创伤和应激相关障碍（OR）为 2.5。DMDD 青少年在整体功能水平上与 MDD 和/或 PDD 没有差异，但报告说在学校和同伴关系方面存在更多困难。与心境障碍相关的脆弱因素（即父母抑郁史和不良生活事件）在三组中出现的频率相当。
回顾性设计和心境障碍患者的选择偏倚限制了结果的普遍性。
DMDD 青少年与 MDD 和 PDD 青少年有一些共同的临床特征。需要进一步研究以确定 DMDD 的发展轨迹以及扩大心境障碍药物治疗的益处。
