Masi Gabriele, Sesso Gianluca, Pfanner Chiara, Valente Elena, Molesti Agnese, Placini Francesca, Boldrini Silvia, Loriaux Nina, Drago Flavia, Montesanto Anna Rita, Pisano Simone, Milone Annarita
IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Pisa, Italy.
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
Front Psychiatry. 2021 Apr 14;12:619037. doi: 10.3389/fpsyt.2021.619037. eCollection 2021.
Emotional dysregulation (ED) is currently the most frequently used term to describe children with an impaired regulation of emotional states. Recent research studies speculate whether ED may be a neurodevelopmental disorder itself, a shared risk factor, or a common key feature of several psychiatric disorders, including, among others, attention deficit hyperactivity disorder (ADHD), and bipolar spectrum disorders (BSD). The association between ADHD and ED is one of the main reasons of misconceptions in the definition of boundaries between ADHD and BSD, leading to the frequent misdiagnosis of ADHD as BSD. Since ED is a multidimensional concept, a novel instrument-the Reactivity, Intensity, Polarity and Stability (RIPoSt) scale-was recently developed to assess the different dimensions of ED, which could help in detecting specific ED profiles in clinical youths. Our study included 154 patients, aged 13.8 ± 2.3 years, diagnosed with either ADHD, BSD, or comorbid condition, and a school-based sample of 40 healthy control (HC) adolescents, aged 12.5 ± 1.2 years. The RIPoSt scale and the Child Behavior Checklist were administered to both groups. Our results indicate that affective instability and negative emotionality subscales, as well as negative emotional dysregulation, are higher in BSD, both pure and comorbid with ADHD, while emotional impulsivity is higher in the comorbid condition and similar in the ADHD and BSD alone group; all clinical groups scored higher than HC. Conversely, positive emotionality is similar among clinical groups and within them and HC. Our findings also support the validity of the RIPoSt questionnaire, since the instrument proved to have good-to-excellent internal consistency, and strongly significant positive correlations were found with the CBCL-Dysregulation Profile, which is a commonly used, indirect measure of ED. Hence, the five subscales of the RIPoSt can be reliably used as an effective tool to study the emotional dysregulation in different clinical conditions, to help disentangle the complex relationship between ADHD and juvenile BSD and to provide clinicians with crucial evidence for better diagnostic characterization and therapeutic indications.
情绪调节障碍（ED）是目前用于描述情绪状态调节受损儿童的最常用术语。最近的研究推测，ED本身是否可能是一种神经发育障碍、一个共同的风险因素，或者是几种精神疾病的共同关键特征，其中包括注意力缺陷多动障碍（ADHD）和双相谱系障碍（BSD）等。ADHD与ED之间的关联是ADHD和BSD界限定义中产生误解的主要原因之一，导致ADHD经常被误诊为BSD。由于ED是一个多维概念，最近开发了一种新的工具——反应性、强度、极性和稳定性（RIPoSt）量表——来评估ED的不同维度，这有助于在临床青少年中检测特定的ED特征。我们的研究纳入了154名年龄在13.8±2.3岁之间、被诊断患有ADHD、BSD或共病的患者，以及一个由40名年龄在12.5±1.2岁之间的健康对照（HC）青少年组成的学校样本。两组均使用了RIPoSt量表和儿童行为检查表。我们的结果表明，无论是单纯的BSD还是与ADHD共病的BSD，其情感不稳定性和负性情绪分量表以及负性情绪调节都更高，而情绪冲动性在共病情况下更高，在单纯ADHD组和单纯BSD组中相似；所有临床组的得分均高于HC。相反，临床组之间以及与HC相比，正性情绪相似。我们的研究结果还支持了RIPoSt问卷的有效性，因为该工具被证明具有良好到优秀的内部一致性，并且与CBCL-失调概况存在强烈的显著正相关，CBCL-失调概况是一种常用的间接测量ED的方法。因此，RIPoSt的五个分量表可以可靠地用作研究不同临床情况下情绪调节障碍的有效工具，以帮助理清ADHD与青少年BSD之间的复杂关系，并为临床医生提供关键证据，以更好地进行诊断特征描述和治疗指导。
