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Statistical Parametric Mapping The Analysis Of Functional Brain Images

Synopsis of Psychiatry

Objectives:To provide advice and guidance regarding the management of mood disorders, derived from scientific evidence and supplemented by expert clinical consensus to formulate s that maximise cli

The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders

Irritability in child and adolescent psychopathology: An integrative review for ICD-11

Objective Persistent irritability and behavior outbursts in disruptive mood dysregulation disorder (DMDD) are associated with severe impairment in childhood and with negative adolescent and adult outcomes. There are no empirically established treatments for DMDD. This study examined the feasibility and preliminary efficacy of dialectical behavior therapy adapted for preadolescent children (DBT-C) with DMDD. Method Children 7 to 12 years old with DMDD (N = 43) were randomly assigned 1:1 to DBT-C or treatment as usual (TAU). The 6 domains of feasibility included recruitment, randomization, retention, attendance, participants’ satisfaction, and therapist adherence. Blinded raters assessed participants at baseline, after 8, 16, 24, and 32 weeks, and at 3-month follow-up. The primary efficacy outcome was the positive response rate on the Clinical Global Impression–Improvement scale. Improvements in behavior outbursts and angry/irritable mood were assessed by the Clinical Global Impression–Severity scale. Results Mean number of participants randomized per month was 2.53 ± 2.72. Participants in DBT-C (n = 21) attended 89% of sessions compared with 48.6% in TAU (n = 22). Eight TAU participants (36.4%) dropped out compared with none in DBT-C. Parents and children in DBT-C expressed significantly higher treatment satisfaction than those in TAU. The rate of positive response was 90.4% in DBT-C compared with 45.5% in TAU, despite 3 times as many participants in TAU receiving psychiatric medications. Remission rates were 52.4% for DBT-C and 27.3% for TAU. Improvements were maintained at 3-month follow-up. Therapists showed adherence to DBT-C. Conclusion DBT-C demonstrated feasibility in all prespecified domains. Outcomes also indicated preliminary efficacy of DBT-C. Clinical trial registration information—Adapting DBT for Children With DMDD: Pilot RCT; http://clinicaltrials.gov/ ; NCT01862549 .

Randomized Clinical Trial of Dialectical Behavior Therapy for Preadolescent Children With Disruptive Mood Dysregulation Disorder: Feasibility and Outcomes.

OBJECTIVE: DSM-5 has added a new developmentally appropriate child and adolescent mood disorder subtype called disruptive mood dysregulation disorder (DMDD). The core features of DMDD are temper outbursts (manifested by either verbal rages and/or physical aggression) and unrelenting irritability or anger. Currently, the literature is lacking a thorough review of the possible treatment options for the cardinal symptoms constituting DMDD. The objective of this article is to provide a thorough review of peer-reviewed studies on the subject of pharmacological treatment options for children and adolescents with the cardinal symptoms of DMDD. METHODS: Relevant articles for this study were obtained through Pubmed, Medline, PsychINFO and PsychINDEXplus using the key words: "adolescents," "children," "paediatric," "youth," "irritability," "temper outbursts," "aggression," "rage," "disruptive behaviour," "treatment," "dysphoria," "autism," "mental retardation/intellectual disability," "impulsivity," "ADHD," "oppositional defiant disorder," and "conduct disorder." A total of 823 studies were generated; only English studies focusing on pharmacological treatment were retained. RESULTS: Currently there are no established guidelines or thorough reviews summarizing the treatment of DMDD. Pharmacotherapeutic treatment options of both aggression and chronic irritability include: antidepressants/selective norepinephrine reuptake inhibitors, mood stabilizers, psychostimulants, antipsychotics, and alpha-2 agonists. CONCLUSION: Treatment options of severe, persistent irritability in youth are numerous, and a consensual treatment algorithm has not yet emerged from the literature. Further studies and clinical trials are warranted to determine efficacious and safe treatment modalities. KEYWORDS: aggression; bipolar disorder; depression; disruptive mood dysregulation; irritability; mood stabilizers Language: en

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Treatment Options for the Cardinal Symptoms of Disruptive Mood Dysregulation Disorder

De nombreuses etudes en neuroimagerie fonctionnelle (IRMf) menees chez les adultes presentant un trouble de personnalite limite (TPL) convergent pour identifier un patron d’activation neuronale, notamment fronto-limbique, different de celui active chez les adultes sans TPL lors des tâches de visualisation d’images emotionnelles. A ce jour, aucune etude en IRMf n’a ete realisee chez les adolescents avec TPL. Ce projet pilote vise a evaluer la faisabilite d’un protocole d’IRMf chez des adolescentes avec TPL et a identifier les regions neuronales d’interet pour les etudes de neuroimagerie chez cette population. Le projet porte sur six adolescentes euthymiques presentant un diagnostic de TPL (âge moyen : 15,8 ± 0,9 ans) et six adolescentes temoins sans diagnostic psychiatrique (âge moyen : 15,5 ± 1,2 ans). Apres l’evaluation diagnostique incluant le Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime et le Diagnostic Interview for Borderline – Revised version, les participantes ont complete une tâche d’IRMf au cours de laquelle elles devaient regarder 20 images a valence affective positive, 20 images a valence affective negative et 20 images neutres. L’etude de faisabilite montre que les participantes ont ete recrutees en 22 mois et que le protocole etait bien tolere par celles-ci. Les resultats montrent que le visionnement des scenes positives et negatives a entraine une plus grande activation de plusieurs aires limbiques ainsi que frontales, temporales et du cervelet chez le groupe TPL. Les aires limbiques et prefrontales semblent etre des regions d’interet dans l’etude du fonctionnement neuronal chez les adolescentes avec TPL.

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Neuroimagerie fonctionnelle chez l’adolescent avec un trouble de personnalité limite

OBJECTIVE To examine the clinical characteristics of adolescent girls consulting in a mood disorder clinic with a history of physical or sexual abuse. METHOD A retrospective review was conducted of the charts of 55 adolescent girls consulting in a mood disorder clinic. An analysis grid was used to gather data on demographics, personal antecedents, symptoms and diagnoses. Girls with a history of physical or sexual abuse were compared with girls without such a history. Univariate analyses and a logistic regression analysis were performed. RESULTS Adolescent girls with a history of physical or sexual abuse did not differ statistically from those without such a history in terms of depressive symptoms or type and number of diagnoses. However, proportionally more girls with a history of physical or sexual abuse presented self-harm and relational problems with their parents and peers. CONCLUSION Both history of physical or sexual abuse and self-destructive behaviors are rooted in relational problems. The results show that these are related to one another among those adolescent girls. Clinically, these findings suggest that it is important for clinicians do a thorough exploration of self-destructive behaviors and family and peer relations when assessing depressed adolescent girls.

Amélie LeBoeuf

Papers

Treatment Options for the Cardinal Symptoms of Disruptive Mood Dysregulation Disorder

Neuroimagerie fonctionnelle chez l’adolescent avec un trouble de personnalité limite

Exploratory Study of the Clinical Characteristics of Adolescent Girls with a History of Physical or Sexual Abuse Consulting in a Mood Disorder Clinic.