Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ASCO Annual Meeting 2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

2024 ASCO Annual Meeting

Keep up to date with all the top stories and latest evidence with our hub page, including official congress videos and expert takeaways.
ADVANCED SEARCH
Log in
Top
European Child & Adolescent Psychiatry
Published in: European Child & Adolescent Psychiatry 1/2013

Open Access 01-02-2013 | Review

Mood dysregulation

Authors: Nina Mikita, Argyris Stringaris

Published in: European Child & Adolescent Psychiatry | Special Issue 1/2013

Login to get access

Abstract

The publication of the DSM-5 is nearing, yet a debate continues about the boundaries of bipolar disorder (BP) in children and adolescents. This article focuses on two key components of this debate that are often treated under the collective term mood dysregulation: the first is chronic irritability (and the proposed DSM-5 category of disruptive mood dysregulation disorder) and the other concerns short episodes of mania-like symptoms. We update our previous review [Stringaris in Eur Child Adolesc Psychiatry 20(2):61–66, 2011] and also present relevant neurobiological evidence. Most findings so far suggests that chronic, severe irritability is not a developmental presentation of mania. The diagnostic status of brief duration hypomania is less clear, with some evidence in support of its clinical relevance to BP. We end with recommendations for future research to inform classification and treatment.
Literature
1.
Stringaris A (2011) Irritability in children and adolescents: a challenge for DSM-5. Eur Child Adolesc Psychiatry 20(2):61–66PubMedCrossRef
2.
Blader JC, Carlson GA (2007) Increased rates of bipolar disorder diagnoses among U.S. child, adolescent, and adult inpatients, 1996–2004. Biol Psychiatry 62(2):107–114PubMedCrossRef
3.
Moreno C, Laje G, Blanco C, Jiang H, Schmidt AB, Olfson M (2007) National trends in the outpatient diagnosis and treatment of bipolar disorder in youth. Arch Gen Psychiatry 64(9):1032–1039PubMedCrossRef
4.
Olfson M, Blanco C, Liu L, Moreno C, Laje G (2006) National trends in the outpatient treatment of children and adolescents with antipsychotic drugs. Arch Gen Psychiatry 63(6):679–685PubMedCrossRef
5.
Leibenluft E (2011) Severe mood dysregulation, irritability, and the diagnostic boundaries of bipolar disorder in youths. Am J Psychiatry 168(2):129–142PubMedCrossRef
6.
Wozniak J, Biederman J, Kiely K, Ablon JS, Faraone SV, Mundy E, Mennin D (1995) Mania-like symptoms suggestive of childhood-onset bipolar disorder in clinically referred children. J Am Acad Child Adolesc Psychiatry 34(7):867–876PubMedCrossRef
7.
Brotman MA, Schmajuk M, Rich BA, Dickstein DP, Guyer AE, Costello EJ et al (2006) Prevalence, clinical correlates, and longitudinal course of severe mood dysregulation in children. Biol Psychiatry 60(9):991–997PubMedCrossRef
8.
Pickles A, Aglan A, Collishaw S, Messer J, Rutter M, Maughan B (2010) Predictors of suicidality across the life span: the Isle of Wight study. Psychol Med 40(09):1453–1466PubMedCrossRef
9.
Leibenluft E, Charney DS, Towbin KE, Bhangoo RK, Pine DS (2003) Defining clinical phenotypes of juvenile mania. Am J Psychiatry 160(3):430–437PubMedCrossRef
10.
Stringaris A, Cohen P, Pine D, Leibenluft E (2009) Adult outcomes of youth irritability: a 20-year prospective community-based study. Am J Psychiatry 166(9):1048–1054PubMedCrossRef
11.
Stringaris A, Baroni A, Haimm C, Brotman M, Lowe CH, Myers F, Rustgi E, Wheeler W, Kayser R, Towbin K, Leibenluft E (2010) Pediatric bipolar disorder versus severe mood dysregulation: risk for manic episodes on follow-up. J Am Acad Child Adolesc Psychiatry 49(4):397–405PubMed
12.
Brotman M, Kassem L, Reising M, Guyer A, Dickstein D, Rich B et al (2007) Parental diagnoses in youth with narrow phenotype bipolar disorder or severe mood dysregulation. Am J Psychiatry 164(8):1238–1241PubMedCrossRef
13.
Guyer AE, McClure EB, Adler AD, Brotman MA, Rich BA, Kimes AS, Pine DS, Ernst M, Leibenluft E (2007) Specificity of facial expression labeling deficits in childhood psychopathology. J Child Psychol Psychiatry 48(9):863–871PubMedCrossRef
14.
Rich BA, Grimley ME, Schmajuk M, Blair KS, Blair RJR, Leibenluft E (2008) Face emotion labeling deficits in children with bipolar disorder and severe mood dysregulation. Dev Psychopathol 20(02):529–546PubMedCrossRef
15.
Brotman MA, Rich BA, Guyer AE, Lunsford JR, Horsey SE, Reising MM, Thomas LA, Fromm SJ, Towbin K, Pine DS, Leibenluft E (2010) Amygdala activation during emotion processing of neutral faces in children with severe mood dysregulation versus ADHD or bipolar disorder. Am J Psychiatry 167(1):61–69PubMedCrossRef
16.
Beesdo K, Lau JF, Guyer AE et al (2009) Common and distinct amygdala-function perturbations in depressed vs anxious adolescents. Arch Gen Psychiatry 66(3):275–285PubMedCrossRef
17.
Thomas KM, Drevets WC, Dahl RE et al (2001) Amygdala response to fearful faces in anxious and depressed children. Arch Gen Psychiatry 58(11):1057–1063PubMedCrossRef
18.
Perez-Edgar K, Fox NA (2005) A behavioral and electrophysiological study of children’s selective attention under neutral and affective conditions. J Cognit Dev 6(1):89–118CrossRef
19.
Rich BA, Carver FW, Holroyd T, Rosen HR, Mendoza JK, Cornwell BR, Fox NA, Pine DS, Coppola R, Leibenluft E (2011) Different neural pathways to negative affect in youth with pediatric bipolar disorder and severe mood dysregulation. J Psychiatr Res 45(10):1283–1294PubMedCrossRef
20.
Rich BA, Schmajuk M, Perez-Edgar KE, Fox NA, Pine DS, Leibenluft E (2007) Different psychophysiological and behavioral responses elicited by frustration in pediatric bipolar disorder and severe mood dysregulation. Am J Psychiatry 164(2):309–317PubMedCrossRef
21.
Nagahama Y, Okada T, Katsumi Y, Hayashi T, Yamauchi H, Sawamoto N, Toma K, Nakamura K, Hanakawa T, Konishi J, Fukuyama H, Shibasaki H (1999) Transient neural activity in the medial superior frontal gyrus and precuneus time locked with attention shift between object features. NeuroImage 10(2):193–199PubMedCrossRef
22.
Blair RJR (2010) Psychopathy, frustration, and reactive aggression: the role of ventromedial prefrontal cortex. Br J Psychol 101(3):383–399PubMedCrossRef
23.
Dickstein DP, Nelson EE, McClure EB, Grimley ME, Knopf L, Brotman MA, Rich BA, Pine DS, Leibenluft E (2007) Cognitive flexibility in phenotypes of pediatric bipolar disorder. J Am Acad Child Adolesc Psychiatry 46(3):341–355PubMedCrossRef
24.
Dickstein DP, Finger EC, Brotman MA, Rich BA, Pine DS, Blair JR, Leibenluft E (2010) Impaired probabilistic reversal learning in youths with mood and anxiety disorders. Psychol Med 40(07):1089–1100PubMedCrossRef
25.
Adleman NE, Kayser R, Dickstein D, Blair RJR, Pine D, Leibenluft E (2011) Neural correlates of reversal learning in severe mood dysregulation and pediatric bipolar disorder. J Am Acad Child Adolesc Psychiatry 50(11):1173–1185.e1172PubMedCrossRef
26.
Stringaris A, Goodman R, Ferdinando S, Razdan V, Muhrer E, Leibenluft E, Brotman MA (2012) The Affective Reactivity Index: a concise irritability scale for clinical and research settings. J Child Psychol Psychiatry 53:1109–1117PubMedCrossRef
27.
Simonoff E, Jones CRG, Pickles A, Happé F, Baird G, Charman T (2012) Severe mood problems in adolescents with autism spectrum disorder. J Child Psychol Psychiatry 53:1157–1166PubMedCrossRef
28.
Stringaris A, Goodman R (2009) Three dimensions of oppositionality in youth. J Child Psychol Psychiatry 50(3):216–223PubMedCrossRef
29.
Kaufman J, Birmaher B, Brent D, Rao U, Flynn C, Moreci P, Williamson D, Ryan N (1997) Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 36(7):980–988PubMedCrossRef
30.
Correll CU, Sheridan EM, DelBello MP (2010) Antipsychotic and mood stabilizer efficacy and tolerability in pediatric and adult patients with bipolar I mania: a comparative analysis of acute, randomized, placebo-controlled trials. Bipolar Disord 12(2):116–141PubMedCrossRef
31.
McCracken JT, McGough J, Shah B, Cronin P, Hong D, Aman MG, Arnold LE, Lindsay R, Nash P, Hollway J, McDougle CJ, Posey D, Swiezy N, Kohn A, Scahill L, Martin A, Koenig K, Volkmar F, Carroll D, Lancor A, Tierney E, Ghuman J, Gonzalez NM, Grados M, Vitiello B, Ritz L, Davies M, Robinson J, McMahon D (2002) Risperidone in children with autism and serious behavioral problems. N Engl J Med 347(5):314–321PubMedCrossRef
32.
Dickstein DP, Towbin KE, Van Der Veen JW, Rich BA, Brotman MA, Knopf L, Onelio L, Pine DS, Leibenluft E (2009) Randomized double-blind placebo-controlled trial of lithium in youths with severe mood dysregulation. J Child Adolesc Psychopharmacol 19(1):61–73PubMedCrossRef
33.
NIHCE (2011) Attention deficit hyperactivity disorder: diagnosis and management of ADHD in children, young people and adults. www.​nice.​org.​uk/​CG72. Accessed 5 October 2012
34.
Leigh E, Smith P, Milavic G, Stringaris A (2012) Mood regulation in youth: research findings and clinical approaches to irritability and short-lived episodes of mania-like symptoms. Curr Opin Psychiatry 25(4):271–276PubMedCrossRef
35.
Angst J, Gamma A, Benazzi F, Ajdacic V, Eich D, Rössler W (2003) Toward a re-definition of subthreshold bipolarity: epidemiology and proposed criteria for bipolar-II, minor bipolar disorders and hypomania. J Affect Disord 73(1):133–146PubMedCrossRef
36.
Axelson D, Birmaher B, Strober M, Gill MK, Valeri S, Chiappetta L et al (2006) Phenomenology of children and adolescents with bipolar spectrum disorders. Arch Gen Psychiatry 63(10):1139–1148PubMedCrossRef
37.
Birmaher B, Axelson D, Strober M, Gill MK, Valeri S, Chiappetta L et al (2006) Clinical course of children and adolescents with bipolar spectrum disorders. Arch Gen Psychiatry 63(2):175–183PubMedCrossRef
38.
Birmaher B, Axelson D, Goldstein B, Strober M, Gill M, Hunt J et al (2009) Four-year longitudinal course of children and adolescents with bipolar spectrum disorders: the course and outcome of bipolar youth (COBY) study. Am J Psychiatry 166(7):795–804PubMedCrossRef
39.
Stringaris A, Santosh P, Leibenluft E, Goodman R (2010) Youth meeting symptom and impairment criteria for mania-like episodes lasting less than four days: an epidemiological enquiry. J Child Psychol Psychiatry 51(1):31–38PubMedCrossRef
40.
Axelson D, Birmaher BJ, Brent D, Wassick S, Hoover C, Bridge J, Ryan N (2003) A preliminary study of the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children mania rating scale for children and adolescents. J Child Adolesc Psychopharmacol 13(4):463–470PubMedCrossRef
41.
Goodman R, Ford T, Richards H, Gatward R, Meltzer H (2000) The Development and Well-Being Assessment: description and initial validation of an integrated assessment of child and adolescent psychopathology. J Child Psychol Psychiatry 41(5):645–655PubMedCrossRef
42.
Stringaris A, Stahl D, Santosh P, Goodman R (2011) Dimensions and latent classes of episodic mania-like symptoms in youth: an empirical enquiry. J Abnorm Child Psychol 39(7):925–937PubMedCrossRef
43.
44.
Axelson DA, Birmaher B, Findling RL, Fristad MA, Kowatch RA, Youngstrom EA et al (2011) Concerns regarding the inclusion of temper dysregulation disorder with dysphoria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. J Clin Psychiatry 72(9):1257–1262PubMedCrossRef
45.
Rutter M (2011) Research review: Child psychiatric diagnosis and classification: concepts, findings, challenges and potential. J Child Psychol Psychiatry 52(6):647–660PubMedCrossRef
46.
Metadata
Title
Mood dysregulation
Authors
Nina Mikita
Argyris Stringaris
Publication date
01-02-2013
Publisher
Springer-Verlag
Published in
European Child & Adolescent Psychiatry / Issue Special Issue 1/2013
Print ISSN: 1018-8827
Electronic ISSN: 1435-165X
DOI
https://doi.org/10.1007/s00787-012-0355-9

Other articles of this Special Issue 1/2013

European Child & Adolescent Psychiatry 1/2013 Go to the issue

Editorial

Introduction to the supplement

Review

Autism spectrum disorders

Review

Non-suicidal self-injury

Review

Attention-deficit/hyperactivity disorder (ADHD)

Review

Conduct disorders

Review

Anxiety disorders