Disruptive Mood Dysregulation Disorder Symptoms and Association with Oppositional Defiant and Other Disorders in a General Population Child Sample
Disruptive Mood Dysregulation Disorder Symptoms and Association with Oppositional Defiant and Other Disorders in a General Population Child Sample
复制标题
DOI：
10.1089/cap.2015.0074
复制
发表时间：
2016-03-01
影响因子：
1.9
通讯作者：
Bixler, Edward O.
中科院分区：
文献类型：
--
作者：
Mayes, Susan D.;Waxmonsky, James D.;Bixler, Edward O.
目的：新的精神障碍诊断和统计手册，第五版。 （DSM-5）诊断，破坏性情绪失调障碍（DMDD），自诞生以来就引起了相当大的争议，主要是关于它作为一种与对立违抗障碍（ODD）不同的障碍的有效性。我们研究的目的是确定两种 DSM-5 DMDD 症状（持续性烦躁或愤怒情绪以及严重反复发作的脾气爆发）是否独立于其他疾病（尤其是 ODD）发生。未评估其他 DSM-5 DMDD 标准。方法：对 6-12 岁人群样本 (n=665) 的两种 DMDD 症状的母亲评级、使用 DSM-5 症状标准的 ODD 临床诊断以及儿科行为量表上的心理问题评分（焦虑、抑郁、对立行为、品行障碍和注意力缺陷/多动障碍 [ADHD]）进行分析。结果：DMDD 症状（母亲认为经常或经常出现的烦躁情绪和脾气暴躁）的患病率为 9%。总的来说，有 DMDD 症状的儿童中有 92% 患有 ODD，而 66% 的 ODD 儿童有 DMDD 症状，这表明没有 ODD 的情况下不太可能出现 DMDD 症状，但没有 DMDD 症状也可能出现 ODD。除了 ODD 之外，共病心理问题（焦虑、抑郁、品行障碍和 ADHD）并不会增加出现 DMDD 症状的风险（超过单纯 ODD 的风险）。只有 3% 的除 ODD 之外有其他心理问题的儿童有 DMDD 症状。结论：我们的总体人群调查结果与精神病学样本相似，表明不能根据症状区分 DMDD 和 ODD。因此，在考虑诊断 DMDD 时，评估所有 DSM 标准并检查共病精神病理学非常重要。我们的结果支持世界卫生组织国际疾病分类第 11 次修订版 (ICD-11) 专家小组提出的建议，即 DMDD 症状可能更适合归类为 ODD 说明符，而不是单独的诊断。
Objective: The new Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5) diagnosis, disruptive mood dysregulation disorder (DMDD), has generated appreciable controversy since its inception, primarily in regard to its validity as a distinct disorder from oppositional defiant disorder (ODD). The goal of our study was to determine if the two DSM-5 DMDD symptoms (persistently irritable or angry mood and severe recurrent temper outbursts) occurred independently of other disorders, particularly ODD. Other DSM-5 DMDD criteria were not assessed. Methods: Maternal ratings of the two DMDD symptoms, clinical diagnosis of ODD using DSM-5 symptom criteria, and psychological problem scores (anxiety, depression, oppositional behavior, conduct disorder, and attention-deficit/hyperactivity disorder [ADHD]) on the Pediatric Behavior Scale were analyzed in a population sample, 6-12 years of age (n=665). Results: The prevalence of DMDD symptoms (irritable-angry mood and temper outbursts both rated by mothers as often or very often a problem) was 9%. In all, 92% of children with DMDD symptoms had ODD, and 66% of children with ODD had DMDD symptoms, indicating that it is very unlikely to have DMDD symptoms without ODD, but that ODD can occur without DMDD symptoms. Comorbid psychological problems (anxiety, depression, conduct disorder, and ADHD) in addition to ODD did not increase the risk of having DMDD symptoms beyond that for ODD alone. Only 3% of children with psychological problems other than ODD had DMDD symptoms. Conclusions: Our general population findings are similar to those for a psychiatric sample, suggesting that DMDD cannot be differentiated from ODD based on symptomatology. Therefore, it is important to assess all DSM criteria and to examine for comorbid psychopathology when considering a diagnosis of DMDD. Our results support the recommendation made by the World Health Organization's International Classification of Diseases, 11th Revision (ICD-11) panel of experts that DMDD symptoms may be more appropriately classified as an ODD specifier than a separate diagnosis.