Are youths with disruptive mood dysregulation disorder different from youths with major depressive disorder or persistent depressive disorder?
Are youths with disruptive mood dysregulation disorder different from youths with major depressive disorder or persistent depressive disorder?
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DOI：
10.1016/j.jad.2020.01.020
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发表时间：
2020-03-15
影响因子：
6.6
通讯作者：
Guile, Jean-Marc
中科院分区：
文献类型：
--
作者：
Benarous, Xavier;Renaud, Johanne;Guile, Jean-Marc
背景：尽管破坏性情绪失调障碍 (DMDD) 包含在 DSM-5 的抑郁症 (DD) 部分中，但 DMDD 与既往存在的 DD（即重度抑郁症 (MDD) 和持续性抑郁症 (PDD)）之间的共同和独特特征很少受到关注。方法：四年来连续在加拿大两家情绪诊所接受门诊评估的青少年被纳入研究（n = 163；平均年龄：13.4 +/- 0.3；范围：7-17）。在控制了评估者间的一致性后，使用先前经过验证的图表审查工具从医学图表中提取数据。结果：22% 的青少年被诊断患有 DMDD（相比之下，MDD 为 36%，PDD 为 25%），这三种疾病之间有很大的重叠。患有 DMDD 的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、比值比 (OR= 3.9)、破坏性、冲动控制和品行障碍 (OR= 3.0) 或创伤和压力源相关障碍 (OR = 2.5)。患有 DMDD 的青少年在整体功能水平方面没有差异，但与 MDD 和/或 PDD 相比，他们报告了更多的学校和同伴关系困难。在三组中发现与情绪障碍相关的脆弱因素（即父母抑郁史和不良生活事件）的频率相当。局限性：回顾性设计和针对情绪障碍患者的选择偏倚限制了结果的普遍性。结论：患有 DMDD 的青少年与患有 MDD 和 PDD 的青少年有一些共同的临床特征。需要进一步的研究来确定 DD 药物治疗的发展轨迹以及将药物治疗扩展到 DMDD 的益处。
Background: 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. Methods: 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.Results: 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. Limitations: The retrospective design and the selection bias for mood disordered patients restricted the generalizability of the results. Conclusions: 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.