Improvements in Irritability with Open-Label Methylphenidate Treatment in Youth with Comorbid Attention Deficit/Hyperactivity Disorder and Disruptive Mood Dysregulation Disorder.
Improvements in Irritability with Open-Label Methylphenidate Treatment in Youth with Comorbid Attention Deficit/Hyperactivity Disorder and Disruptive Mood Dysregulation Disorder.
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开放标签哌醋甲酯治疗可改善患有注意力缺陷/多动症和破坏性心境失调症的青少年的烦躁情绪。
DOI：
10.1089/cap.2017.0124
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发表时间：
2018
影响因子：
1.9
通讯作者：
Hulvershorn,LeslieA
中科院分区：
文献类型：
--
作者：
Winters,DrewE;Fukui,Sadaaki;Leibenluft,Ellen;Hulvershorn,LeslieA
目的：这项开放标签研究的目的是检查长效哌醋甲酯（MPH）治疗对伴有注意力缺陷/多动障碍（ADHD）的青少年破坏性情绪失调障碍（DMDD）相关的易怒和相关情绪症状的影响。方法：样本包括22名符合DMDD和ADHD标准的无药物治疗的男女（9-15岁）。参与者接受了为期4周的长效MPH治疗（Concerta®）试验，每周增加剂量，直到达到治疗剂量。使用重复测量检验来比较治疗前和治疗后主要和次要测量的评分。主要结果是自我报告的易怒程度。次要结局包括父母和孩子对情绪频率、情绪不稳定性和负面影响（NA）的评分。使用多元回归来检验基线多动症、年龄、性别、种族、社会经济地位或合并症诊断对治疗结果的影响。结果：在儿童易怒评分以及父母和儿童情绪不稳定性、NA和愤怒评分方面发现了显著的改善（中到大效应量）。正如预期的那样，多动症的症状也有所改善。虽然大多数样本的儿童易怒症状有所改善（71%），但一小部分（19%）症状恶化，更小一部分（10%）没有变化。没有人口统计学、精神合并症或ADHD症状的严重程度影响治疗结果。结论：研究结果表明，MPH治疗可显著改善DMDD合并ADHD的情绪和情绪症状。这些发现，加上这项开放标签试点研究的良好耐受性，支持了将MPH作为DMDD一线治疗的进一步研究。需要进一步研究MPH治疗伴有或不伴有ADHD的青年DMDD。
Objective:The purpose of this open-label study was to examine the effects of long-acting methylphenidate (MPH) treatment on irritability and related emotional symptoms associated with disruptive mood dysregulation disorder (DMDD) in youth with comorbid attention-deficit/hyperactivity disorder (ADHD).Methods:The sample included 22 medication-free male and female subjects (ages 9–15) who met criteria for both DMDD and ADHD. Participants underwent a 4-week trial of long-acting MPH treatment (Concerta®), with weekly dosing increases until a therapeutic dose was reached. Repeated measurest-tests were used to compare pre- and posttreatment ratings of primary and secondary measures. The primary outcome was self-report irritability. Secondary outcomes included parent and child ratings of emotional frequency, emotional lability, and negative affect (NA). Multiple regression was used to examine the impact baseline hyperactivity, age, gender, race, socioeconomic status, or comorbid diagnosis had on treatment outcomes.Results:Significant improvements (medium to large effect sizes) in child-rated irritability as well as parent and child ratings of emotional lability, NA, and anger were found. As anticipated, ADHD symptoms also improved. While a majority of the sample saw improvement in child-rated irritability (71%), symptoms worsened a small proportion (19%), and an even smaller portion experienced no change (10%). No demographics, psychiatric comorbidities, or severity of ADHD symptoms influenced treatment outcomes.Conclusions:Study findings suggest that MPH treatment significantly improved mood and emotional symptoms associated with DMDD comorbid with ADHD. These findings, coupled with good tolerability in this open-label pilot study supports further research into the use of MPH as a first-line treatment for DMDD. Future work examining MPH treatment of youth with DMDD with and without comorbid ADHD is needed.
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