Prevalence and Correlates of Disruptive Mood Dysregulation Disorder Among Adolescents with Bipolar Disorder.
Prevalence and Correlates of Disruptive Mood Dysregulation Disorder Among Adolescents with Bipolar Disorder.
复制标题
双相情感障碍青少年中破坏性情绪失调的患病率和相关性。
DOI：
10.1089/cap.2015.0063
复制
发表时间：
2016
影响因子：
1.9
通讯作者：
B. Goldstein
中科院分区：
文献类型：
--
作者：
Rachel H. B. Mitchell;Vanessa H. Timmins;Jordan E Collins;Antonette Scavone;Adam Iskric;B. Goldstein
目的
本研究的目的是探讨双相情感障碍（BD）青少年临床人群中破坏性情绪失调障碍表型（DMDDP）的患病率及其相关性。
方法
DMDD标准进行了修改，并适用于样本的116例青少年BD-I（n = 30），BD-II（n = 46）或BD-未另行说明（NOS）（n = 40）从三级教学医院。通过学龄儿童情感障碍和精神分裂症的儿童时间表，现在和终身版本（KSADS-PL）确定诊断。精神障碍诊断与统计手册（DSM-5）DMDD标准A-G源自KSADS对立违抗性障碍（ODD）筛查访谈和补充，以及叙述性总结。适当时进行卡方分析或t检验（p < 0.05），然后进行逻辑回归。使用错误发现率（FDR）方法调整P值。
结果
由于ODD补充资料中的数据缺失，无法确定8名青少年的DMDDP标准。其余25%（27/108）符合DMDDP标准。DMDDP与BD亚型及BD家族史无关。在单变量分析中，在控制了年龄、性别和种族后，DMDDP与功能低下、家庭冲突增加、攻击史和注意力缺陷和/或多动障碍（ADHD）相关（FDR校正的p值分别为：<0.0001、< 0.0001、0.007和0.007）。终生物质使用障碍和药物使用接近显著性（校正p = 0.05）。在逻辑回归中，DMDDP与父母报告的更大的家庭冲突（比值比[OR] 1.17;置信区间[CI- 1.06-1.30; p = 0.001]）和更大的功能障碍（OR 0.89; CI 0.82-0.97; p = 0.006）独立相关。DMDDP也与ADHD增加三倍相关，尽管ADHD仅具有轻微显著性（OR 3.3; CI 0.98-10.94; p = 0.05）。
结论
尽管DMDD在表型和生物学上与BD不同，但这些表型在临床环境中通常重叠。这种重叠不能用BD-NOS或非家族性BD来解释。在这个样本中，ADHD与DMDDP的关联引起了一个问题，即唤醒症状是否应该像最初在严重情绪失调表型中阐述的那样保留。减轻这种合并症的过度功能损害的策略是必要的。
OBJECTIVE
The purpose of this study was to examine the prevalence and correlates of disruptive mood dysregulation disorder phenotype (DMDDP) in a clinical population of adolescents with bipolar disorder (BD).
METHODS
DMDD criteria were modified and applied to a sample of 116 adolescents with BD-I (n = 30), BD-II (n = 46) or BD-not otherwise specified (NOS) (n = 40) from a tertiary teaching hospital. Diagnoses were determined via the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Aged Children, Present and Lifetime version (KSADS-PL). Diagnostic and Statistical Manual of Mental Disorders (DSM-5) DMDD Criteria A-G were derived from the KSADS oppositional defiant disorder (ODD) screening interview and supplement, as well as narrative summaries. Chi-square analyses or t tests (p < 0.05) were conducted as appropriate, followed by logistic regression. P values were adjusted using the false discovery rate (FDR) approach.
RESULTS
DMDDP criteria could not be determined for 8 adolescents because of missing data from the ODD supplement. Twenty-five percent of the remainder (27/108) met criteria for DMDDP. DMDDP was not associated with BD subtype or with family history of BD. In univariate analyses, after controlling for age, sex, and race, DMDDP was associated with lower functioning, increased family conflict, assault history, and attention deficit and/or hyperactivity disorder (ADHD) (FDR adjusted p values: <0.0001, < 0.0001, 0.007, and 0.007, respectively). Lifetime substance use disorder and medication use approached significance (adjusted p = 0.05). In logistic regression, DMDDP was independently associated with greater parent-reported family conflict (odds ratio [OR] 1.17; confidence interval [CI- 1.06-1.30; p = 0.001) and greater functional impairment (OR 0.89; CI 0.82-0.97; p = 0.006). DMDDP was also associated with a threefold increase in ADHD, although ADHD was only marginally significant (OR 3.3; CI 0.98-10.94; p = 0.05).
CONCLUSIONS
Despite the positioning of DMDD as phenotypically and biologically distinct from BD, these phenotypes commonly overlap in clinical settings. This overlap is not explained by BD-NOS or by nonfamilial BD. The association of ADHD with DMDDP in this sample draws into question whether arousal symptoms should have been retained as originally elaborated in the severe mood dysregulation phenotype. Strategies to mitigate the excessive functional impairment of this comorbidity are warranted.
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影响因子：
--
作者：
Chambers,WJ;Puig-Antich,J;Hirsch,M;Paez,P;Ambrosini,PJ;Tabrizi,MA;Davies,M
通讯作者：
Davies,M
影响因子：
--
作者：
D. Shaffer;M. Gould;James Robert Brašić;P. Ambrosini;P. Fisher;H. Bird;S. Aluwahlia
通讯作者：
D. Shaffer;M. Gould;James Robert Brašić;P. Ambrosini;P. Fisher;H. Bird;S. Aluwahlia
DOI：
10.1097/00004583-199707000-00021
发表时间：
1997-07-01
影响因子：
13.3
作者：
Kaufman, J;Birmaher, B;Ryan, N
通讯作者：
Ryan, N
DOI：
10.1176/appi.ajp.2010.10050766
发表时间：
2011-02
期刊：
The American journal of psychiatry
影响因子：
--
作者：
Leibenluft E
通讯作者：
Leibenluft E
影响因子：
--
作者：
Birmaher, B;Axelson, D;Keller, M
通讯作者：
Keller, M