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Evidence-based treatments for youths with severely dysregulated mood: a qualitative systematic review of trials for SMD and DMDD

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Abstract

The aim of this literature review was to examine the evidence for psychotherapeutic and pharmacological treatments in subjects with severely dysregulated mood and to identify potential areas for improvements in research designs. A literature search was conducted using several databases for published (PubMed, PsycINFO) and ongoing (clinical trial registries) studies conducted in youths who met NIMH’s criteria for Severe Mood Dysregulation (SMD) or the DSM-5 diagnosis of Disruptive Mood Dysregulation Disorder (DMDD). Eight completed studies were identified: three randomized trials, four open pilot studies and one case report. Seven ongoing studies were found in trial registries. The available evidence suggests potential efficacy of psychotherapies which have previously been developed for internalizing and externalizing disorders. The two main pharmacological strategies tested are, first, a monotherapy of psychostimulant or atypical antipsychotic such as risperidone, already used in the treatment of severe irritability in youths with developmental disorders; and second, the use of a serotonergic antidepressant as an add-on therapy in youths treated with psychostimulant. Ongoing studies will further clarify the effectiveness of psychotherapeutic interventions for DMDD individuals and whether they should be given alone or in conjunction with other treatments. The short duration of the trials for a chronic disorder, the low number of studies, the lack of placebo or active comparator arm, and restrictive inclusion criteria in most of the controlled trials dramatically limit the interpretation of the results. Finally, future research should be conducted across multiple sites, with standardized procedures to measure DMDD symptoms reduction, and include a run-in period to limit placebo effect.

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Abbreviations

DMDD:

Disruptive mood dysregulation disorder

SMD:

Severe mood dysregulation

ADHD:

Attention deficit with hyperactivity disorder

ODD:

Oppositional defiant disorder

CD:

Conduct disorder

SAD:

Separation anxiety disorder

AD:

Anxiety disorders

MDD:

Major depressive disorder

NIMH:

National Institute of Mental Health

CBT:

Cognitive behavioral therapy

BPT:

Behavioral parental training

DBD:

Disruptive behavior disorders interview

WASH-U-KSADS:

Washington University Kiddie Schedule for Affective Disorders and Schizophrenia

CGI-I:

Clinical global impressions–improvement

CGI-S:

Clinical global impressions–severity

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Authors and Affiliations

  1. Department of Child And Adolescent Psychiatry, Pitié-Salpêtrière Hospital, 47-83 boulevard de l’Hôpital, 75013, Paris, France

    Xavier Benarous, Angèle Consoli, Jean-Marc Guilé, David Cohen & Bertrand Olliac

  2. INSERM U-669, PSIGIAM, Paris, France

    Angèle Consoli

  3. Groupe de Recherches sur l’Analyse Multimodale de la Fonction Cérébrale, INSERM U1105, CHU, Université Picardie Jules Verne, Amiens, France

    Jean-Marc Guilé & Sébastien Garny de La Rivière

  4. Department of Psychiatry, McGill University, Montreal, Canada

    Jean-Marc Guilé

  5. CNRS UMR 7222, Institute for Intelligent Systems and Robotics-ISIR, Paris, France

    David Cohen

  6. Pôle Hospitalo-Universitaire de psychiatrie de l’enfant et de l’adolescent, Centre Hospitalier Esquirol, Limoges, France

    Bertrand Olliac

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  1. Xavier Benarous
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Benarous, X., Consoli, A., Guilé, JM. et al. Evidence-based treatments for youths with severely dysregulated mood: a qualitative systematic review of trials for SMD and DMDD. Eur Child Adolesc Psychiatry 26, 5–23 (2017). https://doi.org/10.1007/s00787-016-0907-5

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