Pharmacologic Approach to Disruptive Mood Dysregulation Disorder in Children

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Combination treatment may provide relief from the distinctive symptoms of severe, recurrent temper outbursts and persistent irritability.
Combination treatment may provide relief from the distinctive symptoms of severe, recurrent temper outbursts and persistent irritability.
The following article is part of live conference coverage from the 2017 Psych Congress in New Orleans, Louisiana. Psychiatry Advisor's staff will be reporting breaking news associated with research conducted by leading experts in psychiatry, as well as presentations from the Congress. Visit Psychiatry Advisor's conference section for continuous coverage live from Psych Congress 2017.

NEW ORLEANS — A paucity of research and minimal guidance in the management of symptoms presents a challenge to both clinicians and parents of children with disruptive mood dysregulation disorder, a new diagnosis included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).  Characterized by persistent, severe temper outbursts and an irritable or angry mood out of proportion to the situation, this condition has the potential to significantly impair a child's quality of life and academic performance and can compromise friendships and familial relationships.

In a poster presentation at the 2017 Psych Congress, a team of researchers from UHS Neurobehavioral Systems in Austin, Texas, described a neuropsychopharmacological approach to the condition that goes beyond current treatments that are often unsuccessful.  The medication protocol included a combination of anticonvulsant to manage mood lability and temper outbursts and a dopamine agonist to address irritability, impulsivity, and difficulty with concentration.

The study involved 91 children and adolescents (52 male, 39 female) ranging in age from 6 to 17 years, with documented inpatient treatment for severe aggression, impulsive behavior, and mood lability.  Retrospective chart review confirmed a diagnosis of disruptive mood dysregulation disorder.  Upon discharge, and with outpatient healthcare provider endorsement, the patients were prescribed oxcarbazepine and amantadine.  Little to no antipsychotic medication was prescribed.

A survey deployed to caregivers 1 year postdischarge assessed adherence to the protocol. For those patients who maintained the protocol with little to no adjustment, 8% (5 of 64) required rehospitalization compared with 26% (7 of 27) who were reported to have discontinued the protocol or substituted other medications.

The investigators report that “the protocol described significantly lowered rates of rehospitalization and potentially improved functional progress.”  Further investigation will be needed to provide evidence to guide diagnosis and treatment of this condition.

Disclaimer:  The investigators report the off-label use of oxcarbazepine and amantadine in this study.

Visit Psychiatry Advisor's conference section for continuous coverage live from Psych Congress 2017.

Reference

Matthews D, Matthews G. Disruptive mood dysregulation disorder: a unique pediatric neuropsychopharmacological approach. Poster presentation at: Psych Congress; September 16-19, 2017; New Orleans, LA.


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