title: Mood regulation in youth:  research findings and clinical approaches to irritability and short-lived episodes of mania-like symptoms.
abstract: OBJECTIVE
  Mood regulation problems, such as severe chronic irritability or short episodes of mania-like symptoms, are common, impairing and a topic of intense recent interest to clinicians, researchers and the Diagnostic and Statistical Manual (DSM)-5 process. Here, we review the most recent findings about these two presentations and discuss the approaches to their treatment.
  
  
  RESULTS
  Longitudinal and genetic findings suggest that chronic irritability should be regarded as a mood problem that is distinct from bipolar disorder. A proportion of children with short (less than 4 days) episodes of mania-like symptoms seem to progress to classical (Type I or II) bipolar disorder over time in the US clinic samples. In a UK sample, such episodes were independently associated with psychosocial impairment. The evidence base for the treatment of either irritability or short-lived episodes of mania-like symptoms is still small. Clinicians should be cautious with extrapolating treatments from classical bipolar disorder to these mood regulation problems. Cognitive and behavioural therapy (CBT)-based approaches targeting general mood regulation processes may be effective for cases with severe irritability or short episodes of mania-like symptoms.
  
  
  CONCLUSIONS
  There is increasing research evidence for the importance of mood regulation problems in the form of either irritability or short episodes of mania-like symptoms in youth. The evidence base for their drug treatment has yet to be developed. CBT-based interventions to modify the processes of mood regulation may be a useful and well tolerated intervention for patients with these presentations.
authors.affiliation: King's College London, Institute of Psychiatry, Mood Disorder Clinic, Michael Rutter Centre for Children & Young People, Maudsley Hospital, London, UK.
authors.forename: Eleanor
authors.initials: E
authors.lastname: Leigh
authors.forename: Patrick
authors.initials: P
authors.lastname: Smith
authors.forename: Gordana
authors.initials: G
authors.lastname: Milavic
authors.forename: Argyris
authors.initials: A
authors.lastname: Stringaris
mesh_terms: D000293:Adolescent; D000928:Antidepressive Agents / Q000627:therapeutic use; D018692:Antimanic Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000175:diagnosis / Q000628:therapy*; D002648:Child; D015928:Cognitive Behavioral Therapy; D003937:Diagnosis, Differential; D018765:Dopamine Uptake Inhibitors / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007508:Irritable Mood; D008297:Male; D006113:United Kingdom
chemical_list: D000928:Antidepressive Agents; D018692:Antimanic Agents; D014150:Antipsychotic Agents; D018765:Dopamine Uptake Inhibitors