title: Disruptive mood dysregulation disorder and chronic irritability in youth at familial risk for bipolar disorder.
abstract: OBJECTIVE
  Disruptive mood dysregulation disorder (DMDD) is a new diagnosis in the DSM-5. Youth with a family history of bipolar disorder (BD) are at increased risk for BD and non-bipolar psychopathology. No studies to date have examined rates of DMDD among offspring of parents with BD. This study examines the risk for DMDD in offspring of parents with BD compared to community controls and considers rates of chronic irritability (independent of a DMDD diagnosis) across diagnoses in youth with parents with BD.
  
  
  METHODS
  Modified DMDD criteria were applied post hoc to 375 offspring of parents with BD and 241 offspring, aged 6 to 17 years, of community control parents. We calculated odds ratios using generalized linear mixed models. In addition, we explored associations with a severe chronic irritability phenotype and various diagnoses in the high-risk cohort.
  
  
  RESULTS
  Offspring of parents with BD were more likely to meet criteria for DMDD than were the offspring of community control parents (Odds ratio [OR] = 8.3, 6.7% vs. 0.8%), even when controlling for demographic variables and comorbid parental diagnoses (OR = 5.4). They also had higher rates of chronic irritability compared to community controls (12.5% vs. 2.5%, χ(2) = 18.8, p < .005). Within the offspring of parents with BD, the chronic irritability phenotype was frequently present in offspring with diagnoses of BD, depression, attention-deficit/hyperactivity disorder, and disruptive behavior disorders.
  
  
  CONCLUSIONS
  Like other non-BD diagnoses, family history of BD increases the risk for DMDD. Severe chronic irritability and temper tantrums are the core features of DMDD, and are associated with mood and behavioral disorders in youth at risk for BD.
authors.affiliation: Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine. Electronic address: sparksgm@upmc.edu.
authors.forename: Garrett M
authors.initials: GM
authors.lastname: Sparks
authors.affiliation: Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine.
authors.forename: David A
authors.initials: DA
authors.lastname: Axelson
authors.affiliation: Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine.
authors.forename: Haifeng
authors.initials: H
authors.lastname: Yu
authors.affiliation: Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine.
authors.forename: Wonho
authors.initials: W
authors.lastname: Ha
authors.affiliation: Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine.
authors.forename: Javier
authors.initials: J
authors.lastname: Ballester
authors.affiliation: Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine.
authors.forename: Rasim S
authors.initials: RS
authors.lastname: Diler
authors.affiliation: Sunnybrook Health Sciences Centre, University of Toronto.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Goldstein
authors.affiliation: Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine.
authors.forename: Tina
authors.initials: T
authors.lastname: Goldstein
authors.affiliation: Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine.
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Hickey
authors.affiliation: Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine.
authors.forename: Cecile D
authors.initials: CD
authors.lastname: Ladouceur
authors.affiliation: Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine.
authors.forename: Kelly
authors.initials: K
authors.lastname: Monk
authors.affiliation: Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine.
authors.forename: Dara
authors.initials: D
authors.lastname: Sakolsky
authors.affiliation: Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine.
authors.forename: Boris
authors.initials: B
authors.lastname: Birmaher
mesh_terms: D000293:Adolescent; D000328:Adult; D001714:Bipolar Disorder / Q000453:epidemiology / Q000235:genetics*; D002648:Child; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D007508:Irritable Mood / Q000502:physiology*; D008297:Male; D019964:Mood Disorders / Q000453:epidemiology / Q000235:genetics*; D010641:Phenotype
keywords: bipolar disorder; disruptive mood dysregulation disorder; familial; high risk; offspring