Treatment Options for the Cardinal Symptoms of Disruptive Mood Dysregulation Disorder.
OBJECTIVE
DSM-5 has added a new developmentally appropriate child and adolescent mood disorder subtype called disruptive mood dysregulation disorder (DMDD). The core features of DMDD are temper outbursts (manifested by either verbal rages and/or physical aggression) and unrelenting irritability or anger. Currently, the literature is lacking a thorough review of the possible treatment options for the cardinal symptoms constituting DMDD. The objective of this article is to provide a thorough review of peer-reviewed studies on the subject of pharmacological treatment options for children and adolescents with the cardinal symptoms of DMDD.


METHODS
Relevant articles for this study were obtained through Pubmed, Medline, PsychINFO and PsychINDEXplus using the key words: "adolescents," "children," "paediatric," "youth," "irritability," "temper outbursts," "aggression," "rage," "disruptive behaviour," "treatment," "dysphoria," "autism," "mental retardation/intellectual disability," "impulsivity," "ADHD," "oppositional defiant disorder," and "conduct disorder." A total of 823 studies were generated; only English studies focusing on pharmacological treatment were retained.


RESULTS
Currently there are no established guidelines or thorough reviews summarizing the treatment of DMDD. Pharmacotherapeutic treatment options of both aggression and chronic irritability include: antidepressants/selective norepinephrine reuptake inhibitors, mood stabilizers, psychostimulants, antipsychotics, and alpha-2 agonists.


CONCLUSIONS
Treatment options of severe, persistent irritability in youth are numerous, and a consensual treatment algorithm has not yet emerged from the literature. Further studies and clinical trials are warranted to determine efficacious and safe treatment modalities.
McGill University - Douglas Mental Health University Institute, Montreal, Quebec.
Leon
L
Tourian
McGill University - Douglas Mental Health University Institute, Montreal, Quebec.
Amélie
A
LeBoeuf
HRDP - Université de Montréal, Montreal, Quebec.
Jean-Jacques
JJ
Breton
Université Pierre et Marie Curie, - GH Pitié Salpêtrière, Paris, France.
David
D
Cohen
Institut Philippe Pinel - Université de Montréal, Montreal, Quebec.
Martin
M
Gignac
Université du Québec à Montréal - Psychology, Montreal, Quebec.
Réal
R
Labelle
CHU - Université Jules Verne, Amiens, France.
Jean-Marc
JM
Guile
McGill University - Douglas Mental Health University Institute, Montreal, Quebec.
Johanne
J
Renaud
aggression; bipolar disorder; depression; disruptive mood dysregulation; irritability; mood stabilizers