Evidence-based treatments for youths with severely dysregulated mood: a qualitative systematic review of trials for SMD and DMDD.
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.
Department of Child And Adolescent Psychiatry, Pitié-Salpêtrière Hospital, 47-83 boulevard de l'Hôpital, 75013, Paris, France. xavierbenarous@gmail.com.
Xavier
X
Benarous
Department of Child And Adolescent Psychiatry, Pitié-Salpêtrière Hospital, 47-83 boulevard de l'Hôpital, 75013, Paris, France.|INSERM U-669, PSIGIAM, Paris, France.
Angèle
A
Consoli
Department of Child And Adolescent Psychiatry, Pitié-Salpêtrière Hospital, 47-83 boulevard de l'Hôpital, 75013, Paris, France.|Groupe de Recherches sur l'Analyse Multimodale de la Fonction Cérébrale, INSERM U1105, CHU, Université Picardie Jules Verne, Amiens, France.|Department of Psychiatry, McGill University, Montreal, Canada.
Jean-Marc
JM
Guilé
Groupe de Recherches sur l'Analyse Multimodale de la Fonction Cérébrale, INSERM U1105, CHU, Université Picardie Jules Verne, Amiens, France.
Sébastien
S
Garny de La Rivière
Department of Child And Adolescent Psychiatry, Pitié-Salpêtrière Hospital, 47-83 boulevard de l'Hôpital, 75013, Paris, France.|CNRS UMR 7222, Institute for Intelligent Systems and Robotics-ISIR, Paris, France.
David
D
Cohen
Department of Child And Adolescent Psychiatry, Pitié-Salpêtrière Hospital, 47-83 boulevard de l'Hôpital, 75013, Paris, France.|Pôle Hospitalo-Universitaire de psychiatrie de l'enfant et de l'adolescent, Centre Hospitalier Esquirol, Limoges, France.
Bertrand
B
Olliac
D000293:Adolescent; D014150:Antipsychotic Agents / Q000627:therapeutic use; D002908:Chronic Disease; D019317:Evidence-Based Medicine / Q000379:methods / Q000592:standards*; D005260:Female; D006801:Humans; D007508:Irritable Mood; D008297:Male; D019964:Mood Disorders / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D010865:Pilot Projects; D011613:Psychotherapy / Q000379:methods / Q000592:standards; D016032:Randomized Controlled Trials as Topic / Q000379:methods / Q000592:standards; D018967:Risperidone / Q000627:therapeutic use
D014150:Antipsychotic Agents; D018967:Risperidone
Disruptive mood dysregulation disorder; Irritability; Pharmacotherapy; Psychotherapy; Severe mood dysregulation; Therapeutics
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