title: Disruptive mood dysregulation disorder, severe mood dysregulation and chronic irritability in youth at high familial risk of bipolar disorder.
abstract: OBJECTIVE
  Disruptive mood dysregulation disorder is a newly proposed childhood disorder included in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition to describe children ⩽18 years of age with chronic irritability/temper outbursts. This study aimed to examine the prevalence of disruptive mood dysregulation disorder, severe mood dysregulation and chronic irritability in an Australian study of young people at increased familial risk of developing bipolar disorder ('HR' group) and controls ('CON' group).
  
  
  METHODS
  A total of 242 12- to 30-year-old HR or CON subjects were administered the severe mood dysregulation module. Of these, 42 were aged ⩽18 years at the time of assessment, with 29 subjects in the HR group and 13 in the CON group.
  
  
  RESULTS
  No subjects ⩽18 years - in either group - fulfilled current or lifetime criteria for disruptive mood dysregulation disorder or severe mood dysregulation, the precursor to disruptive mood dysregulation disorder. Similarly, no subjects in either group endorsed the severe mood dysregulation/disruptive mood dysregulation disorder criteria for irritable mood or marked excessive reactivity. One HR participant endorsed three severe mood dysregulation criteria (distractibility, physical restlessness and intrusiveness), while none of the comparison subjects endorsed any criteria. Exploratory studies of the broader 12- to 30-year-old sample similarly found no subjects with severe mood dysregulation/disruptive mood dysregulation disorder in either the HR or CON group and no increased rates of chronic irritability, although significantly more HR subjects reported at least one severe mood dysregulation/disruptive mood dysregulation disorder criterion (likelihood ratio = 6.17; p = 0.013); most of the reported criteria were severe mood dysregulation 'chronic hyper-arousal' symptoms.
  
  
  CONCLUSIONS
  This study comprises one of the few non-US reports on the prevalence of disruptive mood dysregulation disorder and severe mood dysregulation and is the first non-US study of the prevalence of these conditions in a high-risk bipolar disorder sample. The failure to replicate the finding of higher rates of disruptive mood dysregulation disorder and chronic irritability in high-risk offspring suggests that these are not robust precursors of bipolar disorder.
authors.affiliation: 1 School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.|2 Clinical and Health Psychology Research Initiative (CaHPRI), School of Social Sciences & Psychology, Western Sydney University, Penrith, NSW, Australia.
authors.forename: Tania
authors.initials: T
authors.lastname: Perich
authors.affiliation: 1 School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.|3 Black Dog Institute, Randwick, NSW, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Frankland
authors.affiliation: 1 School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.|3 Black Dog Institute, Randwick, NSW, Australia.
authors.forename: Gloria
authors.initials: G
authors.lastname: Roberts
authors.affiliation: 1 School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Florence
authors.initials: F
authors.lastname: Levy
authors.affiliation: 1 School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.|4 Neuroscience Research Australia, Randwick, NSW, Australia.
authors.forename: Rhoshel
authors.initials: R
authors.lastname: Lenroot
authors.affiliation: 1 School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.|2 Clinical and Health Psychology Research Initiative (CaHPRI), School of Social Sciences & Psychology, Western Sydney University, Penrith, NSW, Australia.|5 Prince of Wales Private Hospital, Randwick, NSW, Australia.
authors.forename: Philip B
authors.initials: PB
authors.lastname: Mitchell
mesh_terms: D000293:Adolescent; D000328:Adult; D001315:Australia / Q000453:epidemiology; D001714:Bipolar Disorder / Q000453:epidemiology*; D002648:Child; D002653:Child Behavior Disorders / Q000145:classification / Q000453:epidemiology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D007508:Irritable Mood; D008297:Male; D019964:Mood Disorders / Q000145:classification / Q000453:epidemiology*; D012306:Risk; D055815:Young Adult
keywords: Disruptive mood dysregulation disorder; bipolar disorder; high risk; irritability; severe mood dysregulation