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Disruptive Mood Dysregulation Disorder and Chronic Irritability in Youth at Familial Risk for Bipolar DisorderSparks GM, Axelson DA, Yu H, Ha W, Ballester J, Diler RS, Goldstein B, Goldstein T, Hickey MB, Ladouceur CD, Monk K, Sakolsky D and Birmaher B
Journal of the American Academy of Child and Adolescent Psychiatry 53:408-416, 2014

Disruptive mood dysregulation disorder (DMDD) is a new diagnosis in the DSM-5. Children and adolescents with a family history of bipolar disorder are at increased risk for bipolar disorder and non-bipolar psychopathology, but to date no studies have examined rates of DMDD among offspring of parents with bipolar disorder. 

Dr. Garrett Sparks and his colleagues in the Child and Adolescent Bipolar Disorders program examined the risk for DMDD in offspring of parents with bipolar disorder compared to community controls and considered rates of chronic irritability (independent of a DMDD diagnosis) across diagnoses in youth of parents with bipolar disorder.  The investigators applied modified DMDD criteria to 375 offspring of parents with bipolar and 241 offspring, ages 6 to 17 years old, of community control parents, and calculated odds ratios using generalized linear mixed models. They also examined associations with a severe chronic irritability phenotype and various diagnoses in the high-risk cohort.  

The researchers found that the offspring of parents with bipolar disorder were more likely to meet criteria for DMDD than the offspring of community control parents (odds ratio = 8.3, 6.7% vs. 0.8%), even when controlling for demographic variables and comorbid parental diagnoses (odds ratio = 5.4). This group also demonstrated higher rates of chronic irritability compared to community controls (12.5% vs. 2.5%). Within the offspring of parents with bipolar disorder, the chronic irritability phenotype was frequently present in offspring with diagnoses of bipolar disorder, depression, attention-deficit/hyperactivity disorder or disruptive behavior disorders.  Their findings suggest that a family history of bipolar disorder, like other non-bipolar disorder diagnoses, 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 bipolar disorder.  Longitudinal studies could elucidate whether severe chronic irritability in the offspring of a parent with bipolar disorder may be associated with a differential risk for later development of bipolar disorder.

Contributors:
Garrett M. Sparks, MD, MS; David A. Axelson, MD; Haifeng Yu, MS; Wonho Ha, PhD; Javier Ballester, MD; Rasim S. Diler, MD; Tina Goldstein, PhD; Mary Beth Hickey, BA; Cecile D. Ladouceur, PhD; Kelly Monk, RN; Dara Sakolsky, MD, PhD; and Boris Birmaher, MD (Department of Psychiatry, University of Pittsburgh School of Medicine)Benjamin Goldstein, MD, PhD (Sunnybrook Health Sciences Centre, University of Toronto)

This article appeared in the Journal of the American Academy of Child and Adolescent Psychiatry.  Click here to view the abstract for this publication.