Disruptive Mood Dysregulation Disorder

Question 1

how many diagnostic criteria are there for DMDD

Answer 1

11

Question 2

criterion A for DMDD

Answer 2

severe, recurrent TEMPER OUTBURSTS manifested verbally and/or behaviourally that are GROSSLY OUT OF PROPORTION in intensity or duration to the situation or provocation

Question 3

criterion B for DMDD

Answer 3

the temper outbursts are inconsistent with developmental level

Question 4

criterion C for DMDD

Answer 4

the temper outbursts occur, on average, THREE OR MORE TIMES per WEEK

Question 5

criterion D for DMDD

Answer 5

the mood between temper outbursts is persistently IRRITABLE or ANGRY most of the day, early every day and is OBSERVABLE by others

Question 6

criterion E for DMDD

Answer 6

criteria A-D have been present for 12 or MORE MONTH

throughout that time, the individual has not has a period lasting three or more consecutive months without ALL of the symptoms in critiera A-D

Question 7

criterion F for DMDD

Answer 7

criteria A and D are present in at least 2/3 settings (i.e home, school, with peers) and are severe in at least one of those

Question 8

criterion G for DMDD

Answer 8

the diagnosis should not be made for the first time before age 6 or after age 18

Question 9

criterion H for DMDD

Answer 9

by history of observation the age at onset for criteria A-E is BEFORE age 10

Question 10

criterion I for DMDD

Answer 10

there has never been a distinct period lasting more than ONE day during which the full symptom criteria, except duration, for a manic or hypomanic episode have been met

Question 11

criterion J for DMDD

Answer 11

the behaviours do not occur exclusively during an episode of MDD and are not better explained by another mental disorder

*this dx CANNOT coexist with ODD, IED or bipolar disorder though it CAN coexist with others like MDD, ADHD, CD and SUD

*if kid meets criteria for both ODD and DMDD should ONLY get diagnosis of DMDD

Question 12

criterion K for DMDD

Answer 12

symptoms not attributable to physiological effects of a substance or another medical or neurological condition

Question 13

how often must the temper outbursts of DMDD occur to meet DSM criteria

Answer 13

at least 3 or more times per week (criterion C)

Question 14

how long must a kid have been symptomatic with irritability and temper outbursts to meet duration criteria for DMDD in the DSM?

Answer 14

12+ months

*during that time, can not have had a period lasting 3 or more consecutive months without ALL of the symptoms in criteria A-D (temper outbursts that are inconsistent with developmental level occurring at least 3x per week and it irritable in between)

Question 15

in how many settings must the DMDD symptoms occur to meet criteria

Answer 15

2/3

Question 16

dx of DMDD cannot be made before what age

Answer 16

6

Question 17

dx of DMDD cannot be made after what age

Answer 17

18

Question 18

symptoms of DMDD must have started before what age to meet criteria

Answer 18

age 10

Question 19

what is the core feature of DMDD

Answer 19

chronic, severe, persistent irritability

(with temper outbursts)

Question 20

when do the outbursts associated with DMDD typically occur

Answer 20

in response to frustration

can be verbal or behavioural (i.e in form of aggression against property, self or others)

Question 21

rates of DMDD appear to be higher in which populations

Answer 21

higher in males and school age children

(lower in females and adolescents)

Question 22

what is the 6-12 month period prevalence of DMDD

Answer 22

2-5%

Question 23

within what age range has the dx of DMDD been validated

Answer 23

6-18 years

Question 24

what % of kids that present with severe, chronic irritability will have a presentation that continues to meet criteria for DMDD a year later

Answer 24

about 50%

Question 25

it is common for severe, nonepisodic irritability to convert to bipolar disorder

Answer 25

rates of conversion are low to bipolar (more likely to develop unipolar depression/anxiety)

Question 26

what is one reason children with DMDD have difficulty succeeding in school

Answer 26

because of their extremely low frustration tolerance

Question 27

how do levels of dysfunction compare between children with bipolar disorder and those with DMDD

Answer 27

comparable generally

both cause severe severe disruption in the lives of the affected individuals and their families

dangerous behaviour, SI and SA, severe aggression and hospitalization are common in boh

Question 28

ddx DMDD

Answer 28

bipolar disorders

ODD

ADHD

MDD

anxiety disorders

ASD

IED

Question 29

what is the central feature that differentiates DMDD from bipolar disorder

Answer 29

the longitudinal course of the core symptoms–>

bipolar I and II are episodic, with episodes that can be clearly distinguishes from the child’s baseline

in DMD sx are persistent and present over many months though may wax and wane slightly

also there is so euphoric/elevated mood in DMDD

Question 30

what distinguishes DMDD from ODD

Answer 30

the mood symptoms associated with DMDD are relatively rare in children with ODD

*MOST kids whose symptoms meet criteria for DMDD will also have a presentation that meets criteria for ODD –> but the reverse is not the case (in those with ODD, only 15% would also meet criteria for DMDD)

Question 31

can you diagnose ODD and DMDD in the same kid?

Answer 31

no–> if criteria for both are met, then dx is DMDD

Question 32

can you diagnose both DMDD and IED in the same kid?

Answer 32

no

Question 33

are there any FDA approved medications for use in DMDD

Answer 33

no

Question 34

describe management of DMDD

Answer 34

should focus on helping children and teens improve emotional dysregulation through parental, school and professional support

social skills training may also be helpful