Neobook — clinical reference

ICD-10 code: F34.81

DESCRIPTION

This is a new addition to DSM 5. Children and adolescents present with a history of chronic, severe, persistent irritability. The irritability presents as frequent temper outbursts with an underlying angry, irritable mood. The onset of symptoms is before 10 years and should not be applied to children with a developmental age less than 6 years. Conversion of non-episodic irritability to bipolar disorder is low. They are at higher risk of developing depressive and anxiety disorders in adulthood.

It is important to consider the differential diagnoses. These include:

Mood disorders, e.g. major depressive disorder, bipolar disorder.
Behavioural disorders, e.g. oppositional defiant disorder (ODD); anxiety disorders.
Neurodevelopmental disorders, e.g. ADHD, autism spectrum disorder (ASD).
Impulse control disorders, e.g. intermittent explosive disorder.

DIAGNOSTIC CRITERIA (DSM 5)

Temper outbursts that are severe and recurrent that manifest verbally or behaviourally, are out of proportion in intensity and duration to the situation or provocation, are inconsistent with the developmental level and occur > 3 times per week.
The mood between the temper outbursts is persistently irritable or angry for most of nearly every day and is observable by others.
Symptoms must be present for > 12 months with symptom-free periods that do not exceed 3 months.
Occurs in > 2 settings and is severe in at least one setting.
Age of diagnosis: 6 - 17 years.
Age of onset of symptoms: < 10 years.
Exclude psychiatric disorders, medical conditions and the effects of substance use.
There are high rates of comorbidity that include disruptive behavioural disorders, mood disorders, anxiety disorders and autistic spectrum disorders. If children meet the oppositional defiant disorder or intermittent explosive disorder criteria with DMDD, then only the DMDD diagnosis is given.

Functional consequences
DMDD is associated with significant functional impairment in all areas of patients’ lives due to their extremely low frustration tolerance. This has a severe impact on family and peer relationships, academic performance and participation in extra-mural activities.

MEDICATION TREATMENT

Currently no specific treatment guidelines exist due to the lack of studies. Many patients present with ADHD and DMDD. The ADHD can be treated with methylphenidate but worsening of the mood may occur with severe aggression.

REFERRAL

Co-morbid DMDD should be referred to a psychiatrist.

Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Paediatrics, 2023 Edition

Chapter 14: Child & Adolescent Psychiatry, 14.4 Mood Disorders, 14.4.3. Disruptive Mood Dysregulation Disorder (DMDD)