{"id":31143,"date":"2012-12-19T18:46:47","date_gmt":"2012-12-19T23:46:47","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=31143"},"modified":"2012-12-19T19:24:47","modified_gmt":"2012-12-20T00:24:47","slug":"let-the-circle-be-unbroken","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2012\/12\/19\/let-the-circle-be-unbroken\/","title":{"rendered":"let the circle be unbroken…"},"content":{"rendered":"
I’m sympathetic to the dilemma of the Child Psychiatrists and parents when they are presented with the a chronically out-of-control kid. I have seen some myself and they are diagnostic and management problems of the first order, particularly in an era where there’s no inpatient back-up for evaluation. We’ve all have heard the debate about the Bipolar Child, persistent for the last several decades – Dr. Biederman’s super angry grouchy cranky irritable kids [bipolar kids: biedermania and super angry\/grouchy\/cranky irritability…<\/a>]. The DSM-5 is approaching the confusion by adding a new diagnostic category – Disruptive Mood Dysregulation Disorder<\/font><\/strong>. So I took a look at the Field Trials to see how that category fared:<\/div>\n
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DSM-5 Field Trials in the United States and Canada, Part II: Test-Retest Reliability of Selected Categorical Diagnoses and Analytic Approaches<\/font><\/strong><\/u><\/a>
by Darrel A. Regier, William E. Narrow, Diana E. Clarke, Helena C. Kraemer, S. Janet Kuramoto, Emily A. Kuhl, and David J. Kupfer<\/sup>
American Journal of Psychiatry.<\/font><\/strong> 2012 October 30, AJP in Advance<\/font><\/strong><\/div>\n

[modified to fit]<\/sup><\/div>\n<\/blockquote>\n
The group below were considered unsuccessful because the 95% confidence limits were unacceptably broad [Bipolar being one of them]:<\/div>\n
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[modified to fit]<\/sup><\/div>\n<\/blockquote>\n
This is the commentary about the Disruptive Mood Dysregulation Disorder<\/font><\/strong> results from the article:
<\/strong><\/div>\n
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"Disruptive mood dysregulation disorder. This condition was proposed to differentiate patients with pediatric bipolar disorder and those with some similar symptoms who did not progress to adult bipolar disorder. However, the field trial data present a challenging case in which one site, the one with the largest number of patients [predominantly from the inpatient service], produced a good level kappa of 0.49 [95% CI=0.33–0.66], whereas two other sites that obtained patients primarily from outpatient settings produced unacceptable kappas. Since the major distinction between this disorder and oppositional defiant disorder or intermittent explosive disorder is the presence of persistent irritability and anger mood states between frequent rage reactions, it appears that this disorder is more reliably diagnosed in its more severe form and with longitudinal assessment associated with inpatient hospitalization. This is consistent with the “severe mood dysregulation” disorder, which has been differentiated from pediatric bipolar disorder in the NIMH studies that provided the research basis for this proposal."<\/strong><\/sup><\/div>\n<\/blockquote>\n
What a mega-wad of confusion! Conduct Disorder? Oppositional Defiant Disorder?, Bipolar Disorder? Intermittent Explosive Disorder? Disruptive Mood Dysregulation Disorder? And the distinction in the text doesn’t help very much in that the inpatient versus outpatient parameter may well reflect availability of services rather than severity. This is obviously a work in progress, and I can’t envision how the DMDD diagnosis is going to contribute much to that progress. But this is not the beginning of the Disruptive Mood Dysregulation Disorder<\/font><\/strong> narrative. It’s already in its second decade. Here’s what I wrote in June 2011, trying to summarize the high points and sleuth it out [trial 93: a bad penny…<\/a>, trial 93: a very<\/u> bad penny…<\/a>, trial 93: a very<\/u> very<\/u> bad penny…<\/a>]:<\/div>\n
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Finding out that Janssen had tried and failed to get Risperdal approved for disruptive kids through the FDA sometime after 1998 got that all stirred up in my mind again. Here is the timeline that keeps rolling around in my mind…<\/strong><\/sup><\/div>\n