Disruptive Mood: Irritability in Children and Adolescents

169 Pages·2015·2.27 MB·English

by  Argyris Stringaris

Disruptive Mood
Irritability in Children
and Adolescents

Disruptive Mood
Irritability in Children
and Adolescents
Argyris Stringaris
Institute of Psychiatry Psychology and Neuroscience,
King’s College London and Mood Disorder Clinic
for Young people, Maudsley Hospital
and
Eric Taylor
Institute of Psychiatry Psychology and Neuroscience,
King’s College London
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Acknowledgements
Professor Taylor gratefully acknowledges the support of the Medical Re-
search Council UK and the Wellcome Trust. Dr Stringaris is grateful for the
support from the Wellcome Trust and from the National Institute of Health
Research Biomedical Research Centre.

Contents
About the authors viii
1 Irritability: overview and introduction 1
2 Terminology 5
3 Assessment of children with irritability 9
4 The development of anger 17
5 Prevalence, comorbidity, and course across development 31
6 Neuroscience of irritability 37
7 ADHD and irritability 51
8 Irritability in autism spectrum disorders 63
9 Irritability and disruptive behaviour disorders 73
10 Irritability and bipolar disorder 77
11 Irritability in depressive disorders 95
12 Irritability and disruptive mood dysregulation disorder 105
13 Irritability in brain disorders and brain damage 111
14 Clinical management of irritability and disruptive mood 117
15 Future directions and a model for irritability 129
Appendix 133
References 137
Index 155
About the authors
Argyris Stringaris, MD, PhD, MRCPsych, is a clinician scientist studying
mood across human development. He trained in psychiatry at the Maudsley
Hospital in London, received his PhD at the Institute of Psychiatry at King’s
College London, and was a Clinical Research Fellow at the National Institute
of Mental Health (NIMH) in the USA. He is a Consultant Child and Ado-
lescent Psychiatrist (Attending Physician) with the Mood Disorder Team for
Young People at the Maudsley Hospital and a Senior Lecturer at the Institute
of Psychiatry, King’s College London.
Eric Taylor, MB, FRCP, FRCPsych(Hon), FMedSci has researched, taught,
and practised child neuropsychiatry for some 40 years. At The Maudsley
Hospital in London he introduced and evaluated a range of treatments, be-
came a director, and is now an honorary consultant. At the Institute of Psy-
chiatry of King’s College London he published many research papers and
several textbooks and guidelines for practice; he was Head of the Depart-
ment of Child and Adolescent Psychiatry and is now an Emeritus Professor.
Chapter 1
Irritability: overview
and introduction
Children with severe irritability present very often to child mental health
services, and there is continuing argument about how to help these young
people and their families. To recognize the needs of children with severe ir-
ritability, a new condition based on it has been brought into the diagnostic
scheme of the fifth edition of the American Psychiatric Association’s Diag-
nostic and Statistical Manual of Mental Disorders (DSM-5), the classification
system for psychiatric disorders used worldwide. We have written the pre-
sent book to bring together scientific and clinical knowledge from several
sources and help clinicians to understand the origins and management of
irritable states in children and adolescents. Our overall perspective is that
clinical irritability is best seen as an emotional extreme:
◆ Irritability is a trait of excessive anger—excessive in frequency, duration,
intensity, ease of elicitation, and/or uncontrollability. In Chapter 2
we define the terms used more closely. In Chapter 3 we describe the
assessment of irritability.
◆ Irritability can lead to aggression towards other people, but very often
does not (and there are many other causes of aggression). Researchers
and clinicians sometimes regard irritability purely as a matter of
disruptive behaviour. This can lead to neglect of the emotional aspects.
Chapter 4 describes the early development of the emotion of anger, and
the reasons for individual differences in its qualities. Chapter 5 goes on
to its prevalence and the course of irritability over time. A central point
is that the key risks it imposes for adult life are mood disorders, such as
depression, and impaired adaptive function.
◆ Irritability can occur in several different disorders with overlapping
diagnostic definitions that often occur together: this can lead to
confusion amongst clinicians. Chapters 7–12 deal with the differences
in presentation in different psychological disorders, such as attention
deficit/hyperactivity disorder (ADHD), autism, and mood disorders,
and with the evidence base for treatment.