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Longitudinal clinical outcomes of children with severe mood dysregulation (SMD)

Friday, November 08, 2013 — Poster Session III

10:00 a.m. – 12:00 p.m.

FAES Academic Center (Upper-Level Terrace)




  • E. J. Reeves
  • C. M. Deveney
  • R. E. Hommer
  • M. A. Brotman
  • A. Stringaris
  • E. Leibenluft


The long-term prognosis of youths with severe, chronic irritability and hyperarousal symptoms (operationalized here as severe mood dysregulation; SMD) is largely unknown. Once hypothesized to be a developmental phenotype of bipolar disorder, epidemiologic studies suggest that chronic, severe childhood irritability predicts later onset of unipolar depressive and anxiety disorders. Yet, little work has directly studied these children and followed them longitudinally. As part of an ongoing NIMH study, the present research sought to identify and evaluate youths with SMD, and complete diagnostic interviews and inventories of mood and irritability symptoms at two year intervals. Of 200 SMD youth, 78 children completed two year and 46 completed four year follow-up. Analyses reveal that 47% continued to meet criteria for SMD after two years and 37% after four years. Notably, the majority exhibited subthreshold SMD symptoms and remained impaired by irritability. At all time points, high rates of co-occurring depressive and anxiety disorders were observed, including new onsets at two and four years. These findings demonstrate that severe irritability in youth is associated with significant impairment and has long-lasting effects on social, academic, and family functioning. Implications for the new, related DSM-V diagnosis of Disruptive Mood Dysregulation Disorder, are also discussed.

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