Chronically irritable mood with frequent temper outbursts

2021 ◽  
pp. 71-78
Author(s):  
Lauren N. Deaver
Keyword(s):  
Selective Serotonin Reuptake Inhibitors ◽  
Treatment Plan ◽  
Comprehensive Treatment ◽  
Diagnostic And Statistical Manual ◽  
Psychotherapeutic Interventions ◽  
Second Generation Antipsychotics ◽  
Critical Components ◽  
New Diagnosis ◽  
Property Destruction ◽  
Temper Outbursts

Disruptive mood dysregulation disorder (DMDD) is a new diagnostic addition to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The core feature of the disorder is chronic, severe, and persistent irritability that manifests as frequent temper outbursts that are inconsistent with the patient’s developmental level. The temper outbursts can be verbal or behavioral including physical aggression or property destruction. Between outbursts, the child remains persistently irritable or angry for most of the day, nearly every day. These symptoms persist across time and settings and are easily observable by others. Psychotherapeutic interventions including parent training and individual psychotherapy are critical components of a comprehensive treatment plan. Since DMDD is a new diagnosis, there are no published randomized controlled medication trials. The use of selective serotonin reuptake inhibitors (SSRIs) or second-generation antipsychotics may be considered for decreasing irritability.

scholarly journals Trichotillomania: What Do We Know So Far?

2021 ◽  
pp. 1-7
Author(s):  
Daniel Fernandes Melo ◽  
Caren dos Santos Lima ◽  
Bianca Maria Piraccini ◽  
Antonella Tosti
Keyword(s):  
Selective Serotonin Reuptake Inhibitors ◽  
Behavioral Therapy ◽  
Treatment Plan ◽  
Interdisciplinary Approach ◽  
Comprehensive Treatment ◽  
Reversal Training ◽  
Pharmacological Management ◽  
Related Disorder ◽  
Pull Out ◽  
Habit Reversal Training

Trichotillomania is defined as an obsessive-compulsive or related disorder in which patients recurrently pull out hair from any region of their body. The disease affects mainly female patients, who often deny the habit, and it usually presents with a bizarre pattern nonscarring patchy alopecia with short hair and a negative pull test. Trichoscopy can reveal the abnormalities resulting from the stretching and fracture of hair shafts, and biopsy can be necessary if the patient or parents have difficulties in accepting the self-inflicted nature of a trichotillomania diagnosis. Trichotillomania requires a comprehensive treatment plan and interdisciplinary approach. Physicians should always have a nonjudgmental, empathic, and inviting attitude toward the patient. Behavioral therapy has been used with success in the treatment of trichotillomania, but not all patients are willing or able to comply with this treatment strategy. Pharmacotherapy can be necessary, especially in adolescents and adult patients. Options include tricyclic antidepressants, selective serotonin reuptake inhibitors, and glutamate-modulating agents. Glutamate-modulating agents such as N-acetylcysteine are a good first-line option due to significant benefits and low risk of side effects. Physicians must emphasize that the role of psychiatry-dermatology liaison is extremely necessary with concurrent support services for the patient and parents, in case of pediatric patients. In pediatric cases, parents should be advised and thoroughly educated that negative feedback and punishment for hair pulling are not going to produce positive results. Social support is a significant pillar to successful habit reversal training; therefore, physicians must convey the importance of familial support to achieving remission. This is a review article that aims to discuss the literature on trichotillomania, addressing etiology, historical aspects, clinical and trichoscopic features, main variants, differential diagnosis, diagnostic clues, and psychological and pharmacological management.

Psychotherapeutic interventions

2017 ◽  
Author(s):  
Fiammetta Cosci ◽  
Giovanni Andrea Fava
Keyword(s):  
Primary Care ◽  
Anxiety Disorders ◽  
Clinical Judgment ◽  
Primary Care Physicians ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Somatic Symptom ◽  
Treatment Plan ◽  
Unipolar Depression ◽  
Psychotherapeutic Interventions ◽  
Primary Care Settings

Primary care physicians may offer a comprehensive care of patients having psychiatric ailments. Psychological interventions are effective in treating major depressive disorder, anxiety disorders, somatic symptom disorders, and tobacco use disorders in primary care settings. Psychotherapeutic approaches are effective either as an alternative or as an adjunct to pharmacotherapy, with enduring benefits after discontinuation of drug treatment. Psychotherapy also represents a pilot area of intervention to treat withdrawal symptoms and disorders due to the tapering or discontinuation of psychotropic medications, in particular selective serotonin reuptake inhibitors (SSRIs). This chapter illustrates the basic steps to establish routine evidence-based psychotherapy for unipolar depression, anxiety disorders, somatic symptom disorder, and substance use disorders in primary care settings. Some factors should be considered to formulate a proper treatment plan for mental disorders in primary care, including primary care physicians’ clinical judgment, availability of treatment, and patient’s preference.

The Psychiatric Interview and Mental Status Examination

2017 ◽  
Author(s):  
Donald W. Black
Keyword(s):  
Differential Diagnosis ◽  
Social History ◽  
Mental Status ◽  
Treatment Plan ◽  
Essential Elements ◽  
Comprehensive Treatment ◽  
Psychiatric Interview ◽  
Psychomotor Activity ◽  
History Of ◽  
Mental Status Examination

The interview and mental status examination are integral to the comprehensive patient assessment and typically follow a standard approach that most medical students and residents learn. The psychiatrist should adjust his or her interview style and information-gathering approach to suit the patient and the situation. For example, inpatients are typically more symptomatic than outpatients, may be in the hospital on an involuntary basis, and may be too ill to participate in even the briefest interview. Note taking is an essential task but should not interfere with patient rapport. The interview should be organized in a systematic fashion that, although covering all essential elements, is relatively stereotyped so that it allows the psychiatrist to commit the format to memory that, once learned, can be varied. The psychiatrist should start by documenting the patient’s identifying characteristics (age, gender, marital status) and then proceed to the chief complaint, history of the present illness, past medical history, family and social history, use of drugs and alcohol, medications, and previous treatments. A formal mental status includes assessment of the patient’s appearance, attitude, and behavior; orientation and sensorium; mood and affect; psychomotor activity; thought process, speech, and thought content; memory and cognition (including attention and abstraction); and judgment and insight. With the data collected, the psychiatrist will construct an accurate history of the symptoms that will serve as the basis for developing a differential diagnosis, followed by the development of a comprehensive treatment plan. This review contains 1 figure, 3 tables, and 12 references. Key words: assessment, differential diagnosis, interviewing, mental status examination, treatment plan

Updates in insomnia diagnosis and treatment

2019 ◽  
Vol 54 (4-5) ◽  
pp. 275-289 ◽  
Author(s):  
Scott Bragg ◽  
JJ Benich ◽  
Natalie Christian ◽  
Josh Visserman ◽  
John Freedy
Keyword(s):  
Drug Therapy ◽  
Behavioral Therapy ◽  
Treatment Plan ◽  
Treatment Options ◽  
First Line ◽  
Safety Concerns ◽  
Diagnostic And Statistical Manual ◽  
First Line Therapy ◽  
Appropriate Treatment ◽  
Central Nervous System Depression

Introduction Insomnia is the most commonly reported sleep disorder and remains undertreated in many patients. New changes to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, have changed the way insomnia is diagnosed. In patients who suffer from insomnia, a number of available treatment options exist including both behavioral therapy and medications. Literature Review: First line therapy for insomnia should always include behavioral modifications such as sleep hygiene and insomnia-oriented cognitive behavioral therapy. In patients deemed to need pharmacotherapy, first line medications include nonbenzodiazepine hypnotics (i.e., z-drugs) and antidepressants depending on the patients’ needs and comorbidities. The risk of next day impairment, parasomnias, and central nervous system depression are some of the most feared side effects with z-drugs. Second line drug therapy includes melatonin and suvorexant. Several concerns exist for suvorexant similar to other insomnia medications, but melatonin remains one of the safest medication alternatives. Other medication options such as benzodiazepines, antihistamines, and antipsychotics should rarely be used because of weak effectiveness data or serious safety concerns. Discussion The most appropriate treatment plan needs to be tailored to meet the needs of individual patients. Many patient factors (e.g., age, other comorbidities, specific problems with sleep) need to be considered before prescribing drug therapy for patients suffering from insomnia. Medications with the best evidence and fewest safety concerns should be prioritized when clinicians work with patients to determine the most appropriate treatment plan. Conclusions Nondrug treatment should be the emphasis for managing insomnia, but several options exist for patients needing multimodal therapy to improve their symptoms and maximize their quality of life. Z-drugs and antidepressants are first line medications options, but other options may be considered when tailored to individual patients. Medications should only be used intermittently and short term until nondrug treatments help to change a patient’s sleep routine.

Persistent Depressive Disorder

2015 ◽  
pp. 226-237
Author(s):  
Daniel N. Klein ◽  
Sarah R. Black
Keyword(s):  
Depressive Disorder ◽  
Future Research ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
The Past ◽  
Psychotherapeutic Interventions ◽  
Interpersonal Difficulties ◽  
Persistent Depression ◽  
Continuation Maintenance ◽  
Persistent Depressive Disorder

Over the past few decades, there has been increasing recognition of the problem of persistent, or chronic, depression. Chronic depressions account for up to a third of the cases of depression in the community and half the cases in clinical practice. Moreover, as reflected in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), persistent depressive disorder differs in many significant respects from nonpersistent depression. This chapter provides an overview of the current literature on persistent depression, starting with classification, epidemiology, and course. Psychosocial and neurobiological risk factors, including early adversity, genetics, personality/temperament, cognitive style, interpersonal difficulties, neural abnormalities, and chronic stress, are then reviewed. Next, we discuss psychopharmacological and psychotherapeutic interventions for acute and continuation/maintenance treatment of persistent depression. We conclude with suggestions for future research.

Demographic Differences in Disruptive Mood Dysregulation Disorder Symptoms in ADHD, Autism, and General Population Samples

2016 ◽  
Vol 23 (8) ◽  
pp. 849-858 ◽  
Author(s):  
Susan D. Mayes ◽  
Susan L. Calhoun ◽  
James G. Waxmonsky ◽  
Cari Kokotovich ◽  
Raman Baweja ◽  
...  
Keyword(s):  
General Population ◽  
School Age Children ◽  
Demographic Differences ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
Disruptive Mood Dysregulation Disorder ◽  
Oppositional Defiant ◽  
Almost All ◽  
New Diagnosis ◽  
Mood Dysregulation

Objective: Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) disruptive mood dysregulation disorder (DMDD) is a controversial new diagnosis. No studies have investigated DMDD symptoms (irritable-angry mood and temper outbursts) and demographics in general population and psychiatric samples. Method: Maternal ratings of DMDD symptoms and diagnoses, age, gender, IQ, race, and parent occupation were analyzed in general population ( n = 665, 6-12 years) and psychiatric samples ( n = 2,256, 2-16 years). Results: Percentage of school-age children with DMDD symptoms were 9% general population, 12% ADHD-I, 39% ADHD-C, and 43% autism. Male, nonprofessional parent, and autism with IQ > 80 were associated with increasing DMDD symptoms, but demographics together explained only 2% to 3% of the DMDD score variance. Conclusion: Demographics contributed little to the presence of DMDD symptoms in all groups, whereas oppositional defiant disorder (ODD) explained most of the variance. Almost all children with DMDD symptoms had ODD suggesting that DMDD may not be distinct from ODD.

scholarly journals Effectiveness and Tolerability of Methylphenidate in Children and Adolescents with Attention Deficit Hyperactivity Disorder

2011 ◽  
Vol 3 ◽  
pp. CMT.S6615
Author(s):  
Caroline Bodey
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Side Effects ◽  
Children And Adolescents ◽  
Attention Deficit ◽  
Treatment Plan ◽  
Immediate Release ◽  
Height Velocity ◽  
Comprehensive Treatment ◽  
Hyperactivity Disorder ◽  
Cardiovascular Side Effects

Attention deficit hyperactivity disorder (ADHD) is a common condition and important for the affected individual, their family and society. It manifests with pervasive symptoms of hyperactivity, impulsivity and inattention. In many children with ADHD these symptoms persist into adolescence and adulthood. Drug treatment with psychostimulants, including methylphenidate, is an important part of a comprehensive treatment plan for children with severe ADHD that includes psychosocial, behavioural and educational advice and interventions. Methylphenidate is a central nervous system stimulant, whose mechanism of action is thought to be due to an increase in catecholamines in areas of the brain concerned with motivation and reward. Methylphendiate is available in short acting (immediate release) and longer acting (modified release) forms. Pharmacotherapy for ADHD is in three stages: initiation, maintenance and termination. The efficacy of methylphenidate in terms of reducing core symptoms is 70% as compared to placebo. This efficacy is maintained for at least 24 months. Methylphenidate generally has a favourable side effect profile. The most significant side effects include appetite suppression with an initial deceleration in height velocity, cardiovascular side effects that are not clinically significant in children with no adverse cardiac history, and tics. Methylphenidate is generally well tolerated and liked by children and adolescents with ADHD, who appreciate the benefits that medication has on their behaviour.

scholarly journals Evaluating Smoking Cessation Interventions and Cessation Rates in Cancer Patients: A Systematic Review and Meta-Analysis

ISRN Oncology ◽  
2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Smriti Nayan ◽  
Michael K. Gupta ◽  
Doron D. Sommer
Keyword(s):  
Systematic Review ◽  
Smoking Cessation ◽  
Usual Care ◽  
Cancer Patients ◽  
Tobacco Smoking ◽  
Treatment Plan ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Comprehensive Treatment ◽  
Oncology Patient

Background. Tobacco smoking cessation interventions in the oncology population are an important part of comprehensive treatment plan. Objectives. To evaluate through a systematic review smoking cessation interventions and cessation rates in cancer patients. Search Strategy. The literature was searched using Medline, EMBASE, and the Cochrane Library (inception to November 2010) by three independent review authors. Selection Criteria. Studies were included if tobacco smoking cessation interventions were evaluated and patients were randomized to usual care or an intervention. The primary outcome measure was cessation rates. Data Collection and Analysis. Two authors extracted data independently for each paper, with disagreements resolved by consensus. Main Results. The systematic review found eight RCTs investigating smoking cessation interventions in the oncology patient population. Pooled relative risks were calculated from two groups of RCTs of smoking cessation interventions based on followup duration. In both groups, the pooled relative risk did not suggest a statistically significant improvement in tobacco cessation compared to usual care. Conclusions. Our review demonstrates that recent interventions in the last decade which are a combination of non-pharmacological and pharmacological approaches yield a statistically significant improvement in smoking cessation rates compared to usual care.

ADHD treatment

2018 ◽  
Author(s):  
Alessandro Zuddas ◽  
Tobias Banaschewski ◽  
David Coghill ◽  
Mark A. Stein
Keyword(s):  
Treatment Plan ◽  
Symptom Improvement ◽  
Comprehensive Treatment ◽  
Short Term ◽  
Serious Adverse Events ◽  
Stimulant Treatment ◽  
Medication Treatment ◽  
Adhd Treatment ◽  
Adolescents And Adults

Stimulants are effective medications and should be used as one of the main pharmacological options for the management of ADHD in children, adolescents, and adults. They all inhibit catecholamine uptake, but they differ for specific aspects of the mechanism of action, pharmacokinetics, as well as on efficacy for specific patients. Short-term efficacy in reducing ADHD symptoms is well established, as is the safety profile for these agents. There is increasing evidence that ADHD symptom improvement generally translates or corresponds to improved functioning and quality of life. Stimulant treatment should be based on a comprehensive assessment and diagnosis, including full medical history and physical examination, and it should always be part of a comprehensive treatment plan that includes psychological, behavioural, and educational advice and interventions. Medication treatment should be closely monitored for both common and unusual (but potentially serious) adverse events.

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