Das Konzept der «Multiple Complex Developmental Disorder» (MCDD)

Fragestellung: Die «Multiple complex developmental disorder» (MCDD) ist ein wenig bekanntes Störungsbild, das durch Auffälligkeiten in der Emotionsregulation, der sozialen Interaktion und Denkstörungen gekennzeichnet ist. Weder im Klassifikationssystem des ICD-10, noch im DSM-IV kommt diese Diagnose vor. Methodik: In der vorliegenden Arbeit wird eine Übersicht über die diagnostischen Kriterien und den aktuellen Forschungsstand zum Konzept der MCDD gegeben und anhand einer Kasuistik eines 17-jährigen Jugendlichen illustriert. Ergebnis: Das Störungsbild der MCDD weist Überschneidungen zu autistischen Störungen, aber auch zu Störungen aus dem schizophrenen Formenkreis auf. Eine klare Abgrenzung bzw. Zuordnung ist bisher nicht eindeutig möglich. Schlussfolgerungen: Viele Fragen bezüglich des Störungsbildes bleiben offen, weitere Forschung ist hier vonnöten.

Aripiprazole in children with multiple-complex developmental disorder (McDD): a case series

IntroductionMultiple-complex Developmental Disorder (McDD) is a developmental disorder characterized by peculiar clinical features: affective dysregulation (anxiety, panic and aggressivity), impairment of social behaviour and hypersensitivity, impaired cognitive processing. McDD is usually included within the Pervasive Developmental Disorders not otherwise specified (PDD NOS) (Cohen et al. 1986; Towbin et al. 1993). Aripiprazole is a new atypical antipsychotic drug. Efficacy of aripiprazole in children and adolescents is supported by some studies (Findling et al. 2007, Wink at al 2010; Kim et al 2010).AimsThe aim of our study is to describe the efficacy and safety of aripiprazole in 4 children with Multiple-complex Developmental Disorder.MethodsMean dosage of aripiprazole was 5 mg/day. Response was evaluated by clinical assessment and by Clinical Global Impressions Scale-Severity, Clinical Global Impressions Scale- Improvement, Children's Global Assessment Scale (CGAS) and by Brief Psychiatric Rating Scale. This assessment was administered at baseline, and at weeks 4, 12 and 24.ResultsA significant reduction of social impairments, thought disorders and affective dysregulation was observed. Drug therapy was well tolerated, even though children complained of mild and transient nausea and somnolence.ConclusionTo date there are only a few reports on the use of aripiprazole in McDD patients. The present case series suggest that aripiprazole may be effective and well tolerated in McDD patients.

MRI-based morphometry in children with multiple complex developmental disorder, a phenotypically defined subtype of pervasive developmental disorder not otherwise specified

BackgroundThe DSM-IV-R classification Pervasive Developmental Disorder – Not otherwise Specified (PDD-NOS) is based on the symptoms for autism and includes a wide variety of phenotypes that do not meet full criteria for autism. As such, PDD-NOS is a broad and poorly defined residual category of the autism spectrum disorders. In order to address the heterogeneity in this residual category it may be helpful to define clinical and neurobiological subtypes. Multiple complex developmental disorder (MCDD) may constitute such a subtype. In order to study the neurobiological specificity of MCDD in comparison with other autism spectrum disorders, we investigated brain morphology in children (age 7–15 years) with MCDD compared to children with autism and typically developing controls.MethodStructural MRI measures were compared between 22 high-functioning subjects with MCDD and 21 high-functioning subjects with autism, and 21 matched controls.ResultsSubjects with MCDD showed an enlarged cerebellum and a trend towards larger grey-matter volume compared to control subjects. Compared to subjects with autism, subjects with MCDD had smaller intracranial volume.ConclusionsWe report a pattern of volumetric changes in the brains of subjects with MCDD, similar to that seen in autism. However, no enlargement in head size was found. This suggests that although some of the neurobiological changes associated with MCDD overlap with those in autism, others do not. These neurobiological changes may reflect differences in the developmental trajectories associated with these two subtypes of autism spectrum disorders.