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Psych Congress  

Disruptive Mood Dysregulation Disorder: A Unique Pediatric Neuropsychopharmacological Approach

Dan Matthews, MD; Glenda Matthews, MD
Universal Health Services, Inc.

This poster was presented at the 30th annual  Psych Congress, held Sept. 16-19, 2017, in New Orleans, Louisiana.

Background: The DSM-5 diagnosis of DMDD has minimal research available exploring psychopharmacological approaches to address the hallmark symptoms of severe, recurrent temper outbursts and persistent irritability. Treated with currently applied medication protocols, a poor long term functional prognosis has been demonstrated.

Objective: To more effectively manage DMDD symptomatology with a unique medication protocol. Protocol components include an anticonvulsant to target mood lability and anger outbursts combined with a dopamine agonist to target impulsivity irritability, and concentration.

Method: Subjects were 91 persistently irritable and explosive children and adolescents (52 male, 39 female, ages 6-17) with previous inpatient treatment for severe aggression, impulsive behaviors, and mood lability. Upon retrospective chart review, all subjects met diagnostic criteria for DMDD. Subjects were discharged on an anticonvulsant (oxcarbazepine) and amantadine HCl. Utilization of antipsychotic medications was minimal to none. Outpatient providers were requested to comply with the approach, based on their assessment of the patients' clinical presentation. One year post discharge, parent/caregiver surveys allowed for the distinction of compliant (maintained the protocol with minimal to no adjustment), or non-compliant (discontinued or substituted other medications) providers.

Results: The percent of re-hospitalization was calculated for compliant versus non-compliant. For the compliant, 8% (5 of 64) required re-hospitalization. For the non-compliant, 26% (7 of 27), required re-hospitalization. Chi-square analysis revealed a significant relationship between re-hospitalization rates and compliance to the protocol (Chi-square, two tailed with Yates = 3.975; P<.05; Phi = .24.

Conclusion: The protocol described provides significantly lower rates of re-hospitalization and potentially improved functional prognosis.

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