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Disruptive Mood Dysregulation Disorder (DMDD) a novel diagnosis listed in DSM-5, which is characterized by severe and recurrent temper outbursts. Between outbursts, children with DMDD display a persistently irritable or angry mood. As a new entity, the treatment guidelines are still not elucidated. Here, we present three cases that are thought to fulfill criteria for DMDD as set forth in DSM-5 and their treatment.
Case 1: The patient was an 11-year-old girl, who was first evaluated for a temper tantrum in an emergency setting. She had been irritable and angry for the past 2 years and temper tantrums involving shouting at and threatening family members. During those tantrums, she attacked furniture and kitchen utensils with a knife. No discrete mood episodes could be elicited and cardinal symptoms of mania were not defined. Screening forms supported presence of ADHD. She was diagnosed as having DMDD and ADHD and started on risperidon 0.5 mg/ day and methylphenidate 20 mg/ day. At the second visit, temper tantrums were reported to be much reduced with moderate improvement in ADHD symptoms.
Case 2: The patient was a 7-year-old boy, who was brought for anger and irritability. He had been irritable and angry for the past 18 months and he had temper tantrums almost every day, which involved throwing things and threatening family members with knives. At the end of mental status examination, he was thought to fulfill criteria for ADHD and DMDD and started on OROS methylphenidate 18 mg/ day and risperidone 0.5 mg/ day with moderate improvement.
Case 3: The patient was a 13-year-old male adolescent, who was being followed up at our department with diagnoses of ADHD and BP-NOS. He had been irritable and angry for the past 4 year and temper tantrums almost every day, which involved threatening and hitting parents along with throwing furnitures around. Moreover, no distinct mood episodes and none of the cardinal symptoms of mania could be elicited. Re-evaluation led to his being diagnosed with ADHD and DMDD as per DSM-5 criteria and started on methylphenidate and risperidone with moderate improvement. DMDD is a new diagnostic entity. Research has demonstrated that children with DMDD usually do not go on to have bipolar disorder in adulthood. They are more likely to develop problems with depression or anxiety. In all of our cases, family history was positive for depressive and anxiety disorders while ADHD was comorbid. One of our patients was also diagnosed as having BP-NOS according to DSM-IV-TR reşecting lack of a better alternative. Our results may support the proposed relationship between DMDD and depressive/ anxiety disorders as well as the utility of this diagnosis for cases that had to be previously diagnosed with BP-NOS. Although all of our cases seemed to improve moderately with methylphenidate combined with risperidone it must be kept in mind that the natural evolution of DMDD and treatment guidelines were still not clearly known and that studies with larger samples who would be followed for longer periods will be necessary.