[Disruptive Mood Dysregulation Disorder: a controversial new diagnostic entity in the DSM-5]. / Disruptive Affektregulations- störung: eine umstrittene neue Diagnose im DSM-5.

The Disruptive Mood Dysregulation Disorder (DMDD) was included for the first time in the 5th Revision of the DSM. A transatlantic controversy surrounding the clinical picture and prevalence of early-onset bipolar disorder gave the occasion to develop a new diagnostic category in the chapter "Depressive Disorders" capturing a behavioral phenotype of non-episodic, chronic irritability and frequent temper tantrums. The present paper reviews the first available studies applying the new criteria. While DMDD can be clearly distinguished from bipolar disorder, preliminary evidence suggests a strong overlap with oppositional-defiant disorders (ODD). For the upcoming revision of the ICD it should be discussed to introduce a specifier indicating whether or not the presentation of ODD includes chronic irritability and anger, rather than establishing a new diagnosis. Regardless of the nosological categorization of the described behavioral phenotype main challenges represent a better understanding with regard to its etiology, developmental psychopathology and prognosis and the development of beneficial treatment options.

[VIA--an intensive therapeutic treatment program for conduct disorders]. / VIA - Intensivtherapeutischer Behandlungsansatz bei Störungen des Sozialverhaltens.

OBJECTIVES: Behavioral multimodal therapeutic approaches have proven effective in the treatment of conduct disorders. Yet there are hardly any findings regarding the effectiveness of outpatient treatment approaches. This article introduces an intensive behavioral therapeutic program for the reduction of aggressive behaviors (VIA - Verhaltenstherapeutisches Intensivprogramm zur Reduktion von Aggression). VIA combines a intensive outpatient group program for children, aged 8 to 14 years, with accompanying parent training. This study investigates the effectiveness of the VIA approach in reducing aggressive and comorbid symptoms. Furthermore, it pursues the question of the differential therapy effectiveness. METHODS: We evaluated the treatment program within the framework of a waitlist-group study design. Pre-post changes and predictors of treatment efficacy were assessed via multivariate analyses of variance and a linear regression model, respectively. RESULTS: A group of 36 boys and their caregivers took part in the study. The between-groups comparison revealed a significantly greater reduction of oppositional behavior problems and co-morbid symptoms of ADHD in the intervention group (IG, n = 18) compared to the waitlist group (WG, n = 18). In addition, age and degree of dissocial-aggressive behavioral symptoms were identified as crucial predictors. CONCLUSIONS: This study shows that the VIA intensive therapeutic treatment program is effective in reducing aggressive behaviour and comorbid ADHD symptoms in patients with conduct disorder.

Heart rate and treatment effect in children with disruptive behavior disorders.

OBJECTIVE: To examine whether children with disruptive behavior disorders (DBDs; hyperkinetic conduct disorder, conduct disorder, hyperkinetic disorder) characterized by low heart rate profit less from an intensive cognitive behavioral intervention aimed at reducing impulsive, oppositional and aggressive behavior problems. METHOD: Basal heart rate was studied in twenty-three children (aged 7-12 years) with DBD at the beginning of intervention comprising an intensive day-care treatment and parent training. The disruptive behavior of the child was assessed before treatment and after termination (12 weeks later). Therapy responders and non-responders were compared in regard to heart rate and other risk factors (cognitive functioning and socio-economic status). RESULTS: Statistical analyses yielded evidence for a significant reduction of disruptive problem behaviors (aggression, delinquency) that is more prominent in DBD children with high heart rate scores compared to patients with low heart rate scores. Heart rate was significantly lower in children who did not profit from therapy. A logistic regression analysis revealed that heart rate is a significant predictor for therapy success whereas other risk factors had no impact on therapy success. CONCLUSION: Further studies investigating biological and psychosocial predictors of treatment effectiveness are necessary. In addition, it might be helpful to consider different subtypes of aggressive behavior for selecting the best possible treatment options.