ABSTRACT
Chronic irritability is a core feature of oppositional defiant disorder (ODD) and disruptive mood dysregulation disorder (DMDD), but few irritability-specific interventions have been tested. Existing evidence-based treatments for disruptive behavior problems offer a strong template. This pilot study was conducted to develop and evaluate a brief irritability-specific module of a validated cognitive-behavioral group intervention for children (Stop Now And Plan (SNAP) Program). Stop now and plan for irritability (I-SNAP) retained core elements of SNAP in a shortened 6-week format. Community families with irritable children (M = 8.44 years, SD = 1.42) were recruited for parent and child emotion regulation skills groups. Of 18 children enrolled (72% male), 14 completed (78%). Half of children attended all six sessions, though homework compliance was lower. All parents reported favorable impressions and would recommend I-SNAP to others. Significant improvements were seen from pre- to post-treatment across parent-reported irritability, ODD symptoms, emotion regulation, and disciplinary effectiveness. This pilot study provides initial support suggesting I-SNAP may be feasible to implement and acceptable to parents. In addition, pilot analyses demonstrated that this brief group intervention was associated with positive outcomes consistent with treatment targets. This preliminary evidence supports the need for further research to assess I-SNAP's effects on irritability relative to control groups.
Subject(s)
Attention Deficit and Disruptive Behavior Disorders/therapy , Cognitive Behavioral Therapy/methods , Irritable Mood , Mood Disorders/therapy , Attention Deficit and Disruptive Behavior Disorders/psychology , Child , Emotional Regulation , Feasibility Studies , Female , Humans , Male , Mood Disorders/psychology , Patient Acceptance of Health Care , Pilot Projects , Problem Behavior/psychology , Psychotherapy, Brief/methods , Psychotherapy, Group/methodsABSTRACT
Inflammatory diseases are highly associated with affective disorders including depression and anxiety. While the role of the innate immune system on emotionality has been extensively studied, the role of adaptive immunity is less understood. Considering that chronic inflammatory conditions are mediated largely by maladaptive lymphocyte function, the role of these cells on brain function and behavior during inflammation warrants investigation. In the present study we employed mice deficient in lymphocyte function and studied behavioral and inflammatory responses during challenge with bacterial lipopolysaccharides (LPS). Rag2(-/-) mice lacking mature lymphocytes were susceptible to death under sub-septic (5 mg/kg) doses of LPS and survived only to moderate (1 mg/kg) doses of LPS. Under these conditions, they displayed attenuated TNF-alpha responses and behavioral symptoms of sickness when compared with immunocompetent mice. Nevertheless, Rag2(-/-) mice had protracted motivational impairments after recovery from sickness suggesting a specific function for lymphocytes on the re-establishment of motivational states after activation of the innate immune system. The behavioral impairments in Rag2(-/-) mice were paralleled by an elevation in plasma corticosterone after behavioral tests. These results provide evidence that the absence of adaptive immunity may be associated with emotional deficits during inflammation and suggest that depressive states associated with medical illness may be mediated in part by impaired lymphocyte responses.
