Diagnostic Trends and Prescription Patterns in Disruptive Mood Dysregulation Disorder and Bipolar Disorder

• Published in: Journal of the American Academy of Child and Adolescent Psychiatry Vol. 61; no. 3; pp. 434 - 445
• Main Authors: Findling, Robert L., Zhou, Xiaofeng, George, Prethibha, Chappell, Phillip B.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-03-2022; Elsevier BV
• Subjects: Accountability; Adolescent; Adolescents; Antipsychotics; Attention Deficit and Disruptive Behavior Disorders - diagnosis; Attention Deficit and Disruptive Behavior Disorders - drug therapy; Attention Deficit and Disruptive Behavior Disorders - epidemiology; Behavior disorders; Bipolar disorder; Bipolar Disorder - diagnosis; Bipolar Disorder - drug therapy; Bipolar Disorder - epidemiology; Child; Children & youth; Clinical medicine; Coding; Cohort analysis; Comorbidity; Demographics; Diagnosis; Disruptive behaviour; disruptive mood dysregulation disorder; Electronic health records; Electronic medical records; Emotional disorders; Ethnicity; Health insurance; Health services; Health services utilization; Hospitalization; Humans; Inpatient care; Irritable Mood; Language Processing; Medical diagnosis; Mental disorders; Mental health; Mental Health Programs; Mood; Mood disorders; Mood Disorders - diagnosis; Mood Disorders - drug therapy; Mood Disorders - epidemiology; Natural language processing; Oppositional defiant disorder; Patients; pediatric; Pediatrics; Prescription drugs; Prescriptions; Psychiatry; Psychotropic drugs; Retrospective Studies; Teenagers; Trends; Uptake; Youth; antipsychotics; disruptive mood dysregulation disorder; bipolar disorder; pediatric
• ISSN: 0890-8567; 1527-5418
• DOI: 10.1016/j.jaac.2021.05.016

Disruptive mood dysregulation disorder (DMDD) was introduced in DSM-5 to distinguish a subset of chronically irritable youth who may be incorrectly diagnosed and/or treated for pediatric bipolar disorder (BPD). This study characterized the rate of new treatment episodes and treated prevalence of BPD and DMDD from a longitudinal electronic health record database and examined the impact of DMDD on prescription trends.
A retrospective cohort study using 2008-2018 Optum electronic health record data was conducted. Youth aged 10 to < 18 years with ≥ 183 days of database enrollment before the study cohort entry were included. Annual new treatment episode rates per 1,000 patient-years and treated prevalence (%) were estimated. Prescriptions for medications, concomitant diagnoses, and acute mental health service use for 2016-2018 were evaluated.
There were 7,677 youths with DMDD and 6,480 youths with BPD identified. Mean age (13-15 years) and ethnicity were similar for both groups. A rise in new treatment episode rates (0.87-1.75 per 1,000 patient-years, p < .0001) and treated prevalence (0.08%-0.35%, p < .0001) of DMDD diagnoses (2016-2018) following diagnosis inception was paralleled by decreasing new treatment episode rates (1.22-1.14 per 1,000 patient-years, p < .01) and treated prevalence (0.42%-0.36%, p < .0001) of BPD diagnoses (2015-2018). More youth in the DMDD group were prescribed medications compared with the BPD group (81.9% vs 69.4%), including antipsychotics (58.9% vs 51.0%). Higher proportions of youth with DMDD vs youth with BPD had disruptive behavior disorders (eg, 35.9% vs 20.5% had oppositional defiant disorder), and required inpatient hospitalization related to their mental health disorder (45.0% vs 33.0%).
Diagnosis of DMDD has had rapid uptake in clinical practice but is associated with increased antipsychotic and polypharmacy prescriptions and higher rates of comorbidity and inpatient hospitalization in youth with a DMDD diagnosis compared with a BPD diagnosis.