Purpose of review: Mood regulation problems, such as severe chronic irritability or short episodes of mania-like symptoms, are common, impairing and a topic of intense recent interest to clinicians, researchers and the Diagnostic and Statistical Manual (DSM)-5 process. Here, we review the most recent findings about these two presentations and discuss the approaches to their treatment.
Recent findings: Longitudinal and genetic findings suggest that chronic irritability should be regarded as a mood problem that is distinct from bipolar disorder. A proportion of children with short (less than 4 days) episodes of mania-like symptoms seem to progress to classical (Type I or II) bipolar disorder over time in the US clinic samples. In a UK sample, such episodes were independently associated with psychosocial impairment. The evidence base for the treatment of either irritability or short-lived episodes of mania-like symptoms is still small. Clinicians should be cautious with extrapolating treatments from classical bipolar disorder to these mood regulation problems. Cognitive and behavioural therapy (CBT)-based approaches targeting general mood regulation processes may be effective for cases with severe irritability or short episodes of mania-like symptoms.
Summary: There is increasing research evidence for the importance of mood regulation problems in the form of either irritability or short episodes of mania-like symptoms in youth. The evidence base for their drug treatment has yet to be developed. CBT-based interventions to modify the processes of mood regulation may be a useful and well tolerated intervention for patients with these presentations.