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Mood regulation in youth: research findings and clinical approaches to irritability and short-lived episodes of mania-like symptoms

Leigh, Eleanora,b; Smith, Patricka,b; Milavic, Gordanab; Stringaris, Argyrisa,b

Current Opinion in Psychiatry: July 2012 - Volume 25 - Issue 4 - p 271–276
doi: 10.1097/YCO.0b013e3283534982
CHILD AND ADOLESCENT PSYCHIATRY: Edited by Richard Williams and Philip Hazell

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.

aKing's College London, Institute of Psychiatry

bMood Disorder Clinic, Michael Rutter Centre for Children & Young People, Maudsley Hospital, London, UK

Correspondence to Dr Argyris Stringaris, MD, PhD, MRCPsych, Institute of Psychiatry, PO85, Denmark Hill, London, SE5 8AF, UK. Tel: +44 207 848 0302; fax: +44 20 7708 5800; e-mail:

© 2012 Lippincott Williams & Wilkins, Inc.