Disruptive Mood Dysregulation Disorder - Research Proposal Example

Disruptive Mood Dysregulation Disorder Literature Review Disruptive Mood Dysregulation Disorder (DMDD) is a general health problem that affects a significant number of the world’s population. Grohol (2012) notes that DMDD affects about 60% of youths and is associated with bipolar disorder risk that claims approximately 25% of the suicide attempt cases. There are numerous cases of inadequate treatment for DMDD, which results in the high rates of jailing of the patients (Quay & Hogan, 1999). Similarly, DMDD depressions remain untreated or inadequately attended. DMDD affects children at a mean age of 11 years, but parents report the disease seven years earlier. According to National Comorbidity Study, individuals likely to suffer most from DMDD range between ages 7 and 18 years. However, the chances of an individual suffering from DMDD are determined by factors other than age. A community study by Copel (2012) applied Mental Disorder Questionnaire (MDQ), and indicated that DMDD claims about 3.7% of patients suffering from mental illness like bipolar disorder. This occurs because there are many chances of misdiagnosis and failure to notice the changes in behavior. A survey documented by DBSA shows that a half of DMDD patients do not seek medical care, while those who do, receive the wrong diagnosis until when the problem has developed for over eight years. DMDD has consistently been associated with the sex factor, for example, it affects boys more than girls. In addition, the symptom profile of DMDD differs between males and females. Nonetheless, research shows that women suffer more from mania and mixed episodes in relation to men. In a study by World Health Organization (2013), data collected among the male and female populations showed that, the male gender is likely to suffer from mental dysfunction compared to female. In the results, men suffering from DMDD consisted of 29.0% while women were 15.3% (World Health Organization, 2013). Epidemiological studies based on community lifestyle indicate that an individual has 3.3% chances of developing DMDD in his lifetime. However, the prevalence varies from one country to another, as well as over time. A recent study conducted worldwide indicates that lifetime DMDD prevalence in Australia is 2.5% while, in America, it revealed a prevalence of about 0.6%. European study, on the other hand, estimates DMDD prevalence as ranging from 0.2% to 2.0% (Krieger & Stringaris, 2013). This disease is diagnosed from the age of 9 years and cannot be diagnosed after 18 years. However, it has an approximately early onset with the first episode beginning at the age of six and dominating in an individual’s later adolescent stages. A longitudinal study showed that DMDD could occur at a very late age of 15 to 19 years (Krieger & Stringaris, 2013). Additionally, family history affects the prevalence of bipolar in an individual’s life. Pharmacologic and Biochemical studies trace the root cause of DMDD to excess depression resulting from depletion of catecholamine. However, the actual causes of DMDD disorder are unknown. DMDD has affected individuals, as well as countries both economically and socially (Cohel, 2012). DMDD mental health diagnosis is very expensive for patients, caregivers and even to the governments. Eme & Mouritson (2013) prevalence cost study in US, which indicates that $ 12 billion was spent in 2012 for DMDD patient care and treatment. The defining characteristics of DMDD among children include persistent and severe irritability. Patients with this disorder display temper tantrums or outbursts. This disorder being new in DSM-V was developed to replace the bipolar disorder among children. DMDD diagnosis replaced bipolar disorder among children because bipolar disorder diagnosis in children could not fit the bipolar diagnosis criteria. Research structure This research structure aims at analyzing the causes, medical interventions and the effects of bipolar. In this document, I will examine the theoretical approaches to DMDD, diagnosis, and treatment. I will also examine the case study of a DMDD patient, his medical history, diagnosis of the problem and the challenges experienced during his treatment process. Theoretical Approaches Psychological theories have been put forward to give evidence based explanations as to why people behave, feel, and think the way they do. Personality factors, experiences, and interpersonal relationships are used as a basis for determining depression causes. Many schools of thoughts emerged to give elaborate explanations on DMDD disorder. This research paper will analyze two theories that explain the behavior associated to DMDD. Psychodynamic theories Psychodynamic theory was dominant in the 20th century. The advocates of this theory focused on the relationship of mind and emotional or motivational forces that influence and shape character. The proponent of this theory, Sigmund Freud, divided the human mind into multiple parts that constitute impulsive and irrational id, the judgmental superego, and the rational ego that attempt to resolve the conflicts between id and superego. Psychodynamic theory holds that manic-depressive dynamics is linked through a common pathway. The advocates of this theory argue that depression experienced by bipolar patients is because of the loss of self-esteem and a sense self-worth. Mania among patients of AMDD serves as a defense mechanism against feelings associated with depression. Anger outbursts experienced by DMDD patients is attributed to the suppressed anger against the surrounding people that is converted into self-hatred. Another dimension to this theory is neurotic parents who are demanding and show inconsistent warmth towards their children. These parents are often angry, tired, hostile and inconsiderably selfish (First & Tasman, 2011). They fail to pay close attention to their children making the children experience feelings of loneliness, confusion, helplessness, anger, and isolation. However, the anger held by such a child towards the parents is neutralized by the realization that the parents are the only means of survival. The child responds to his situation by developing feelings of fear, love, and guilt that leads to repression of anger towards the parents. The child turns the anger against his parents on himself; thus, resulting in self-despise, which leads to deep feelings of anxiety and depression. Psychodynamic theory perceives object relations because of relationships that people experienced in the past (Hendren, 1999). Cognitive-Behavioral theories Cognitive behavioral theorists take a pragmatic approach on the issue of DMDD disorder. The theory, however, focuses on the solution to the problem rather than causes or origins of the behavior. This does not mean that the cognitive-behavioral ignores the origins of dysfunctional behavior emotional patterns. CBT emerged due to the observation of people reacting emotionally and behaviorally to the events surrounding them. In other words, our cognitions determine our behaviors (Finnerty, 2011). For example, if a person is offended, he responds by exploring the options of hurting the offender. The mechanisms through, which individuals respond to the situations relates with how they interpret the existing conditions. Interpretation of events in life relates to the type of beliefs held by a person. This explains the misinterpretations of good intentions by bipolar patients. Beliefs arise because of a blend of factors that include both nature and nurture. Cognitive theory holds that some disposition as temperaments and children interactions form a person’s character and influences personal interrelationships. Cognitive theory explains depression faced by bipolar patients as arising from childhood experiences such as child abuse and trauma that establishes personal views (Scott, 2010). According to psychologist’s account of cognitive personality disorders, human beings act in response to their core beliefs. These core beliefs represent the assumptions we hold about ourselves and the objects and the people surrounding us. The core beliefs are dysfunctional and may lead people into behaving unwittingly; thus, provoking reactions from other individuals. According to behavioral theorists, manic behavior results from setbacks and failures experienced in the past (Margulies, 2013). Intervention review DMDD has many treatment alternatives. Intervention strategies include both pharmacological and non-pharmacological approaches. DMDD can be diagnosed, and medication prescribed by medical doctors. However, psychiatrists usually prescribe DMDD medications. In some countries, clinical psychologists and psychiatric nurse practitioners are licensed to practice DMDD diagnosis and medication (Copel, Costello & Egger, 2013) Other than the medical/pharmacological strategies, performance based strategies are acknowledged as effective methods of treating DMDD. This research paper will examine pharmacological and behavior based approaches to treatment of DMDD. These approaches are based on psychodynamic and cognitive behavioral theories explanation of DMDD. Pharmacological interventions Pharmacological approach involves the use of medicine for the treatment of DMDD. There are many medical approaches to DMDD. However, for research, we are going to examine Mood Stabilizing Medications. Mood stabilizing medications are usually the first medical attempts applied by medical practitioners to solve DMDD. Anticonvulsant treatments are applied in the treatment of seizures and moods. Commonly applied stabilizing medications include: Lithium, also referred to as Lithobid is the first mood stabilizer developed in US and approved by US Food and Drug Administration as an effective treatment for mood disorders. This drug should be applied on patients with DMDD to control recurrence of anger outbursts and extreme depressive episodes (Grasso, Vincent & Seagraves, 2005). The second medical strategy involves the use of Valproic acid. This drug was developed approved by FDA in 1995 to treat mania and extreme depression. It can be used to replace lithium because it is also efficient as lithium itself. Other anticonvulsant treatments include the use of Lamictal for control of DMDD. Recent treatments that may be applied include gabapentin, topiramate, and Tripletail. However, no records show that these drugs are effective compared to other anticonvulsants (First & Tasman, 2011). Valproic acid use should be regulated because they contain FDA warning that their use may increase the chances of incurring suicidal thoughts and behaviors. Cognitive Behavioral Therapy CBT This approach applies a blend of two therapies that include cognitive and behavioral therapy, developed by psychotherapist Aaron Beck. Cognitive therapy relies on a person’s thoughts and beliefs and how these thoughts and beliefs influence the person’s behavior. Cognitive Therapy CT also focuses on a person’s actions that result from his or her thinking. Behavioral treatment BT focuses on a person’s actions and aims to change their unacceptable behavioral habits (Eme, & Mouritson, 2013). Treatment of DMTT is attained by the use of CBT because health clinicians apply CBT to help their patients restructure their negative thoughts and behaviors. This will involve the exposure of DMDD client to his inner thoughts in order to understand himself. This treatment will help the patient understand his situation positively and in realistic ways. This will also help the patient realize the factors behind his or her depression, and thus, find out ways of overcoming the problem. A CBT for anxiety disorders should be applied to treat anxiety disorders responsible for DMTT (Copel et al, 2013). This includes exposure treatment that helps the patient confront certain fears existing in the memory. Helping the patient confronts fears of specific experiences associated with phobias and posttraumatic exposures are an effective way of handling stress related bipolar. Copel argues that CBT helps patients identify their unproductive thoughts. Clinical history taking Client’s concerns include irritability, emotional outbursts, poor academic performance, aggression, and tantrums. He is a single parent residing with his mother and has minimal contact with his father. He has poor social skills and misinterprets good intentions by well-wishers. He suffers from distractions, is often frustrated, and manifests aggressive behaviors. He suffers from disinterest, sadness, anxiety, and depression. The mother suffered from domestic violence during her pregnancy and even a few months after Michael’s birth. Classmates ridicule him, which makes him dislike school. Mental status examination Mood Michael displayed changing emotional states. Given the toys, Michael displayed disinterest and complained that they belong to children below his age. Michael dislikes schoolmates and school in general. He experiences sadness, frustration, and anxiety. There is evidence of regular outbursts, tantrums, and aggression. His anger is ignited by lack of attention that makes him yell irresponsibly at his classmates. Michael suffers from inferred conflicts, fantasies, and feelings of worthlessness. Affects The patient displays outward expression of disinterest and frustration. Moods and emotions reactions include anger and yelling. His normal appearance through the interview displays a hidden anger and frustration, depression, bewilderment and aloofness. Little social interactions found led to feelings of aloofness. There is an element of dislike for classmates and his mother. He is cooperative and sarcastic in his dreams. Thought process Michael is conversional with flight of ideas that characterize a mental disorganization. Failure to handle or solve simple tasks characterizes his poverty of associations or loss of associations. He is illogical and incoherent in his thought system. Thought content includes preoccupations on exaggerated desires, phobias, and hypochondriacal thoughts. DSM V Diagnosis A- The patient experiences severe temper outbursts manifested verbally and behaviorally. He undergoes frequent anger that makes him despised by friends and classmates. He misinterprets good intentions and end up yelling at other children. B- The temper outbursts are inconsistent with developmental stage. No history of early mood disorders is reported, and there is no report of an increase in anger tantrums. There is no distinct time reported that the patient experienced full symptom criteria. C- Temper outbursts occur averagely. He yells at his classmates when he is angry; screams at the boys in the hallway and class. D- The mood between the client’s temper outbursts is irritability or angry most of the day and nearly every day. His teachers, his mother and fellow students, have noticed his anger. E- The symptoms have been present for the last twelve months, and he has not had a period lasting three months without experiencing the symptoms categorized in criteria A-D. The signs are noticed in three settings; school, at home and with his peers. F- The diagnosis is made at the age of twelve years, which ranges between the ages 6-18 as required by the DSM-5 criteria. Treatment Plan Initial treatment My patient’s initial treatment involves the use of lamotrigine that involves a necessary titration dose (A). Application of antidepressants, for example, selective serotonin reuptake inhibitor (SSRI) and anti-manic agent to reduce the chances of severe manic BP. Additionally, it applies cognitive behavioral therapy and family therapy if available to help shorten the acute episodes. My patient’s response to the antidepressants will determine my next step of treatment alternative. If he responds negatively to depressants, I will apply anti-depressants (Carlson, 2013). Long-term treatment Long-term treatment of DMDD includes prevention of new episodes. I will apply strategies that control early bipolar data in order to avoid relapse. Further, I will widen the package of treatment to involve social support for my client. The first step for long-term treatment involves the patient’s informed consent. I will inform my patient of his situation and ask him if he accepts long-term treatment that will help recover from the disorder. If he accepts, I will recommend the use of mood stabilizers alongside short-term medications like benzodiazepines or antipsychotics. Other long-term medicines include the use of aripiprazole and lithium to prevent manic relapse. If my client does not respond to monotherapy treatments, I will apply a combination of lamotrigine and quetiapine. I will also consider clozapine treatment if my patient displays symptoms of refractory (Dougherty, et al., 2014). Knowledge gained Literature study on DMDD helped in my study and diagnosis of my patient’s mental disorder. Literature review on the topic offered statistical or demographic information on DMDD, as well as causes and symptoms of bipolar DMDD. The study recommended medical interventions as treatment alternatives for bipolar. Article reviews provided an analysis of epidemiology, etiology, assessment, and management of DMDD. Special attention paid to the factors that promote and complicate DMDD treatment helped in my selection of the best diagnosis approach, as well as in choosing the best medical approach (Axelson, et al., 2012). Article review recognizes DMDD as a health problem that evolves from one stage to another. It also gives a suggestion on the causes of the disorder. Article review provides statistical details of the effects of bipolar on different patients who include children, males, and females. There are also the statistical differences among countries revealed by the article review. The analysis of demographic and epidemic effects of bipolar helped in my analysis of my patient’s medical history through study his background in relation to his mental disorder. The information I obtained on DSM V diagnosis helped in coming up with the axes that define my patient’s medical condition. Analysis of earlier works indeed helped me in general attendance to my patient’s health needs. Critical review of the treatment The medical strategies that I applied on my client worked well. Within the first three months, the patient reported change in his social life. He acquired new friends and reduced the levels of emotional excitement. He participated in many social activities while at school and home. His teachers reported an improvement in his performance and general concentration both in the classroom and outside class setting. There are many challenges I experienced during the treatment process. In some instances, my client failed to cooperate by acting indifferently to some of the diagnosis procedures. The client failed to accept his mental situations and took some time before accepting a long-term treatment after failing to respond to the short-term treatment. There were no cases of transference or countertransference although the patient displayed dislike for his mother and the school. The ethical challenges encountered resulted from the need to gain historical background of my patient. The client also failed to respond to some of the questions. Additionally, there were mild cases of depression experienced by the patient despite application of strong antidepressants. Conclusion DMDD is a medical condition that poses a threat to individuals and countries worldwide. Many strategies have been developed to prevent and suppress the disease. Nevertheless, research indicates that DMDD bipolar is responsible for a significant number of mental disabilities in the world. New diagnosis methods like DSM V have helped in disease prevention and treatment. References Axelson, D. Findling, R. L., Fristad, M. A., Kowatch, R. A., Youngstrom, E. A., Horwitz, S. M., Arnold, L. E., Frazier, T. W., Ryan, N., Demeter, C. & Others (2012). 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