World Psychiatry最新文献

{"title":"The long‐term impact of bullying victimization on mental health","authors":"L. Arseneault","doi":"10.1002/wps.20399","DOIUrl":"https://doi.org/10.1002/wps.20399","url":null,"abstract":"3. Hiday VA, Swartz MS, Swanson JW et al. Psychiatr Serv 1999;50:62-8. 4. Lehman AF, Linn LS. Am J Psychiatry 1984;141:271-4. 5. Walsh E, Moran P, Scott C et al. Br J Psychiatry 2003;183:233-8. 6. Silver E, Arseneault L, Langley J et al. Am J Public Health 2005;95:2015-21. 7. Maniglio R. Acta Psychiatr Scand 2009;119:180-91. 8. Latalova K, Kamaradova D, Prasko J. Neuropsychiatr Dis Treat 2014;10: 1925-39. 9. Tsai AC, Weiser SD, Dilworth SE et al. Am J Epidemiol 2015;181:817-26. 10. Khalifeh H, Johnson S, Howard LM et al. Br J Psychiatry 2015;206:275-82.","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/wps.20399","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43748129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mind and body: physical health needs of individuals with mental illness in the 21st century","authors":"D. Bhugra, A. Ventriglio","doi":"10.1002/wps.20381","DOIUrl":"https://doi.org/10.1002/wps.20381","url":null,"abstract":"It is well recognized that individuals with severe mental illness show high rates of suicide and also various physical illnesses which contribute to reduced longevity. This is a major public health challenge in the 21st century. Drugs and alcohol consumption and tobacco use further add to the increased rates of morbidity and mortality. The delays in helpseeking, whether it is for physical illness or psychiatric illness, and the underdiagnosis due to stigma and other factors contribute further to this disparity. Liu et al provide a model based on a multilevel approach at individual, health care systems and social determinant levels to cope with the excess mortality among mentally ill people. We believe that it is a relevant proposal in the framework of modern medicine. At the individual level, although early recognition of physical comorbidity and early interventions are effective strategies to reduce mortality, it is also relevant to explore what people seek help for and where they seek it from. In fact, culture and explanatory models will guide people to the sources of help, especially those which are easily available and accessible. Explanations of distress and symptoms (explanatory models) will vary across cultures and communities and also be related to educational and socioeconomic status. Health care systems need to be geographically and emotionally available and accessible for people affected by mental illness, so that they can seek help early. Some of the physical comorbidity may not be recognized by clinicians and on occasion the responsibility for managing physical illness may be left to primary care physicians or specialists who in turn may not recognize mental illness or due to stigma may not intervene early enough. This might be due, in the West at least, to a somewhat rigid division between mental health and physical health services. For centuries, the mind-body dualism attributable to Descartes’ dogma has affected clinical practice and has increased the dichotomy between psychiatric and physical health care services. This dualism may well have contributed to stigma against mental illness, the mentally ill and the psychiatric services. Furthermore, if physicians are not very good at identifying psychiatric disorders or carrying out mental state examinations, psychiatrists are often not very good at identifying and managing physical illnesses either. When interventions have taken place in partnerships between services, physical health of patients with severe mental illness has been shown to improve. At a social level, explanatory models of disease do not only vary across cultures and communities. They may also differ between the patients, their families and their carers, who may interpret these experiences on the basis of physical or psychosocial factors. More industrialized societies are likely to have psychological, medical or social causative factors as explanations, whereas more traditional societies may hold supra-natural and nat","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/wps.20381","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41735586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Irritability in children: what we know and what we need to learn","authors":"E. Leibenluft","doi":"10.1002/wps.20397","DOIUrl":"https://doi.org/10.1002/wps.20397","url":null,"abstract":"Irritability can be defined as increased proneness to anger, relative to peers. Clinically, it manifests as developmentally inappropriate temper outbursts and sullen, grouchy mood; thus, it includes both behavioral and mood components. Related constructs are mood dysregulation, which is broader than irritability, and aggression, which encompasses only behavioral manifestations. Anger proneness has a defined developmental trajectory, peaking in the preschool period and declining thereafter, with a modest increase during adolescence. Irritability is a common reason for mental health evaluation in children, and pediatric irritability is associated with both concurrent and future impairment. In the 1990s, American researchers suggested that pediatric bipolar disorder does not present with distinct manic episodes as in adults, but instead with severe, chronic irritability. However, post-hoc analyses of epidemiological studies found associations between pediatric irritability and risk for subsequent anxiety and depression, but not for bipolar disorder. Similarly, in studies comparing the two dimensions of oppositional defiant disorder (ODD) (i.e., irritability and headstrong behavior), irritability predicts subsequent anxiety and depression, while headstrong behavior predicts attention-deficit/hyperactivity disorder (ADHD) and conduct disorder. Thus, the diagnosis of bipolar disorder should be reserved for youth (and adults) with distinct manic episodes, rather than chronic irritability. Genetically informative studies link irritability and depression. Twin studies document that longitudinal associations between irritability and both anxiety and depression have a genetic component. These studies also find that the heritability of irritability is approximately 40-60%, similar to anxiety or unipolar depression. Irritability is a diagnostic criterion for multiple disorders in youth, including anxiety disorders, major depressive disorder, and ODD. It is also common in youth with ADHD, bipolar disorder, conduct disorder, and autism. However, for children and adolescents, the validity and clinical utility of a diagnostic category characterized primarily by irritability remains an important and unanswered question. Historically, that category has been ODD, which is conceptualized as a disruptive behavior disorder. However, ODD consists of two dimensions, only one of which, irritability, has genetically mediated longitudinal associations with depression and anxiety. Also, severe irritability has significant cross-sectional associations with anxiety disorders. These considerations call into question the appropriateness of combining irritable and headstrong features into one disorder, and of categorizing a diagnosis characterized primarily by irritability as an externalizing, disruptive behavior disorder, rather than as a mood disorder. Given these complexities, it is not surprising that DSM-5 and ICD-11 take different approaches to diagnosing youth whose primar","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/wps.20397","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48777504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antipsychotic augmentation vs. monotherapy in schizophrenia: systematic review, meta‐analysis and meta‐regression analysis","authors":"B. Galling, A. Roldán, K. Hagi, L. Rietschel, F. Walyzada, Wei Zheng, Xiao‐Lan Cao, Y. Xiang, M. Zink, J. Kane, J. Nielsen, S. Leucht, C. Correll","doi":"10.1002/wps.20387","DOIUrl":"https://doi.org/10.1002/wps.20387","url":null,"abstract":"Antipsychotic polypharmacy in schizophrenia is much debated, since it is common and costly with unclear evidence for its efficacy and safety. We conducted a systematic literature search and a random effects meta‐analysis of randomized trials comparing augmentation with a second antipsychotic vs. continued antipsychotic monotherapy in schizophrenia. Co‐primary outcomes were total symptom reduction and study‐defined response. Antipsychotic augmentation was superior to monotherapy regarding total symptom reduction (16 studies, N=694, standardized mean difference, SMD=–0.53, 95% CI: −0.87 to −0.19, p=0.002). However, superiority was only apparent in open‐label and low‐quality trials (both p<0.001), but not in double‐blind and high‐quality ones (p=0.120 and 0.226, respectively). Study‐defined response was similar between antipsychotic augmentation and monotherapy (14 studies, N=938, risk ratio = 1.19, 95% CI: 0.99 to 1.42, p=0.061), being clearly non‐significant in double‐blind and high‐quality studies (both p=0.990). Findings were replicated in clozapine and non‐clozapine augmentation studies. No differences emerged regarding all‐cause/specific‐cause discontinuation, global clinical impression, as well as positive, general and depressive symptoms. Negative symptoms improved more with augmentation treatment (18 studies, N=931, SMD=–0.38, 95% CI: −0.63 to −0.13, p<0.003), but only in studies augmenting with aripiprazole (8 studies, N=532, SMD=–0.41, 95% CI: −0.79 to −0.03, p=0.036). Few adverse effect differences emerged: D2 antagonist augmentation was associated with less insomnia (p=0.028), but more prolactin elevation (p=0.015), while aripiprazole augmentation was associated with reduced prolactin levels (p<0.001) and body weight (p=0.030). These data suggest that the common practice of antipsychotic augmentation in schizophrenia lacks double‐blind/high‐quality evidence for efficacy, except for negative symptom reduction with aripiprazole augmentation.","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/wps.20387","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48173067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The relationship of subjective social status to mental health in South Korean adults","authors":"Jihyung Hong, Jonghan Yi","doi":"10.1002/wps.20357","DOIUrl":"https://doi.org/10.1002/wps.20357","url":null,"abstract":"South Korea has witnessed an unprecedented rise in suicide rates following the 1997 Asian financial crisis. Unfortunately, the rate has not decreased and still remains the highest among the 34 countries which are part of the Organization for Economic Co-operation and Development (OECD). Several researchers have suggested that, in high-income countries, it is no longer the absolute level of one’s socioeconomic status (SES) that is most important for health, but rather inequality or a sense of inequality. A number of studies have been undertaken to examine the relationship of inequality (at the country level) or a sense of inequality (at the individual level) to health. Some of these studies have focused on subjective SES, which measures one’s perception of his/her own position in the social hierarchy. We aimed to examine how both objective and subjective SES are related to mental health problems (suicidal ideation, depressive symptoms and psychological distress) in South Korea, using data from the 2013 Korea Health Panel survey. Subjective SES was measured using the MacArthur scale, a 10rung ladder on which individuals indicate their perceived standing in the social hierarchy. The assessment of suicidal ideation and depression was based on self-report (“yes” versus “no” in the past 12 months). Psychological distress in the past month was assessed using the Korean version of the Brief Encounter Psychosocial Instrument (BEPSI-K). A score 2.4 was defined as “severe stress”. Of the 16,313 respondents aged 19 years or older, the 14,432 who had no missing data were included in this analysis. All data were weighted to represent the structure of the Korean population. Of the 14,432 participants, 5.4% and 7.2% had suicidal ideation and depression, respectively, in the past 12 months, and 13.6% had severe psychological distress in the past month. A clear social gradient was found in the prevalence of these mental health problems, especially when SES was measured subjectively (subjective SES) rather than objectively (income quintile) (p&lt;0.001). Notably, this pattern was more apparent in the case of severe psychological distress. Of those with the lowest subjective SES (i.e., a rating of 1 on the 10-rung ladder), nearly one in three (29.6%) reported the experience of severe psychological distress in the past month, while only 7.2% reported the same experience among those with the highest subjective SES (i.e., a rating 5). The equivalent rates were 19.3% in the lowest income quintile and 10.2% in the highest income quintile. The associations with subjective SES appeared to far outweigh those with conventional measures of SES when considering both in logistic regression models. Subjective SES was the only factor that was consistently associated with any type of mental health problems. For instance, compared to the respondents with the lowest subjective SES (i.e., a rating of 1 on the 10-rung ladder), those with higher subjective SES were much less likely to rep","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/wps.20357","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41856300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Excess mortality in severe mental disorder: the need for an integrated approach","authors":"G. Ivbijaro","doi":"10.1002/wps.20382","DOIUrl":"https://doi.org/10.1002/wps.20382","url":null,"abstract":"top of the political agenda, so that patients with severe mental illness get the best services they need, deserve and will utilize. It is imperative that psychiatrists take the lead in identifying the physical health needs of persons with severe mental illness as well as in orienting the public mental health agenda to ensure that cultural norms and values are taken into account when developing and delivering integrated care at all levels. They must work with stakeholders, including service users and their families groups, to ensure that integrated care and services are sensitive to patients’ needs.","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/wps.20382","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46122553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular risk and incidence of depression in young and older adults: evidence from the SUN cohort study","authors":"P. Molero, M. Martínez-González, M. Ruíz-Canela, F. Lahortiga, A. Sánchez-Villegas, A. Perez-Cornago, A. Gea","doi":"10.1002/wps.20390","DOIUrl":"https://doi.org/10.1002/wps.20390","url":null,"abstract":"ANCOVA analysis, which included age and education as covariates. The model also remained significant in a follow-up analysis in which participants who identified as AfricanAmerican (N515) were excluded. Carriers of the 5HTTLPR-S’ allele had increased PTSD symptoms compared to individuals homozygous for the L’ allele (IES mean score: L’L’547.3 6 5.3, S559.8 6 4.1). For DISC1, individuals homozygous for the T allele had increased PTSD symptoms compared to A carriers (A545.3 6 2.8, TT561.9 6 7.2). In ANCOVA analysis of symptom sub-factors, 5-HTTLPR and DISC1 selectively influenced intrusion and hypervigilance symptoms, but did not affect avoidance symptoms. PTSD symptom severity (total IES scores) increased by an average of 40% with each risk genotype (none538.4, one5 54.5, two565.6). These data support prior observations of 5-HTTLPR effects on PTSD symptoms in military veterans. Although 5-HTTLPR has been identified as a potential contributor to PTSD susceptibility in civilian-based populations, its effect may be less robust in those populations, due to lower overall level of trauma exposure. The effects of 5-HTTLPR on PTSD in military veterans after deployment to a war zone may be more robust because of a universal and constant exposure to threat, military training, and/or separation from family and home social support. In addition to 5-HTTLPR, genetic variation in DISC1, a gene associated with susceptibility to multiple mental disorders, was found to contribute to PTSD symptom severity. Possessing both DISC1 and 5-HTTLPR risk genotypes resulted in a 1.7fold increase in PTSD symptoms. Although this is the first report of DISC1 S704C TT allele as a risk factor for PTSD, the finding is not surprising, considering that this allele has been identified as a risk factor for major depression. DISC1 variants interfere with a protein complex important for organelle transport and in tethering of mitochondria, interfering with dendritic development and reducing densities of dendritic spines in the frontal cortex, paralleling our recent report of spine density reductions in the frontal cortex in PTSD. This study was powered to screen for candidate genes with relatively large effect sizes on PTSD symptoms in combat veterans, which may be different from sets of genes affecting PTSD in civilian populations. Study of the serotonin system in PTSD is motivated in large part by the therapeutic utility of serotonin uptake inhibitors to treat symptoms of PTSD. Our data provide additional impetus for continued study of this system in PTSD pharmacotherapy. In addition, antipsychotics such as risperidone have been shown to reverse DISC1-related behavioral deficits and pathophysiology in animal models, suggesting the possibility that such agents could be re-examined for use as alternative pharmacotherapies for PTSD. Keith A. Young, Sandra B. Morissette, Robert Jamroz, Eric C. Meyer, Matthew S. Stanford, Li Wan, Nathan A. Kimbrel Central Texas Veterans Health Care System, ","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/wps.20390","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42701745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physical health of people with severe mental disorders: leave no one behind.","authors":"Shekhar Saxena, Mario Maj","doi":"10.1002/wps.20403","DOIUrl":"10.1002/wps.20403","url":null,"abstract":"","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":"1-2"},"PeriodicalIF":60.5,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5269495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49047440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nonmedical use of prescription drugs in adolescents and young adults: not just a Western phenomenon","authors":"S. Martins, L. Ghandour","doi":"10.1002/wps.20350","DOIUrl":"https://doi.org/10.1002/wps.20350","url":null,"abstract":"onists have been tested in ASD associated with fragile X syndrome, and showed promise in a subgroup of patients. GABAergic agents, such as the GABA-B receptor agonist arbaclofen (STX209), have shown some effect on irritability and social withdrawal in ASD children. The peptide hormone oxytocin is important in social cognition and behavior. In ASD adults, acute intravenous administration of oxytocin reduced repetitive behaviors and improved accuracy of recognizing emotions in speech over time. Intranasal administration improved social cognition in children, adolescents and adults with ASD. A vasopressin 1a receptor antagonist had some effect on speech recognition of emotions such as fear and lust in high-functioning ASD adults. Insulin-like growth factor 1 (IGF-1) is important in central nervous system maturation, development and connectivity, that are perturbed in ASD. Studies in Shank-3 deficient mice that model Phelan-McDermid syndrome (PMS), which may be associated with some cases of ASD, indicated that IGF-1 may reverse structural changes in ionotropic glutamate receptors, functional synaptic plasticity changes, and excitation/inhibition imbalance. A clinical trial with recombinant human IGF-1 in PMS children showed improvement in social impairment and restricted behaviors. Agents modulating the immune system have been tested in ASD. The immune response induced by the whipworm Trichuris suis ova has shown benefit on the repetitive behavior domain in adult ASD. Immunosuppressive and protein synthesis inhibiting drugs such as the mTOR inhibitor rapamycin have been shown to improve social deficits in some forms of ASD. The alpha-7 nicotinic acetylcholine receptor (nACR) gene is associated with autism and ADHD. nACR drugs tested in clinical trials include mecamylamine, transdermally administered nicotine, and donepezil. Some alpha-7 nACR antagonists such as galantamine have shown promise in animal models and clinical trials. Drugs modulating the cannabinoid system, such as cannabidiol, have been found effective in childhood epilepsy, and may be worth studying in ASD due to their anti-anxiety, antiepileptic, immunomodulating and cognitive-enhancing effects and good safety. Interestingly, social reward and oxytocin induce release of endocannabinoids in nucleus accumbens. In ASD animal models, cannabidiol has some impact on social deficits, repetitive behaviors and irritability. Complementary and alternative medicine (CAM) treatments have been tested in ASD. However, they are not strictly regulated and have not been studied in large-scale clinical trials. Therefore, their safety and efficacy is not well determined. CAM treatments may complement rather than replace proven therapies for ASD. Melatonin may be used for sleep disorders, omega-3 fatty acids for reducing repetitive behaviors and improving sociability. Vitamin B12 supplements are believed to protect against the oxidative damage in ASD. Curcumin, an active ingredient of turmeric, may be bene","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/wps.20350","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45719520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are there new advances in the pharmacotherapy of autism spectrum disorders?","authors":"E. Hollander, G. Uzunova","doi":"10.1002/wps.20398","DOIUrl":"https://doi.org/10.1002/wps.20398","url":null,"abstract":"they may be helpful for DMDD. Data support the use of atypical antipsychotic medication in youth with autism and irritability, and in youth with aggression. However, recent increases in antipsychotic prescriptions may have resulted in part from attempts to treat pediatric irritability, perhaps without adequate exploration of alternative pharmacologic and psychotherapeutic approaches. Selective serotonin reuptake inhibitors (SSRIs) may treat irritability in adults; such an approach in children is supported by the high comorbidity and longitudinal associations among irritability, anxiety and depression. SSRIs are now being tested in youth with DMDD. Psychotherapeutic approaches are likely to be important in the treatment of irritability. Parent training can decrease a child’s aggression and might also decrease irritability. Cognitive behavioral approaches are being tested, as is implicit training designed to alter irritable children’s tendency to view ambiguous faces as angry. In conclusion, the recent focus on irritability has yielded considerable knowledge about its longitudinal course and associations with psychopathology. Ongoing work is aimed at identifying the brain mechanisms mediating irritability and at using that knowledge to inform novel treatment approaches.","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/wps.20398","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45200646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}