Objective: Childhood irritability is a common, impairing problem with changing age-related manifestations that predict long-term adverse outcomes. However, more investigation of overall and age-specific neural correlates is needed. Because youths with irritability exhibit exaggerated responses to frustrating stimuli, the authors used a frustration functional MRI (fMRI) paradigm to examine associations between irritability and neural activation and tested the moderating effect of age.
Method: The authors studied a transdiagnostic sample of 195 youths with varying levels of irritability (disruptive mood dysregulation disorder, N=52; anxiety disorder, N=42; attention deficit hyperactivity disorder, N=40; and healthy volunteers, N=61). Irritability was measured by parent and child reports on the Affective Reactivity Index. The fMRI paradigm was a cued-attention task differentiating neural activity in response to frustration (rigged feedback) from activity during attention orienting in the trial following frustration.
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The participant will explain how brain mechanisms underlie childhood irritability and their age-related manifestation.
This program is designed for all psychiatrists in clinical practice, residents in Graduate Medical Education programs, medical students interested in psychiatry, and other physicians who wish to advance their current knowledge of clinical medicine.
Duration: 1 hour
Begin Date: January 1, 2019
End Date: December 31, 2020
In order to earn CME credit, subscribers should read through the material presented in the article. After reading the article, complete the quiz and submit your evaluation and study hours (up to 1 AMA PRA Category 1 Credit™). A score of 60% or higher is required to receive credit.
The American Psychiatric Association (APA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The APA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Title: Brain Mechanisms of Attention Orienting Following Frustration: Associations With Irritability and Age in Youths
Authors: Wan-Ling Tseng, Ph.D., Christen M. Deveney, Ph.D., Joel Stoddard, M.D., Katharina Kircanski, Ph.D., Anna E. Frackman, M.D., Jennifer Y. Yi, M.A., Derek Hsu, M.D., Elizabeth Moroney, B.A., Laura Machlin, B.A., Laura Donahue, B.A., Alexandra Roule, B.A., Gretchen Perhamus, B.A., Richard C. Reynolds, M.S., Roxann Roberson-Nay, Ph.D., John M. Hettema, M.D., Ph.D., Kenneth E. Towbin, M.D., Argyris Stringaris, M.D., Ph.D., Daniel S. Pine, M.D., Melissa A. Brotman, Ph.D., Ellen Leibenluft, M.D.
Affiliations: The Department of Health and Human Services, Emotion and Development Branch and Scientific and Statistical Computing Core, NIMH, Bethesda, Md. (W.-L.T., K.K., D.H., A.R., G.P., K.E.T., A.S., D.S.P., M.A.B., E.L., R.C.R.); the Department of Psychiatry and the Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond (R.R.-N., J.M.H.); the Department of Psychology, Wellesley College, Wellesley, Mass. (C.M.D.); the University of Colorado School of Medicine, Aurora, Colo. (J.S.); the Department of Medicine, Stanford University, Stanford, Calif. (A.E.F.); the Departments of Psychology and Neuroscience, University of North Carolina at Chapel Hill (J.Y.Y., L.M.); Emory University School of Medicine, Atlanta (D.H.); the Department of Psychology, University of California at Los Angeles (E.M.); and University of Michigan Medical School, Ann Arbor (L.D.).
Disclosures: Drs. Tseng and Stoddard have received research grant support from NIMH (grant K99MH110570 to Dr. Tseng and grant K23MH113731 to Dr. Stoddard). The other authors report no financial relationships with commercial interests.
Discussion of unapproved or investigational use of products*: No.
*APA policy requires disclosure by CME authors of unapproved or investigational use of products discussed in CME programs. Off-label use of medications by individual physicians is permitted and common. Decisions about off-label use can be guided by scientific literature and clinical experience.
Ned H. Kalin, M.D. (Editor-in-Chief, AJP); Michael D. Roy (Editorial Director, AJP); Michael A. Pogachar (Online Content Manager, Journals).
Dr. Kalin has received research support from NIH and NIMH; has served as a consultant for APA, CME Outfitters, the Pritzker Neuropsychiatric Disorders Research Consortium, the Skyland Trail Advisory Board, and TC MSO; owns stock in Celgene and Seattle Genetics; and received honoraria from Elsevier as co-editor of the journal Psychoneuroendocrinology. Mr. Roy and Mr. Pogachar report no financial relationships with commercial interests.
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