Objective

This meta-analysis examined the efficacy of available pharmacological and nonpharmacological interventions for irritability among youth with autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), disruptive behavior disorders (DBD), disruptive mood dysregulation disorder (DMDD), and/or severe mood dysregulation (SMD).

Method

Literature searches were conducted in October 2020, resulting in 564 abstracts being reviewed to identify relevant papers, with 387 articles being reviewed in full. A random effects model was used for the meta-analysis, with subgroup meta-regressions run to assess effects of study design, intervention type, medication class, and clinical population.

Results

A total of 101 studies were included (80 pharmacological, 13 nonpharmacological, 8 combined). Despite high heterogeneity in effects (I² = 94.3%), pooled posttreatment effect size for decreasing irritability was large (Hedges’ g = 1.62). Large effects were found for pharmacological (g = 1.85) and nonpharmacological (g = 1.11) interventions; moderate effects were found for combined interventions relative to monotherapy interventions (g = 0.69). Antipsychotic medications provided the largest effect for reducing irritability relative to all other medication classes and nonpharmacological interventions. A large effect was found for youth with ASD (g = 1.89), whereas a medium effect was found for youth with ADHD/DMDD/DBD/SMD (g = 0.64).

Conclusion

This meta-analysis provides a comprehensive review of interventions targeting persistent nonepisodic irritability among youth with various psychiatric disorders. Strong evidence was found for medium-to-large effects across study design, intervention type, and clinical populations, with the largest effects for pharmacological interventions, particularly antipsychotic medications and combined pharmacological interventions, and interventions for youth with ASD.

中文翻译：

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系统评价和荟萃分析：针对持续性非发作性烦躁的药理学和非药理学干预措施

客观的

这项荟萃分析检查了现有药物和非药物干预措施对患有自闭症谱系障碍（ASD）、注意力缺陷/多动障碍（ADHD）、破坏性行为障碍（DBD）、破坏性情绪失调障碍（DMDD）、和/或严重情绪失调（SMD）。

方法

文献检索于 2020 年 10 月进行，共审查了 564 篇摘要以找出相关论文，其中 387 篇文章得到了完整审查。随机效应模型用于荟萃分析，并运行亚组荟萃回归来评估研究设计、干预类型、药物类别和临床人群的影响。

结果

总共纳入 101 项研究（80 项药理学研究、13 项非药理学研究、8 项综合研究）。尽管效果异质性很高（I ²  = 94.3%），但降低烦躁性的治疗后效果汇总值很大（Hedges' g  = 1.62）。药物（ g  = 1.85）和非药物（g  = 1.11）干预措施效果显着；相对于单一治疗干预措施，联合干预措施具有中等效果（g  = 0.69）。相对于所有其他药物类别和非药物干预措施，抗精神病药物在减少烦躁方面提供了最大的效果。对患有自闭症谱系障碍 (ASD) 的青少年有很大影响 ( g  = 1.89)，而对患有 ADHD/DMDD/DBD/SMD 的青少年则有中等影响 ( g  = 0.64)。

结论

这项荟萃分析对针对患有各种精神疾病的青少年持续性非发作性烦躁的干预措施进行了全面回顾。强有力的证据表明，研究设计、干预类型和临床人群都存在中到大的影响，其中药物干预的影响最大，特别是抗精神病药物和联合药物干预，以及针对自闭症谱系障碍青少年的干预措施。