His teacher states Jonah "flies into a rage" when asked to follow directions, and outbursts sometimes escalate into throwing objects, yelling, or threatening peers. Both parents and school staff observed near-constant irritability with outbursts occurring 4-5 times per week for a year. Attempts at discipline or redirection often result in aggression, crying spells, or prolonged tantrums lasting 30 minutes to over an hour. These behaviors are not isolated to one setting but occur at home, in class, and during extracurricular activities. No episodes of depression.

Questions:

1. Which feature best differentiates DMDD from Oppositional Defiant Disorder (ODD)?

A) Frequency of temper outbursts
B) Severity of mood symptoms between outbursts
C) Presence of hyperactivity
D) Family history of mood disorders

2.At what age must DMDD symptoms first appear?

A) Before age 5
B) Before age 7
C) Before age 10
D) Before age 12

3. In DMDD, temper outbursts must occur in how many settings?

A) One setting
B) Two or more settings
C) Only at home
D) Only at school

4. Which of the following medications might a PMHNP consider for Jonah’s DMDD?

A) Stimulants
B) SSRI
C) Antipsychotic
D) Mood stabilizer

Answers:

1. B) Severity of mood symptoms between outbursts

2. C) Before age 10

3. B) Two or more settings

4. B) SSRI (for mood regulation)