Hostname: page-component-848d4c4894-x5gtn Total loading time: 0 Render date: 2024-05-29T09:41:03.084Z Has data issue: false hasContentIssue false
  • English
  • Français

Presence of Irritability During Depressive Episodes in Bipolar Disorder

Published online by Cambridge University Press:  07 November 2014

Thilo Deckersbach ,
Roy H. Perlis ,
W. Gordon Frankle ,
Stephen M. Gray ,
Louisa Grandin ,
Darin D. Dougherty ,
Andrew A. Nierenberg  and
Gary S. Sachs
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:This study examined the prevalence of irritability in patients with bipolar I disorder during an episode of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) major depression who do not meet criteria for a mixed episode.

Method:A chart review of 111 patients with bipolar I disorder treated at the Massachusetts General Hospital Bipolar Clinic between 1998 and 2000 identified 34 patients who met criteria for a DSM-IV major depressive episode in the absence of (1) mood elevation and/or (2) irritability associated with any additional above threshold DSM-IV symptoms of mania. Data gathered from the charts utilized prospective ratings made routinely at each clinic visit using the Clinical Monitoring Form (CMF), a structured assessment instrument which includes modified versions of the mood modules of the Structured Clinical Interview for DSM-IV. Data from these 34 patients were reviewed to determine the presence of irritability.

Results:The frequency of abnormal irritability in these 34 patients followed a bimodal distribution: 26% of the patients showed abnormal irritability ≥75% of the time, compared with 68% of the patients with abnormal irritabihty ≤30% of the time. Of the high-irritability patients, psychomotor agitation was rated as definitely present to a significant degree in 44%. Talkativeness and distractibility were rated present but subthreshold in one patient each. All other symptoms of DSM-IV mania were absent.

Conclusion:Approximately 25% of patients with bipolar I disorder who meet criteria for a DSM-IV major depressive episode also experienced substantial irritability in the absence of associated symptoms of mania. Our results suggest that abnormal irritability is not limited to mania or mixed states.

Type
Original Research
Information
CNS Spectrums , Volume 9 , Issue 3 , March 2004 , pp. 227 - 231
Copyright
Copyright © Cambridge University Press 2004

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Altman, EG, Hedeker, DR, Janicak, PG, et. al.The clinician-administered rating scale for mania (CARS-M): development, reliability, and validity. Biol Psychiatry. 1994;36:124–134.CrossRefGoogle ScholarPubMed
2.Perugi, G, Akiskal, HS, Micheli, C, et al.Clinical subtypes of bipolar mixed states: validating a broader European definition in 143 cases. J Affect Disord. 1997;43:169–180.CrossRefGoogle ScholarPubMed
3.Cassidy, F, Murry, E., Forest, Ket al.Signs and symptoms of mania and mixed episodes. J Affect Disord. 1998;50:187–201.CrossRefGoogle ScholarPubMed
4.Dilsaver, S, Chen, YR, Shoaib, AM, et al.Phenomenology of mania: Evidence for distinct depressed, dysphoric and euphoric presentations. Am J Psychiatry. 1999;156:426–430.CrossRefGoogle ScholarPubMed
5.Cassidy, F, Forest, K, Murry, E. et al.A factor analysis of the signs and symptoms of mania. Am J Psychiatry. 1998;155:27–32.Google Scholar
6.Dayer, A, Aubry, J-M, Roth, L, et al.A theoretical reappraisal of mixed states: dysphoria as a third dimension. Bipolar Disord. 2000;2:16–324.CrossRefGoogle ScholarPubMed
7.Akiskal, HS, Benazzi, F. Family history validation of the bipolar nature of depressive mixed states. J Affect Disord. 2003;73:113–122.CrossRefGoogle ScholarPubMed
8.Perugi, G, Akiskal, HS, Micheli, C, Toni, C, Madaro, D. Clinical characterization of depressive mixed state in bipolar-1 patients: Pisa - San Diego collaboration. J Affect Disord. 2001;67:105–114.CrossRefGoogle Scholar
9.Winokur, G, Clayton, PJ, Reich, T. Manic Depressive Illness. St. Louis, Mo: CV Mosby; 1969.Google Scholar
10.Benazzi, F. Atypical depression with hypomanic symptoms. J Affect Disord. 2001;65:179–183.CrossRefGoogle ScholarPubMed
11.Benazzi, F. Major depressive disorder with anger: a bipolar spectrum disorder? Psychother Psychosom. 2003;72:300–306.CrossRefGoogle Scholar
12.Guille, C, Sachs, G, Demopulos, C. A clinical monitoring form for mood disorders (CMF-M), Paper presented at: Annual Meeting of the New Clinical Drug Evaluation Unit, June 1-4, 1999. Boca Raton, FL.Google Scholar
13.Diagnostic Statistical Manual of Mental Disease. 4th ed. Washington, DC: American Psychiatric Association; 1994.Google Scholar
14.First, MB, Spitzer, RL, Gibbon, M, et al.Structured Clinical Interview for DSM-IV Axis I Disorders-Patient Edition. (SCID-I/D, Version 2.0). Washington, DC: American Psychiatric Association; 1995.Google Scholar
15.Koukopulos, A, Koukopoulos, A. Agitated depression as a mixed state and the problem of melancholia. Psychiatr Clin North Am. 1999;22:547–564.CrossRefGoogle Scholar
16.Fava, M, Anderson, K, Rosenbaum, J. “Anger attacks”: possible variants of panic and major depressive disorder. Am J Psychiatry. 1990;147:867–870.Google Scholar
17.Guy, W. Assessment Manual for Psychopharmacology. Washington, DC: US Government Printing Office; 1976.Google Scholar