Impact of irritability: a 2‐year observational study of outpatients with bipolar I or schizoaffective disorder

Berk, Lesley; Hallam, K; Venugopal, Kamalesh; Lewis, Andrew J.; Austin, David W.; Kulkarni, Jayashri; Dodd, Seetal; Castella, Anthony de; Fitzgerald, Paul B.; Berk, Michael

doi:10.1111/bdi.12486

Cited by 19 publications

(14 citation statements)

References 105 publications

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“…Regarding irritability, the findings from the present study are in line with findings from another study suggesting that irritability in patients with bipolar disorder is associated with an earlier illness onset, increased family history of bipolar disorder, increased risk of suicidality, decreased quality of life and functioning, that was not fully explained by illness severity . Thus, identification and monitoring of irritability may aid clinicians to identify patients at risk of a severe course of illness .…”

Section: Discussionsupporting

confidence: 90%

“…‘Irritable mood’ as a psychopathological symptom is more non‐specific with a transdiagnostic occurrence and is associated with many psychiatric conditions . Thus, it is more difficult to ascertain whether the irritability experienced by patients with bipolar disorder is related to a (hypo)‐manic or mixed picture or simply a symptom of illness in general . Irritable mood has been observed in three‐quarters of patients with bipolar disorder , also between mood episodes , and studies have found that patients with bipolar disorder experiencing irritable mood has an increased risk of mixed episodes compared with patients not experiencing irritable mood .…”

Section: Introductionmentioning

confidence: 99%

“…Irritable mood has been observed in three‐quarters of patients with bipolar disorder , also between mood episodes , and studies have found that patients with bipolar disorder experiencing irritable mood has an increased risk of mixed episodes compared with patients not experiencing irritable mood . Further, in patients with bipolar disorder, irritable mood has been associated with an earlier illness onset, increased family history of bipolar disorder, increased risk of suicidality, impaired course of illness, decreased quality of life and functioning, that was not fully explained by illness severity . Identification and monitoring of irritability may aid clinicians to identify patients at risk of a severe course of illness .…”

Section: Introductionmentioning

confidence: 99%

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The association between mixed symptoms, irritability and functioning measured using smartphones in bipolar disorder

Faurholt‐Jepsen

Frost²,

Christensen

et al. 2019

Acta Psychiatr Scand

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LV. The association between mixed symptoms, irritability and functioning measured using smartphones in bipolar disorder Objective: To (i) validate patient-evaluated mixed symptoms and irritability measured using smartphones against clinical evaluations; (ii) investigate associations between mixed symptoms and irritability with stress, quality of life and functioning, respectively, in patients with bipolar disorder. Methods: A total of 84 patients with bipolar disorder used a smartphone-based system for daily evaluation of mixed symptoms and irritability for nine months. Clinically evaluated symptoms, stress, quality of life and clinically rated functioning were collected multiple times during follow-up. Results: Patients presented mild affective symptoms. Patient-reported mixed symptoms and irritability correlated with clinical evaluations. In analyses including confounding factors there was a statistically significant association between both mixed symptoms and irritability and stress (P < 0.0001) and between irritability and both quality of life and functioning (P < 0.0001) respectively. There was no association between mixed mood and both quality of life and functioning. Conclusion: Mixed symptoms and irritability can be validly selfreported using smartphones in patients with bipolar disorder. Mixed symptoms and irritability are associated with increased stress even during full or partial remission. Irritability is associated with decreased quality of life and functioning. The findings emphasize the clinical importance of identifying inter-episodic symptoms including irritability pointing towards smartphones as a valid tool. Significant outcomes• Daily evaluated mixed symptoms and irritability were validly self-reported using smartphones compared with clinically evaluated symptoms in patients with bipolar disorder.• Mixed symptoms and irritability were associated with increased perceived stress even during full or partial remission, and irritability was associated with decreased quality of life and functioning. Limitations• Data on perceived stress and quality of life were collected using questionnaires answered by patients who, due to the nature of the smartphone-based monitoring system, were not blinded to the monitoring tool.• The patients received different types of psychopharmacologic treatment during the study; thus, medication class were included as a covariate in the statistical analyses.• The findings were based on analyses of associations between variables, and the included covariates did not alter the estimates. It may be that other possible confounding factors could have affected the associations and thus interpretation should be taken with caution.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The association between mixed symptoms, irritability and functioning measured using smartphones in bipolar disorder

Faurholt‐Jepsen

Frost²,

Christensen

et al. 2019

Acta Psychiatr Scand

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“…In the ICD-11, the diagnostic guideline for mania allows for euphoria, irritability, or expansiveness together with increased activity or subjectively increased energy as well as other characteristic manic symptoms, without specifying the number of symptoms. There remains controversy around the inclusion of irritability, which is a far more non-specific phenomenon with much overlap with disorders such as ADHD, conduct disorder, and personality disorders [38]. Allowing mania based principally in the context of irritability risks blurring the boundary between these disorders [39].…”

Section: Bipolar Disordersmentioning

confidence: 99%

Mental, behavioral and neurodevelopmental disorders in the ICD-11: an international perspective on key changes and controversies

Stein

Szatmári

Gäebel

et al. 2020

BMC Med

Self Cite

162

121

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An update of the chapter on Mental, Behavioral and Neurodevelopmental Disorders in the International Classification of Diseases and Related Health Problems (ICD) is of great interest around the world. The recent approval of the 11th Revision of the ICD (ICD-11) by the World Health Organization (WHO) raises broad questions about the status of nosology of mental disorders as a whole as well as more focused questions regarding changes to the diagnostic guidelines for specific conditions and the implications of these changes for practice and research. This Forum brings together a broad range of experts to reflect on key changes and controversies in the ICD-11 classification of mental disorders. Taken together, there is consensus that the WHO's focus on global applicability and clinical utility in developing the diagnostic guidelines for this chapter will maximize the likelihood that it will be adopted by mental health professionals and administrators. This focus is also expected to enhance the application of the guidelines in non-specialist settings and their usefulness for scaling up evidence-based interventions. The new mental disorders classification in ICD-11 and its accompanying diagnostic guidelines therefore represent an important, albeit iterative, advance for the field.

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“…Proximal and distal risk factors that increase the likelihood of suicidal behaviors in bipolar disorder from multiple sources [Colour figure can be viewed at wileyonlinelibrary.com]…”

Section: Risk Factors For Suicidal Behaviours In Bdmentioning

confidence: 99%

Modeling suicide in bipolar disorders

et al. 2018

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Suicide is complex, and it is evident that a multidimensional and integrated approach is required to reduce its prevalence. The proposed model exposes and provides access to components of the suicide process that are potentially measurable and may serve as novel and specific therapeutic targets for interventions in the context of bipolar disorder. Thus, this model is useful not only for research purposes, but also for future real-world clinical practice.

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Impact of irritability: a 2‐year observational study of outpatients with bipolar I or schizoaffective disorder

Cited by 19 publications

References 105 publications

The association between mixed symptoms, irritability and functioning measured using smartphones in bipolar disorder

The association between mixed symptoms, irritability and functioning measured using smartphones in bipolar disorder

Mental, behavioral and neurodevelopmental disorders in the ICD-11: an international perspective on key changes and controversies

Modeling suicide in bipolar disorders

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