Irritability through Research Domain Criteria: an opportunity for transdiagnostic conceptualisation

Bell, Erica; Bryant, Richard A.; Boyce, Philip; Porter, Richard; Malhi, Gin S

doi:10.1192/bjo.2020.168

Cited by 16 publications

(9 citation statements)

References 15 publications

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“… 2 – 4 Despite its seeming ubiquity and impact, irritability remains poorly understood and lacks an operational definition that would allow both valid and reliable measurement. 1 , 5 , 6 This is partly because there is a lack of consensus as regards the essential components that should be included in an optimal measure of irritability and its causal determinants are poorly understood, as are the subjective experience of being irritable and its behavioural consequences. 1 , 5 …”

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confidence: 99%

Novel insights into irritability: the relationship between subjective experience, age and mood

et al. 2021

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Background The relationship between irritability as a subjective experience and the behavioural indicators typically used to measure the construct are not known. Its links to mood, and contextual relationships, vary with age and are yet to be thoroughly examined. Aims First, to interrogate the relationship between the subjective experience of irritability and mood, and that with its behavioural indicators. Second, to determine how these relationships vary with age and over time. Method This study examined data from a previous clinical trial of adolescents and young adults (N = 82) with bipolar disorder, who received a psychological intervention over 18 months. Participants completed a battery of questionnaires, which included assessments of irritability. Analyses of covariance were conducted to examine the interaction between mood symptoms, subjective measures of irritability, behavioural measures of irritability and age over time. Results Subjective irritability scores differed significantly over time when controlling for manic, but not depressive, symptom scores. Further, subjective irritability significantly differed when controlling for behavioural measures of irritability (temper outbursts and argumentativeness). There were significant interactions between scores of depressive symptoms, temper outbursts and subjective irritability with age, wherein younger participants showed no correlation between depressive symptoms and temper outbursts. In addition, younger participants showed lower correlations between subjective irritability and both depressive and temper outburst scores, than older participants. Conclusions Subjective irritability is linked to mood morbidity and behavioural outbursts, and these relationships are contingent on age. Our novel findings suggest that subjective irritability should be assessed in greater detail in patients with mood disorders.

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Novel insights into irritability: the relationship between subjective experience, age and mood

et al. 2021

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“…Chronic irritability was identified by both DSM and ICD taskforces as a topic of interest, making it a circumstance likely to foster specific research efforts [ 43 ]. Therefore, irritability represents a new treatment target and a clinically relevant trans-diagnostic dimension associated with significant personal, social, and family burden [ 44 ]. Parent management programs are a cornerstone of the evidence-based treatment of behavioural disorders and have also shown efficacy for internalized and externalized symptoms [ 13 , 17 – 22 , 25 , 45 ].…”

Section: Discussionmentioning

confidence: 99%

Parent training for the treatment of irritability in children and adolescents: a multisite randomized controlled, 3-parallel-group, evaluator-blinded, superiority trial

Fongaro

Picot²,

Stringaris

et al. 2022

BMC Psychol

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Background Irritability is common in children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD) and with anxiety/depressive disorders. Although youth irritability is linked with psychiatric morbidity, little is known regarding its non-pharmacological treatments. Developing non-pharmacological treatments for children with severe, chronic irritability is an important target for clinical research. To achieve this goal, we will test the benefits of parent-focused therapies in reducing irritability. The aim of the study is to compare Parent Management Training (PMT) and Non-Violent Resistance Training (NVR) programs with treatment-as-usual (TAU) on the improvement of irritability in children and adolescents with a baseline Parent-rated Affective Reactivity Index of 4 or higher, in the context of ADHD and other emotional and behavioural disorders. Additionally, we will assess (i) improvement of irritability at different times and according to different informants (parents, children, clinicians); (ii) improvement of parental strategies; and (iii) acceptability of the interventions, exploring possible mechanisms of the therapeutic effect. Methods Two hundred and seventy participants between 6 and 15 years with ADHD and other emotional and behavioural disorders will be recruited and randomly assigned with their parents to the PMT, NVR, and TAU groups. PMT and NVR programs have 10 online sessions and two booster sessions at 1 and at 3 months. The primary outcome measure is the change from baseline at 3 months after completion of the program of the Clinician-rated Affective Rating Scale (CL-ARI) assessed by a blind evaluator. Secondary outcome measures include the change from baseline from those scales: the CL-ARI, the Clinical Global Impression Improvement scale, the Parenting and Familial Adjustment Scales, the Child-rated Cranky thermometers and the Parent-rated ARI. We will assess the parent’s expressed emotions and reflexivity during the online five-minute speech sample, clinical dimensions through the Child Behavior Checklist 6–18 and the Inventory of Callous Unemotional traits. Evaluations will be done remotely at baseline and at 1- and 3-months follow-up visits. Discussion We expect a benefit in controlling irritability in the treatment groups. This will constitute an important achievement in promoting parental support programs in the treatment of irritability in the context of emotional and behavioural disorders. Clinicaltrials.gov. Number: NCT05528926. Registered on the 2nd of September, 2022.

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“…Moreover, other symptoms which do occur in youth, such as irritability, meld with the vicissitudes of mood that are common as individuals develop and mature. 34 Indeed, the angst of adolescence is an accepted norm and the transformation of one's world view § is an integral part of maturation in this phase of growth. 35 In addition to the inherent flaws within the diagnostic criteria, the phenomenological signal in young people that is necessary for detecting the disorder is naturally 'weak' as the illness is still nascent and only just beginning to take form.…”

Section: Difficulty 1: a Flawed Signalmentioning

confidence: 99%

“…On top of this, the threshold for their behaviours to be regarded as grandiose, impulsive or risky is different in nature and far higher when compared to adults. Moreover, other symptoms which do occur in youth, such as irritability, meld with the vicissitudes of mood that are common as individuals develop and mature 34 . Indeed, the angst of adolescence is an accepted norm and the transformation of one's world view § is an integral part of maturation in this phase of growth 35…”

Section: From Adults To Youthmentioning

confidence: 99%

The diagnosis of bipolar disorder in children and adolescents: Past, present and future

Malhi,

Jadidi,

Bell

2023

Bipolar Disorders

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AimsThis article examines the ongoing debate concerning the diagnosis of bipolar disorder in children and adolescents. This contentious issue has generated robust discussion over the past two decades without consensus, and as such the true prevalence of so‐called paediatric bipolar disorder (PBD) remains unknown. In this article we offer a solution to break this deadlock.MethodsRecent meta‐analyses and additional literature concerning the definition and prevalence of PBD was critically reviewed with a view to understanding the perspectives of those developing the taxonomy of PBD, and those engaged in research and clinical practice.ResultsA key finding is the lack of iteration and meaningful communication between the various groups interested in PBD that stems from deep‐seated problems within our classificatory systems. This undermines our research efforts and complicates clinical practice. These problems make the already difficult diagnosis of bipolar disorder in adults even more challenging to transpose to younger populations, and additional complexities arise when parsing clinical phenomenology from normative developmental changes in youth. Therefore, in those manifesting bipolar symptoms post‐puberty, we argue for the use of adolescent bipolar disorder to describe bipolar symptoms whereas in pre‐pubertal children, we propose a reconceptualisation that allows symptomatic treatment to be advanced whilst requiring critical review of these symptoms over time.ConclusionSignificant changes in our current taxonomy are necessary and to be clinically meaningful, these revisions to our diagnoses need to be developmentally‐informed.

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Irritability through Research Domain Criteria: an opportunity for transdiagnostic conceptualisation

Cited by 16 publications

References 15 publications

Novel insights into irritability: the relationship between subjective experience, age and mood

Novel insights into irritability: the relationship between subjective experience, age and mood

Parent training for the treatment of irritability in children and adolescents: a multisite randomized controlled, 3-parallel-group, evaluator-blinded, superiority trial

The diagnosis of bipolar disorder in children and adolescents: Past, present and future

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