Prospective longitudinal course of aggression among adults with bipolar disorder

Abstract

Objectives Bipolar disorder (BP) has been associated with increased aggressive behaviors. However, all existing studies are cross-sectional and include forensic or inpatient populations and many do not take into account the effects of comorbid conditions. The goal of this study was to evaluate the longitudinal course of aggression among adult outpatients with BP compared with non-BP patients and healthy controls. Methods Subjects with bipolar I disorder (BP-I)/bipolar II disorder (BP-II) (n = 255), non-BP psychopathology (n = 85), and healthy controls (n = 84) (average 38.9 years, 78.7% female, and 84.9% Caucasian) were evaluated at intake and after two- and four-years of follow-up. Aggression was self-rated using the Aggression Questionnaire (AQ). Comparisons were adjusted for any significant demographic and clinical differences and for multiple comparisons. For subjects with BP, associations of AQ with subtype of BP, current versus past mood episodes, polarity and severity of the current episode, psychosis, and current pharmacological treatment were evaluated. Results In comparison with subjects with non-BP psychiatric disorders and healthy controls, subjects with BP showed persistently higher total and subscale AQ scores (raw and T-scores) during the four-year follow-up. There were no effects of BP subtype, severity or polarity of the current episode, psychosis, and current pharmacological treatments. Subjects in an acute mood episode showed significantly higher AQ scores than euthymic subjects. Conclusions BP, particularly during acute episodes, is associated with increased self-reported verbal and physical aggression, anger, and hostility. These results provide further evidence for the need of treatments to prevent mood recurrences and prompt treatment of acute mood episodes in subjects with BP.

Emotion-relevant impulsivity predicts sustained anger and aggression after remission in bipolar I disorder

“…Previous research documented that persons diagnosed with BD reported significantly more difficulty with anger, verbal aggression, physical aggression, and hostility than did control participants, and that these difficulties were sustained across follow-up (Ballester et al, 2014) and even during a state of remission (Johnson et al, in press). Not all persons with BD have such difficulties, however.…”

“…Nonetheless, aggression, as well as subjective experiences of anger, continues to be of concern for some with BD even after remission. Anger and aggression are core predictors of functioning (Ballester et al, 2014), mania (Wright et al, 2008), suicidality (Oquendo et al, 2000), and incarceration (Arseneault et al, 2000;Casiano et al, 2008). As such, there is need for richer models that integrate both clinical and personality predictors to enhance treatment.…”

“…In pediatric BD, anger and aggression are common reasons for referral (Wozniak et al, 2005). Moreover, self-rated anger and aggression levels have been found to be robustly related to lower functioning within BD, r¼ À.55 (Ballester et al, 2014). In sum, data from community representative and clinical samples suggest that problems with anger and aggressive behavior are a substantial concern for those with BD, with these difficulties being severe enough to lead to high rates of incarceration.…”

“…In one study, people diagnosed with BD obtained high scores on the Aggression Questionnaire compared to psychiatric and healthy controls across a four-year follow-up, and the difficulties with anger and aggression were not explained by episode status (Ballester et al, 2014). Heightened anger has also been reported among those at risk for the disorder, as indicated by subsyndromal symptoms (Cooke and Jones, 2009) or parental diagnosis of BD (Maoz et al, 2014).…”

Neuropeptide S reduces mouse aggressiveness in the resident/intruder test through selective activation of the neuropeptide S receptor

“…Despite most of psychiatric patients are not violent, some severe mental illness, particularly bipolar disorder, personality disorders and schizophrenia, are associated with an increased risk for aggressive behavior (Ballester et al, 2014;Volavka, 2013). Aggressiveness and social behaviors are known to be modulated by classical neurotransmitters, in particular dopamine and serotonin (Comai et al, 2012a), but also by neuropeptides, such as vasopressin and oxytocin (Albers, 2012;Bosch and Neumann, 2012;Calcagnoli et al, 2013;Neumann and Landgraf, 2012;Veenema and Neumann, 2008).…”