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

Abstract

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.

Irritability in bipolar disorder and unipolar disorder measured daily using smartphone‐based data: An exploratory post hoc study

“…These findings are in line with previous studies suggesting that the presence of irritability is associated with increased severity of illness activity. [10][11][12][13][14] As hypothesized, increased irritability was associated with impaired functioning and increased perceived stress, respectively. Importantly, the findings remained statistically significant when adjusting for psychopharmacological treatments, such as antidepressants, in both patients with BD and UD, which add evidence to the findings of irritability as part of the symptomatology rather than as part of an activation syndrome related to antidepressants or akathisia.…”

“…[7][8][9] In patients with BD, the presence of irritability seems associated with increased severity of depressive episodes, longer episode duration and increased perceived stress and decreased quality of life and functioning, respectively. [10][11][12] In patients with UD, irritability has been associated with a more chronic and complex course of illness and more psychiatric comorbidities. 13,14 Furthermore, there is growing evidence that irritability as part of UD may indicate greater illness severity and may suggest a misdiagnosed bipolar disorder.…”

“…14,15 Previous studies investigating irritability and related clinical features in affective disorders, have evaluated irritability using various paper-based questionnaires and clinical evaluations based on cross-sectional evaluations or weekly evaluations. 11,12,14 Smartphones are well suited for real-time patientreports given their widespread adoption and ownership. They can offer the opportunity to collect fine-grained data at a self-chosen interval outside clinical settings, which enables characterization of daily information of important symptomatology and may increase adherence to monitoring as well as reduce potential recall bias.…”

“…Elevated or irritable mood is included as a mandatory A criterion in the diagnosis of hypomania, and mania in the International Classification of Diseases 10th revision (ICD‐10), ICD‐11 and The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM‐5) 7–9 . In patients with BD, the presence of irritability seems associated with increased severity of depressive episodes, longer episode duration and increased perceived stress and decreased quality of life and functioning, respectively 10–12 . In patients with UD, irritability has been associated with a more chronic and complex course of illness and more psychiatric comorbidities 13,14 .…”

“…Furthermore, there is growing evidence that irritability as part of UD may indicate greater illness severity and may suggest a misdiagnosed bipolar disorder 14,15 . Previous studies investigating irritability and related clinical features in affective disorders, have evaluated irritability using various paper‐based questionnaires and clinical evaluations based on cross‐sectional evaluations or weekly evaluations 11,12,14 …”