Perlis Roy H, Fraguas Renerio, Fava Maurizio, Trivedi Madhukar H, Luther James F, Wisniewski Stephen R, Rush A John
Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
J Clin Psychiatry. 2005 Feb;66(2):159-66; quiz 147, 273-4.
Irritability is a common feature of major depressive disorder (MDD), though it is not included in the DSM-IV diagnostic criteria for adult MDD and is not assessed in most standard depression rating scales. Irritability with or without depression has been associated with risk for suicide, violence, and cardiovascular disease.
The prevalence of significant levels of irritability was examined among the first 1456 outpatients with nonpsychotic MDD entering the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. Sociodemographic and clinical features were compared for participants who did and did not report irritability at least 50% of the time during the week preceding study entry.
Of 1456 evaluable subjects, 582 (40%) reported irritability more than half the time. These individuals were more likely than nonirritable subjects to be female, to be younger, to be unemployed, and to report a history of at least 1 suicide attempt. Functional status and quality of life were also poorer in this group. Irritability was correlated with overall depressive severity, which accounted for nearly all of the clinical differences noted, with the exception of vascular disease, for which the association persisted after controlling for age, sex, and depressive severity.
Irritability is prevalent among depressed outpatients and associated with a greater likelihood of suicide attempts, poorer functional status, and greater prevalence of vascular disease. It is correlated with overall depression severity and thus may not represent a distinct depressive subtype per se. The impact of irritability on course and treatment outcome merits further study.
易激惹是重度抑郁症（MDD）的常见特征，尽管它未被纳入成人MDD的《精神疾病诊断与统计手册》第四版（DSM-IV）诊断标准，且在大多数标准抑郁评定量表中也未得到评估。伴有或不伴有抑郁的易激惹与自杀、暴力和心血管疾病风险相关。
在1456名进入缓解抑郁的序贯治疗方案（STAR*D）研究的非精神病性MDD门诊患者中，检查了显著易激惹水平的患病率。比较了在研究入组前一周内至少50%时间报告有易激惹和未报告易激惹的参与者的社会人口学和临床特征。
在1456名可评估受试者中，582名（40%）报告易激惹的时间超过一半。与不易激惹的受试者相比，这些个体更可能为女性、更年轻、失业，且报告有至少一次自杀未遂史。该组的功能状态和生活质量也较差。易激惹与总体抑郁严重程度相关，除血管疾病外，几乎所有观察到的临床差异都可由其解释，在控制年龄、性别和抑郁严重程度后，血管疾病的关联依然存在。
易激惹在抑郁门诊患者中普遍存在，与自杀未遂的可能性更大、功能状态较差以及血管疾病患病率更高相关。它与总体抑郁严重程度相关，因此可能本身并不代表一种独特的抑郁亚型。易激惹对病程和治疗结果的影响值得进一步研究。
