Berk Lesley, Hallam Karen T, Venugopal Kamalesh, Lewis Andrew James, Austin David W, Kulkarni Jayashri, Dodd Seetal, de Castella Anthony, Fitzgerald Paul B, Berk Michael
Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Vic., Australia.
Department of Psychiatry, University of Melbourne, Parkville, Vic., Australia.
Bipolar Disord. 2017 May;19(3):184-197. doi: 10.1111/bdi.12486. Epub 2017 May 3.
Many people experience irritability when manic, hypomanic, or depressed, yet its impact on illness severity and quality of life in bipolar and schizoaffective disorders is poorly understood. This study aimed to examine the relationship between irritability and symptom burden, functioning, quality of life, social support, suicidality, and overall illness severity in a naturalistic cohort of people with bipolar I or schizoaffective disorder.
We used data from 239 adult outpatients with bipolar I or schizoaffective disorder in the Bipolar Comprehensive Outcomes Study (BCOS) - a non-interventional observational study with a 2-year follow-up period. Baseline demographic and clinical characteristics of participants with and without irritability were compared. A mixed-model repeated measures analysis was conducted to examine the longitudinal effect of irritability on clinical and quality-of-life variables over follow-up using significant baseline variables.
At baseline, 54% of participants were irritable. Baseline irritability was associated with illness severity, mania, depression, psychotic symptoms, suicidality, poor functioning, and quality of life, but not diagnosis (schizoaffective/bipolar disorder). Participants with irritability were less likely to have a partner and perceived less adequate social support. On average, over follow-up, those with irritability reported more symptoms, functional impairment, and suicidality. Furthermore, the effects of irritability could not be fully explained by illness severity.
Irritability was associated with more negative symptomatic, functional, and quality-of-life outcomes and suicidality. The identification, monitoring, and targeted treatment of irritability may be worth considering, to enhance health and wellbeing outcomes for adults with bipolar and schizoaffective disorders.
许多人在躁狂、轻躁狂或抑郁时会出现易怒情绪，但人们对其在双相情感障碍和精神分裂症性障碍中对疾病严重程度和生活质量的影响了解甚少。本研究旨在探讨在一组患有双相I型障碍或精神分裂症性障碍的自然人群中，易怒情绪与症状负担、功能、生活质量、社会支持、自杀倾向及整体疾病严重程度之间的关系。
我们使用了双相情感障碍综合结局研究（BCOS）中239名患有双相I型障碍或精神分裂症性障碍的成年门诊患者的数据，这是一项为期2年随访期的非干预性观察研究。比较了有易怒情绪和没有易怒情绪的参与者的基线人口统计学和临床特征。使用显著的基线变量进行混合模型重复测量分析，以研究随访期间易怒情绪对临床和生活质量变量的纵向影响。
在基线时，54%的参与者存在易怒情绪。基线时的易怒情绪与疾病严重程度、躁狂、抑郁、精神病症状、自杀倾向、功能不良和生活质量相关，但与诊断（精神分裂症性障碍/双相情感障碍）无关。有易怒情绪的参与者拥有伴侣的可能性较小，且感觉获得的社会支持不足。平均而言，在随访期间有易怒情绪的参与者报告有更多症状、功能损害和自杀倾向。此外，疾病严重程度无法完全解释易怒情绪的影响。
易怒情绪与更多负面的症状、功能和生活质量结果以及自杀倾向相关。识别、监测和针对性治疗易怒情绪可能值得考虑，以改善患有双相情感障碍和精神分裂症性障碍的成年人的健康和幸福结局。
