Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, TX, USA.
Psychol Med. 2021 Jun;51(8):1355-1363. doi: 10.1017/S0033291720000112. Epub 2020 Mar 6.
This report tests the association of self-reported symptoms of irritability with overt behavior of anger attacks (uncharacteristic sudden bouts of anger that are disproportionate to situation and associated with autonomic activation).
Participants of the Establishing Moderators and Biosignatures of Antidepressant Response in Clinical Care study who completed Massachusetts General Hospital Anger Attacks questionnaire were included ( = 293). At each visit, the 17-item Hamilton Depression Rating Scale and the 16-item Concise Associated Symptom Tracking scale were used to measure depression, anxiety, and irritability. In those with anger attacks present those without anger attacks, separate tests and mixed model analyses compared afore-mentioned symptoms at baseline and changes with treatment respectively. As anger attacks may occur without aggressive behaviors, analyses were repeated based only on the presence of aggressive behaviors.
At baseline, those with anger attacks ( = 109) those without anger attacks ( = 184) had similar levels of depression but higher levels of irritability [effect size () = 0.80] and anxiety ( = 0.32). With acute-phase treatment, participants with anger attacks experienced a greater reduction in irritability ( < 0.001) but not in depression ( = 0.813) or anxiety ( = 0.771) as compared to those without anger attacks. Yet, irritability levels at week-8 were higher in those with anger attacks ( = 0.32) than those without anger attacks. Similar results were found in participants with aggressive behaviors.
The presence of anger attacks in outpatients with major depressive disorder may identify a sub-group of patients with persistently elevated irritability.
本报告测试了自述的易怒症状与愤怒发作的明显行为之间的关联（愤怒发作是指不典型的突发性愤怒，与情境不成比例，并伴有自主神经激活）。
本研究纳入了参与临床护理中抗抑郁反应的调节因子和生物标志物研究的参与者，他们完成了马萨诸塞州总医院愤怒发作问卷（ = 293）。在每次就诊时，使用 17 项汉密尔顿抑郁评定量表和 16 项简明伴随症状跟踪量表来评估抑郁、焦虑和易怒。在有愤怒发作的患者（ = 109）和无愤怒发作的患者（ = 184）中，分别进行检验和混合模型分析，比较基线时和治疗过程中的上述症状变化。由于愤怒发作可能在没有攻击性行为的情况下发生，因此仅基于存在攻击性行为进行了分析。
基线时，有愤怒发作的患者（ = 109）和无愤怒发作的患者（ = 184）的抑郁程度相似，但易怒程度更高（效应量（）= 0.80）和焦虑程度更高（ = 0.32）。在急性治疗阶段，与无愤怒发作的患者相比，有愤怒发作的患者易怒症状明显减轻（ < 0.001），但抑郁（ = 0.813）和焦虑（ = 0.771）症状无明显改善。然而，有愤怒发作的患者在第 8 周时的易怒水平仍高于无愤怒发作的患者（ = 0.32）。在有攻击性行为的患者中也发现了类似的结果。
在患有重度抑郁症的门诊患者中，愤怒发作的存在可能会识别出一组持续存在易激惹的亚组患者。
