Seção de Afeto Negativo e Processos Socias, Hospital de Clínicas de Porto Alegre, Departamento de Psiquiatria, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
Section on Mood Dysregulation and Neuroscience, Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA.
Trends Psychiatry Psychother. 2020 Oct-Dec;42(4):375-386. doi: 10.1590/2237-6089-2019-0078.
Irritability has both mood and behavioral manifestations. These frequently co-occur, and it is unclear to what extent they are dissociable domains. We used confirmatory factor analysis and external validators to investigate the independence of mood and behavioral components of irritability.
The sample comprised 246 patients (mean age 45 years; 63% female) from four outpatient programs (depression, anxiety, bipolar, and schizophrenia) at a tertiary hospital. A clinical instrument rated by trained clinicians was specifically designed to capture irritable mood and disruptive behavior dimensionally, as well as current categorical diagnoses i.e., intermittent explosive disorder (IED); oppositional defiant disorder (ODD); and an adaptation to diagnose disruptive mood dysregulation disorder (DMDD) in adults. Confirmatory factor analysis (CFA) was used to test the best fitting irritability models and regression analyses were used to investigate associations with external validators.
Irritable mood and disruptive behavior were both frequent, but diagnoses of disruptive syndromes were rare (IED, 8%; ODD, 2%; DMDD, 2%). A correlated model with two dimensions, and a bifactor model with one general dimension and two specific dimensions (mood and behavior) both had good fit indices. The correlated model had root mean square error of approximation (RMSEA) = 0.077, with 90% confidence interval (90%CI) = 0.071-0.083; comparative fit index (CFI) = 0.99; and Tucker-Lewis index (TLI) = 0.99, while the bifactor model had RMSEA = 0.041; CFI = 0.99; and TLI = 0.99 respectively). In the bifactor model, external validity for differentiation of the mood and behavioral components of irritability was also supported by associations between irritable mood and impairment and clinical measures of depression and mania, which were not associated with disruptive behavior.
Psychometric and external validity data suggest both overlapping and specific features of the mood vs. disruptive behavior dimensions of irritability.
易激惹既有情绪表现，也有行为表现。这些表现经常同时出现，目前尚不清楚它们在多大程度上是可分离的领域。我们使用验证性因子分析和外部验证器来研究易激惹的情绪和行为成分的独立性。
该样本由四家门诊项目（抑郁症、焦虑症、双相情感障碍和精神分裂症）的 246 名患者（平均年龄 45 岁，63%为女性）组成，这些患者均来自一家三级医院。一种由训练有素的临床医生专门设计的临床仪器，从维度上评估易激惹的情绪和破坏性行为，以及当前的分类诊断，即间歇性爆发障碍（IED）；对立违抗性障碍（ODD）；以及成人破坏性情绪失调障碍（DMDD）的诊断适应。验证性因子分析（CFA）用于测试最佳拟合的易激惹模型，回归分析用于研究与外部验证器的关联。
易激惹的情绪和行为都很常见，但破坏性综合征的诊断却很少见（IED，8%；ODD，2%；DMDD，2%）。一个具有两个维度的相关模型和一个具有一个一般维度和两个特定维度（情绪和行为）的双因素模型都具有良好的拟合指数。相关模型的近似均方根误差（RMSEA）为 0.077，90%置信区间（90%CI）为 0.071-0.083；比较拟合指数（CFI）为 0.99；和 Tucker-Lewis 指数（TLI）为 0.99，而双因素模型的 RMSEA 为 0.041；CFI 为 0.99；TLI 为 0.99。在双因素模型中，易激惹情绪和行为成分的区分的外部有效性也得到了支持，这与易激惹情绪与抑郁和躁狂的临床测量结果之间的关联有关，而这些关联与破坏性行为无关。
心理测量学和外部有效性数据表明，易激惹的情绪和行为维度既有重叠特征，也有特定特征。
