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International Journal of Bipolar Disorders

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Open Access 01-12-2016 | Research

Current irritability associated with hastened depressive recurrence and delayed depressive recovery in bipolar disorder

Authors: Laura D. Yuen, Saloni Shah, Dennis Do, Shefali Miller, Po W. Wang, Farnaz Hooshmand, Terence A. Ketter

Published in: International Journal of Bipolar Disorders | Issue 1/2016

Abstract

Background

Current irritability is associated with greater retrospective and current bipolar disorder (BD) illness severity; less is known about prospective longitudinal implications of current irritability. We examined relationships between current irritability and depressive recurrence and recovery in BD.

Methods

Outpatients referred to the Stanford BD Clinic during 2000–2011 were assessed with the Systematic Treatment Enhancement Program for BD (STEP-BD) Affective Disorders Evaluation at baseline, and with the Clinical Monitoring Form during follow-up during up to 2 years of naturalistic treatment. Prevalence and clinical correlates of any current irritability in depressed and recovered (euthymic ≥8 weeks) BD patients were assessed. Kaplan–Meier analyses (Log-Rank tests) assessed relationships between current irritability and longitudinal depressive severity, with Cox Proportional Hazard analyses assessing potential mediators.

Results

Recovered BD outpatients with vs. without current irritability had significantly higher rates of 13/19 (68.4 %) other baseline unfavorable illness characteristics/current mood symptoms and hastened depressive recurrence (Log-Rank p = 0.020), driven by lifetime history of anxiety disorder and prior year rapid cycling, and attenuated by history of psychosis. Depressed BD outpatients with vs. without current irritability had significantly higher rates of 7/19 (36.8 %) other unfavorable illness characteristics/current mood symptoms and delayed depressive recovery (Log-Rank p = 0.034), NOT mediated by any assessed parameter.

Limitations

Limited generalizability beyond our predominately white, female, educated, insured American BD specialty clinic sample.

Conclusions

Current irritability was associated with hastened depressive recurrence and delayed depressive recovery in BD. Treatment studies targeting irritability may yield strategies to mitigate increased longitudinal depressive burden.

Altshuler LL, Post RM, Black DO, Keck PE Jr, Nolen WA, Frye MA, et al. Subsyndromal depressive symptoms are associated with functional impairment in patients with bipolar disorder: results of a large, multisite study. J Clin Psychiatry. 2006;67:1551–60.CrossRefPubMed

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Washington: American Psychiatric Association; 2013.

Balázs J, Benazzi F, Rihmer Z, Rihmer A, Akiskal KK, Akiskal HS. The close link between suicide attempts and mixed (bipolar) depression: implications for suicide prevention. J Affect Disord. 2006;91:133–8.CrossRefPubMed

Benazzi F. Delineation of the clinical picture of dysphoric/mixed hypomania. Prog Neuropsychopharmacol Biol Psychiatry. 2007;31:944–51.CrossRefPubMed

Benazzi F, Akiskal H. Clinical and factor analytic-validation of depressive mixed states: a report from the Ravenna-San Diego collaboration. Curr Opin Psychiatry. 2003a;16:S71–8.CrossRef

Benazzi F, Akiskal H. Irritable-hostile depression: further validation as a bipolar depressive mixed state. J Affect Disord. 2005;84:197–207.CrossRefPubMed

Benazzi F, Akiskal HS. The dual factor structure of self-rated MDQ hypomania: energized-activity vs. irritable-thought racing. J Affect Disord. 2003b;73:59–64.CrossRefPubMed

Benazzi F, Koukopoulos A, Akiskal HS. Toward a validation of a new definition of agitated depression as a bipolar mixed state (mixed depression). Eur Psychiatry. 2004;19:85–90.CrossRefPubMed

Berk M, Brnabic A, Dodd S, Kelin K, Tohen M, Malhi GS, et al. Does stage of illness impact treatment response in bipolar disorder? Empirical treatment data and their implication for the staging model and early intervention. Bipolar Disord. 2011;13:87–98.CrossRefPubMed

Dilsaver SC, Chen YW, Swann AC, Shoaib AM, Tsai-Dilsaver Y, Krajewski KJ. Suicidality, panic disorder and psychosis in bipolar depression, depressive-mania and pure-mania. Psychiatry Res. 1997;73:47–56.CrossRefPubMed

First MB, Spitzer RL, Gibbon M, Williams JB. User’s guide for the structured clinical interview for DSM-IV axis I disorders SCID-I: clinician version: American Psychiatric Publishing, Inc.; 1997.

Goldberg JF, Harrow M. A 15-year prospective follow-up of bipolar affective disorders: comparisons with unipolar nonpsychotic depression. Bipolar Disord. 2011;13:155–63.CrossRefPubMed

Goldberg JF, Perlis RH, Bowden CL, Thase ME, Miklowitz DJ, Marangell LB, et al. Manic symptoms during depressive episodes in 1,380 patients with bipolar disorder: findings from the STEP-BD. Am J Psychiatry. 2009;166:173–81.CrossRefPubMed

Gyulai L, Bauer MS, Marangell LB, Dennehy EB, Thase ME, Otto MW, et al. Correlates of functioning in bipolar disorder. Psychopharmacol Bull. 2008;41:51–64.PubMed

Judd LL, Akiskal HS, Schettler PJ, Coryell W, Endicott J, Maser JD, et al. A prospective investigation of the natural history of the long-term weekly symptomatic status of bipolar II disorder. Arch Gen Psychiatry. 2003;60:261–9.CrossRefPubMed

Judd LL, Akiskal HS, Schettler PJ, Endicott J, Maser J, Solomon DA, et al. The long-term natural history of the weekly symptomatic status of bipolar I disorder. Arch Gen Psychiatry. 2002;59:530–7.CrossRefPubMed

Judd LL, Schettler PJ, Akiskal HS, Coryell W, Leon AC, Maser JD, et al. Residual symptom recovery from major affective episodes in bipolar disorders and rapid episode relapse/recurrence. Arch Gen Psychiatry. 2008;65:386–94.CrossRefPubMed

Keller MB, Lavori PW, Kane JM, Gelenberg AJ, Rosenbaum JF, Walzer EA, et al. Subsyndromal symptoms in bipolar disorder. A comparison of standard and low serum levels of lithium. Arch Gen Psychiatry. 1992;49:371–6.CrossRefPubMed

Ketter TA. Handbook of Diagnosis and Treatment of Bipolar Disorder. Washington, DC: American Psychiatric Publishing, Inc.; 2010.

Lish JD, Dime-Meenan S, Whybrow PC, Price RA, Hirschfeld RM. The National Depressive and Manic-depressive Association (DMDA) survey of bipolar members. J Affect Disord. 1994;31:281–94.CrossRefPubMed

MacQueen GM, Marriott M, Begin H, Robb J, Joffe RT, Young LT. Subsyndromal symptoms assessed in longitudinal, prospective follow-up of a cohort of patients with bipolar disorder. Bipolar Disord. 2003;5:349–55.CrossRefPubMed

Maj M, Pirozzi R, Magliano L, Bartoli L. Agitated depression in bipolar I disorder: prevalence, phenomenology, and outcome. Am J Psychiatry. 2003;160:2134–40.CrossRefPubMed

Maj M, Veltro F, Pirozzi R, Lobrace S, Magliano L. Pattern of recurrence of illness after recovery from an episode of major depression: a prospective study. Am J Psychiatry. 1992;149:795–800.CrossRefPubMed

Otto MW, Simon NM, Wisniewski SR, Miklowitz DJ, Kogan JN, Reilly-Harrington NA, et al. Prospective 12-month course of bipolar disorder in out-patients with and without comorbid anxiety disorders. Br J Psychiatry. 2006;189:20–5.CrossRefPubMed

Pae CU, Vohringer PA, Holtzman NS, Thommi SB, Patkar A, Gilmer W, et al. Mixed depression: a study of its phenomenology and relation to treatment response. J Affect Disord. 2012;136:1059–61.CrossRefPubMed

Parmentier C, Etain B, Yon L, Misson H, Mathieu F, Lajnef M, et al. Clinical and dimensional characteristics of euthymic bipolar patients with or without suicidal behavior. Eur Psychiatry. 2012;27:570–6.CrossRefPubMed

Perlis RH, Ostacher MJ, Patel JK, Marangell LB, Zhang H, Wisniewski SR, et al. Predictors of recurrence in bipolar disorder: primary outcomes from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Am J Psychiatry. 2006;163:217–24.CrossRefPubMed

Perugi G, Angst J, Azorin JM, Bowden CL, Mosolov S, Reis J, et al. Mixed features in patients with a major depressive episode: the BRIDGE-II-MIX study. J Clin Psychiatry. 2015;76:e351–8.CrossRefPubMed

Rosa AR, Gonzalez-Ortega I, Gonzalez-Pinto A, Echeburua E, Comes M, Martinez-Aran A, et al. One-year psychosocial functioning in patients in the early vs. late stage of bipolar disorder. Acta Psychiatr Scand. 2012;125:335–41.CrossRefPubMed

Sachs GS, Guille C, McMurrich SL. A clinical monitoring form for mood disorders. Bipolar Disord. 2002;4:323–7.CrossRefPubMed

Sachs GS, Thase ME, Otto MW, Bauer M, Miklowitz D, Wisniewski SR, et al. Rationale, design, and methods of the systematic treatment enhancement program for bipolar disorder (STEP-BD). Biol Psychiatry. 2003;53:1028–42.CrossRefPubMed

Shah S, Kim JP, Park DY, Kim H, Yuen LD, Do D, et al. Lifetime anxiety disorder comorbidity associated with hastened depressive recurrence in bipolar disorder. J Affect Disord. 2016. (In Review).

Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59:22–33.PubMed

Sokolski KN, Denson TF. Adjunctive quetiapine in bipolar patients partially responsive to lithium or valproate. Prog Neuropsychopharmacol Biol Psychiatry. 2003;27:863–6.CrossRefPubMed

Solomon DA, Keitner GI, Miller IW, Shea MT, Keller MB. Course of illness and maintenance treatments for patients with bipolar disorder. J Clin Psychiatry. 1995;56:5–13.PubMed

Spearing MK, Post RM, Leverich GS, Brandt D, Nolen W. Modification of the Clinical Global Impressions (CGI) Scale for use in bipolar illness (BP): the CGI-BP. Psychiatry Res. 1997;73:159–71.CrossRefPubMed

Suttajit S, Paholpak S, Choovanicvong S, Kittiwattanagul K, Pratoomsri W, Srisurapanont M. Correlates of current suicide risk among Thai patients with bipolar I disorder: findings from the Thai Bipolar Disorder Registry. Neuropsychiatr Dis Treat. 2013;9:1751–7.PubMedPubMedCentral

Vazquez GH, Holtzman JN, Lolich M, Ketter TA, Baldessarini RJ. Recurrence rates in bipolar disorder: systematic comparison of long-term prospective, naturalistic studies vs. randomized controlled trials. Eur Neuropsychopharmacol. 2015;25:1501–12.CrossRefPubMed

Vieta E, Martinez-Aran A, Nieto E, Colom F, Reinares M, Benabarre A, et al. Adjunctive gabapentin treatment of bipolar disorder. Eur Psychiatry. 2000;15:433–7.CrossRefPubMed

Winokur G, Clayton P, Reich T. Manic-Depressive Illness. Saint Louis: Mosby; 1969.

Winokur G, Tsuang MT. Elation vs. irritability in mania. Compr Psychiatry. 1975;16:435–6.CrossRefPubMed

Yuen LD, Miller S, Wang PW, Hooshmand F, Holtzman JN, Goffin KC, et al. Current irritability robustly related to current and prior anxiety in bipolar disorder. J Psychiatr Res. 2016;79:101–7.CrossRefPubMed

Title: Current irritability associated with hastened depressive recurrence and delayed depressive recovery in bipolar disorder
Authors: Laura D. Yuen
Saloni Shah
Dennis Do
Shefali Miller
Po W. Wang
Farnaz Hooshmand
Terence A. Ketter
Publication date: 01-12-2016
Publisher: Springer Berlin Heidelberg
Published in: International Journal of Bipolar Disorders / Issue 1/2016
Electronic ISSN: 2194-7511
DOI: https://doi.org/10.1186/s40345-016-0056-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Current irritability associated with hastened depressive recurrence and delayed depressive recovery in bipolar disorder

Abstract

Background

Methods

Results

Limitations

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Limitations

Conclusions

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