Negative Outcomes in Bipolar, Schizoaffective Disorder Linked to Irritability

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Irritability may confer an increased risk of greater symptom burden, functional and social impairment in bipolar and schizoaffective disorder.
Irritability may confer an increased risk of greater symptom burden, functional and social impairment in bipolar and schizoaffective disorder.

Irritability has a significant influence on outcomes in adults with bipolar and schizoaffective disorders, according to a study published in Bipolar Disorders. As a result, clinicians should monitor and target irritability carefully during treatment.

While irritability frequently occurs in patients who are manic, hypomanic, or depressed, it remains a nonspecific factor. Lesley Berk, PhD, and colleagues from the School of Medicine, Deakin University, Geelong, Victoria, Australia, sought to better understand irritability as a factor and to examine its impact on symptom burden, functioning, quality of life, social support, suicidality, and overall severity illness in adult patients.

The researchers used data from 239 adult outpatients from the Bipolar Comprehensive Outcomes Study (BCOS), a non-interventional study in which participants were assessed every 3 months over a 2-year period. There were 175 participants with bipolar I disorder, and 64 patients with schizoaffective disorder, all of whom were older than 18 and whose clinician had prescribed them either an atypical antipsychotic agent (olanzapine)or a mood stabilizer (lithium carbonate, sodium valproate, or carbamezepine).

Of the full sample, 54% of the participants was irritable. In the irritable group (58.2% female and 41.8% male; mean age 41.8), 35 patients (27%) scored as aggressive or disruptive on item 9 of the Young Mania Rating Scale (YRMS), which suggests that a range of irritability exists within the group. Baseline irritability was associated with illness severity, mania, depression, psychotic symptoms, suicidality, poor functioning, and quality of life, but not with diagnosis.

Irritability was significantly associated with suicidality, with generalized affective disorder and drug/alcohol dependence comorbidity, as well as with psychotic symptoms. Age, gender, and income showed no univariate association with irritability, but individuals who did not have a partner were more likely to exhibit irritability. Also, individuals reporting irritability had poorer perceptions of social support overall than individuals without irritability at 2-year follow-up. While average suicidality scores were not high, they were significantly elevated in the irritable group.

The study's findings supported the expectation that in addition to its role in manic and hypomanic episodes, irritability is potentially a common and stable indicator of emotion reactivity and dysregulation in bipolar and schizoaffective disorder.

"Our study supports the importance of considering irritability, not only as a diagnostic criterion of mania/hypomania, but also as an independent and clinically powerful factor, deserving of increased research and clinical attention," the researchers said.

"Irritability may have wide-ranging impacts on symptomatic, functional, and social elements of quality of life," they continued. "Further studies are needed…to enhance the identification, monitoring, and treatment of irritability, and to help patients improve their QoL across the spectrum of symptoms, and their interpersonal relationships."

Reference

Berk L, Hallam KT, Venugopal K, et al. Impact of irritability: a 2-year observational study of outpatients with bipolar I or schizoaffective disorder [published online May 3, 2017]. Bipolar Disord. doi:10.1111/bdi.12486.

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