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Musoni-Rwililiza E, Arnbjerg CJ, Rurangwa NU, Bendtsen MG, Carlsson J, Kallestrup P, Vindbjerg E, Gishoma D. Adaption and validation of the Rwandese version of the Young Mania Rating Scale to measure the severity of a manic or hypomanic episode. BMC Psychiatry 2024; 24:450. [PMID: 38890629 PMCID: PMC11186071 DOI: 10.1186/s12888-024-05890-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 06/05/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Bipolar Disorder is one of the most incapacitating diseases among young persons, leading to cognitive and functional impairment and raised mortality, particularly death by suicide. Managing a manic episode and developing new and more effective treatment modalities requires sensitive and reliable instruments. This study aims to translate the English version of the YMRS questionnaire into Kinyarwanda, adapt it to the Rwandan context, and assess its validity. METHODS The original English version of The Young Mania Rating Scale questionnaire was translated into Kinyarwanda. The translation process followed a standardized approach, including back-translation, cross-cultural adaptation, and final adjustments. A total of 130 inpatients with bipolar disorder in a manic episode from CARAES Ndera Teaching Hospital were included. The descriptive statistics and test-retest correlations were carried out, as well as the CFA for validation and Rasch-analysis. RESULTS The Rwandese version of The Young mania rating scale had an adequate internal consistency (Cronbach's alpha = 0.90). Item 11 provided the lowest standardized loading in both ratings (0.51 and 0.55). The second lowest loading involved the highly correlated item pairs 5 & 9, with item 5 loading 0.51 in rating 1 and item 9 loading 0.57 in rating 2. The remaining loadings ranged from 0.59 to 0.79. This relatively narrow range indicated that a fit to a Rasch model was plausible if excluding item 11. CONCLUSION The findings demonstrate that the translated YMRS, the R-YMRS, can be used as a reliable and valid instrument for assessing mania in the Rwandese population in clinical and research settings. However, the results supported using an unweighted total score of 32 and removing items 5, 9, and 11. Studies on this revised scale with an added interview guide for less-trained clinical staff are recommended.
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Affiliation(s)
- E Musoni-Rwililiza
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
- Center for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark.
- University Teaching Hospital of Kigali (CHUK), Kigali, Rwanda.
| | - C J Arnbjerg
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Center for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - N U Rurangwa
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - M G Bendtsen
- Competence Centre for Transcultural Psychiatry (CTP), Mental Health Centre Ballerup, Ballerup, Denmark
| | - J Carlsson
- Competence Centre for Transcultural Psychiatry (CTP), Mental Health Centre Ballerup, Ballerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - P Kallestrup
- Center for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - E Vindbjerg
- Competence Centre for Transcultural Psychiatry (CTP), Mental Health Centre Ballerup, Ballerup, Denmark
| | - D Gishoma
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
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Hazell P, Balzer BWR, Garden F, Handelsman DJ, Paxton K, Hawke C, Ivers R, Skinner SR, Luscombe G, Steinbeck KS. Association of urinary sex hormones with mood and behavior changes in a community adolescent cohort. PLoS One 2023; 18:e0293040. [PMID: 37844097 PMCID: PMC10578568 DOI: 10.1371/journal.pone.0293040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/03/2023] [Indexed: 10/18/2023] Open
Abstract
OBJECTIVE To examine the contribution of variation in sex hormone excretion to mood and behavioral changes in adolescent females and males. DESIGN Prospective, longitudinal observational cohort study. METHODS Participants were 342 volunteers aged 10-12 years living in rural Australia. Urinary estradiol and testosterone levels measured by liquid chromatography-mass spectrometry were obtained at three-month intervals for three years. Integrated measures (area-under-curve) of urinary steroid excretion summarised as absolute and variability during each 12-month period of the study. Psychosocial data were gathered annually with the primary outcome of depressive symptomatology. Secondary outcomes were the other subscales of the Youth Self-Report, impulsive-aggression, sleep habits, and self-harm. RESULTS 277 (158 male) participants contributed data over the full duration of the study and could be included in the analyses. In females, analyses of absolute urine hormone levels found no relationship between estradiol and any outcome, but higher testosterone was significantly associated with depression and poorer sleep. Greater variability of both urine estradiol and testosterone was associated with lower total psychopathology, anxious/depressed and social problems scores. Greater variability in urine estradiol was associated with lower attention problems and impulsive aggression in females. In males, higher testosterone and estradiol levels were associated with rule-breaking, and poorer sleep, and no associations were found for gonadal hormone variability for males. CONCLUSIONS Longitudinal measurement of both iso-sexual and contra-sexual gonadal hormones contributes to a more nuanced view of the impact of sex steroids on mood and behavior in adolescents. These findings may enlighten the understanding of the impact of sex steroids during normal male and female puberty with implications for hormone replacement therapies as well as management of common mood and behavioral problems.
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Affiliation(s)
- Philip Hazell
- Faculty of Medicine and Health, The University of Sydney School of Medicine, Camperdown, NSW, Australia
| | - Ben W. R. Balzer
- Faculty of Medicine and Health, The University of Sydney School of Medicine, Camperdown, NSW, Australia
- The University of New South Wales Faculty of Medicine, School of Women’s and Children’s Health, Randwick, NSW, Australia
- Sydney Children’s Hospital, Randwick, NSW, Australia
| | - Frances Garden
- Ingham Institute for Medical Research, The University of New South Wales, Liverpool, NSW, Australia
| | - David J. Handelsman
- Faculty of Medicine and Health, The University of Sydney School of Medicine, Camperdown, NSW, Australia
| | - Karen Paxton
- Faculty of Medicine and Health, The University of Sydney School of Medicine, Camperdown, NSW, Australia
| | - Catherine Hawke
- Faculty of Medicine and Health, The University of Sydney School of Medicine, Camperdown, NSW, Australia
| | - Rebecca Ivers
- The University of New South Wales Faculty of Medicine, School of Public Health and Community Medicine, Kensington, NSW, Australia
| | - S. Rachel Skinner
- Faculty of Medicine and Health, The University of Sydney School of Medicine, Camperdown, NSW, Australia
- Specialty of Child and Adolescent Health, The Children’s Hospital at Westmead Clinical School, Sydney, NSW, Australia
| | - Georgina Luscombe
- Faculty of Medicine and Health, The University of Sydney School of Medicine, Camperdown, NSW, Australia
| | - Katharine S. Steinbeck
- Faculty of Medicine and Health, The University of Sydney School of Medicine, Camperdown, NSW, Australia
- Specialty of Child and Adolescent Health, The Children’s Hospital at Westmead Clinical School, Sydney, NSW, Australia
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Barclay ME, Silvers JA, Lee SS. Childhood Irritability: Predictive Validity and Mediators of Adolescent Psychopathology. Res Child Adolesc Psychopathol 2022; 50:1165-1177. [PMID: 35522397 DOI: 10.1007/s10802-022-00908-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2022] [Indexed: 10/18/2022]
Abstract
Despite its transdiagnostic significance, there is modest evidence with respect to the predictive validity of childhood irritability, especially across developmental periods; similarly, little is known about explanatory factors underlying these predictions. This study had two goals: (1) to test the predictive validity of childhood irritability with respect to adolescent internalizing and externalizing problems, controlling for baseline ADHD and related psychopathology and (2) to test theoretically-derived family (i.e., parenting behavior, parenting stress) and social (i.e., peer status, social skills) constructs as explanatory factors of adolescent psychopathology. Two hundred thirty ethnically diverse (51.5% White) 5-10-year-old youth (32% female) with (n = 121) and without (n = 110) ADHD completed three separate laboratory-based assessments across six to seven years. Temporally-ordered predictors, putative mediators, and psychopathology outcomes were assessed using multiple informants (i.e., parent, teacher, youth) and methods (i.e., structured interviews, normed rating scales). Controlling for demographic factors, clinical correlates, and baseline psychopathology, childhood irritability uniquely predicted adolescent externalizing problems, but not internalizing problems. Next, analyses revealed that low social skills partially explained predictions of adolescent internalizing problems. However, family or social factors did not underlie predictions of adolescent externalizing problems. These preliminary findings support the predictive validity of childhood irritability with respect to early adolescent externalizing problems and implicate low social skills as a potentially unique mediator of internalizing outcomes. Intervention-induced improvements in social skills may minimize emergent psychopathology initiated by significant childhood irritability.
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Affiliation(s)
- Margot E Barclay
- Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Box 951563, 90095, CA, Los Angeles, USA
| | - Jennifer A Silvers
- Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Box 951563, 90095, CA, Los Angeles, USA
| | - Steve S Lee
- Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Box 951563, 90095, CA, Los Angeles, USA.
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Zik J, Deveney CM, Ellingson JM, Haller SP, Kircanski K, Cardinale EM, Brotman MA, Stoddard J. Understanding Irritability in Relation to Anger, Aggression, and Informant in a Pediatric Clinical Population. J Am Acad Child Adolesc Psychiatry 2022; 61:711-720. [PMID: 34438022 PMCID: PMC8863995 DOI: 10.1016/j.jaac.2021.08.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 07/13/2021] [Accepted: 08/16/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Despite its clinical relevance to pediatric mental health, the relationship of irritability with anger and aggression remains unclear. We aimed to quantify the relationships between well-validated, commonly used measurements of these constructs and informant effects in a clinically relevant population. METHOD A total of 195 children with primary diagnoses of attention-deficit/hyperactivity disorder, disruptive mood dysregulation disorder, or no major disorder and their parents rate irritability, anger, and aggression on measures of each construct. Construct and informant relationships were mapped via multi-trait, multi-method factor analysis. RESULTS Parent- and child-reported irritability and child-reported anger are highly associated (r = 0.89) but have some significant differences. Irritability overlaps with outward expression of anger but diverges from anger in anger suppression and control. Aggression has weaker associations with both irritability (r = 0.56) and anger (r = 0.49). Across measures, informant source explains a substantial portion of response variance. CONCLUSION Irritability, albeit distinct from aggression, is highly associated with anger, with notable overlap in child-reported outward expression of anger, providing empirical support for formulations of clinical irritability as a proneness to express anger outwardly. Diagnostic and clinical intervention work on this facet of anger can likely translate to irritability. Further research on external validation of divergence of these constructs in anger suppression and control may guide future scale revisions. The proportion of response variance attributable to informant may be an under-recognized confound in clinical research and construct measurement.
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Affiliation(s)
- Jodi Zik
- Pediatric Mental Health Institute, Children's Hospital Colorado, University of Colorado, Anschutz Medical Campus, Aurora.
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Vance A, Winther J. Irritability and Inattention Not Sad Low Mood Predict Impulsiveness in Children and Adolescents With Major Depressive Disorder and Persistent Depressive Disorder. J Nerv Ment Dis 2021; 209:454-458. [PMID: 34037553 DOI: 10.1097/nmd.0000000000001293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The specific relationships between impulsiveness, inattention, sad, low mood, and irritability have not been systematically examined in young people with major depressive disorder with and without persistent depressive disorder. The relationships are important to clarify because these symptom dimensions may increase suicidal risk in children and adolescents with these depressive disorders. A total of 313 medication-naive young people (aged 6-16 years) with active major depressive disorder (MDD) alone, persistent depressive disorder (DD) alone, and comorbid MDD and DD were identified. "Inattention," "sad/unhappy," and "irritable" mood were identified by parent standardized questionnaire. Standard multiple regression was used to investigate how well inattention, sad/unhappy, and irritable mood predict impulsiveness. Inattention (32% of the variance, increased) and irritable mood (5% of the variance, increased) both made independent significant contributions to impulsiveness, whereas sad/unhappy mood did not. Decreasing irritability via more targeted and comprehensive management approaches may ameliorate impulsiveness in young people with these depressive disorders.
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Affiliation(s)
- Alasdair Vance
- Academic Child Psychiatry Unit, Department of Paediatrics, University of Melbourne
| | - Jo Winther
- Developmental Neuropsychiatry Program, Royal Children's Hospital, Parkville, VIC, Australia
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6
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Courbet O, Slama H, Purper-Ouakil D, Massat I, Villemonteix T. Context-dependent irritability in Attention Deficit/Hyperactivity Disorder: correlates and stability of family-restricted versus cross-situational temper outbursts. Child Adolesc Ment Health 2021; 26:122-133. [PMID: 32558093 DOI: 10.1111/camh.12399] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 05/26/2020] [Accepted: 05/27/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Impairing irritability is highly prevalent in children with attention deficit/hyperactivity disorder (ADHD), although manifestations of irritability are not necessarily present in all settings (home, school, with peers). At the moment, little is known about the relative prevalence, stability, and etiologies of contextual versus cross-situational manifestations of irritability in ADHD. In this study, levels of dysfunctional parenting practices and sleep problems were compared in irritable versus nonirritable children with ADHD, in cases of family-restricted versus cross-situational irritability, and examined as predictors of irritability levels over a one-year interval. Stability of irritability manifestations over time was investigated, and prevalence of cross-situational disruptive mood dysregulation disorder (DMDD) versus 'family-restricted' DMDD was compared. METHOD One hundred and seventy children with ADHD (age 6-11) were examined. Parents completed a semi-structured interview and questionnaire to assess irritability, and parent-report questionnaires were used to evaluate parenting practices and sleep problems. Questionnaires were completed for a second time after a one-year interval. RESULTS Parenting practices were more dysfunctional in the irritable group compared to the nonirritable group, while sleep problems did not differ between these two groups. Levels of parenting practices and sleep problems did not predict later irritability after correction for multiple comparison nor did they differ between the family-restricted and cross-situational irritable groups. Finally, family-restricted irritability was as prevalent and as stable over time as cross-situational irritability and family-restricted DMDD as prevalent as cross-situational DMDD. CONCLUSIONS Factors associated with contextual versus cross-situational manifestations of irritability in ADHD remain elusive. More subtle measures of parenting practices should be considered, including psychological control or accommodation, and other constructs such as social inhibition. Despite not being captured by current nosography, severe forms of family-restricted irritability may be as prevalent as severe forms of cross-situational irritability.
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Affiliation(s)
- Ophélie Courbet
- Psychopathology and Neuropsychology Laboratory, Paris 8 Vincennes - St Denis University, Saint-Denis, France
| | - Hichem Slama
- UR2NF - Neuropsychology and Functional Neuroimaging Research Group at CRCN - Center for Research in Cognition and Neurosciences, Free University of Brussels, Brussels, Belgium.,Department of Clinical and Cognitive Neuropsychology, Erasmus Hospital, Free University of Brussels, Brussels, Belgium
| | - Diane Purper-Ouakil
- Psychological Medicine for Children and Adolescents, Secteur 1, Saint-Éloi Hospital, University Hospital of Montpellier, Montpellier, France
| | - Isabelle Massat
- Laboratory of Experimental Neurology, Free University of Brussels, Brussels, Belgium.,National Fund of Scientific Research (FNRS), Brussels, Belgium.,Department of Neurology, Erasmus Hospital, Brussels, Belgium
| | - Thomas Villemonteix
- Psychopathology and Neuropsychology Laboratory, Paris 8 Vincennes - St Denis University, Saint-Denis, France
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Elvin OM, Modecki KL, Finch J, Donnolley K, Farrell LJ, Waters AM. Joining the pieces in childhood irritability: Distinct typologies predict conduct, depressive, and anxiety symptoms. Behav Res Ther 2020; 136:103779. [PMID: 33291055 DOI: 10.1016/j.brat.2020.103779] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/15/2020] [Accepted: 11/17/2020] [Indexed: 11/26/2022]
Abstract
This study utilised a person-centered approach to understand childhood irritability as a transdiagnostic feature of psychopathology. Latent profile analysis was employed within a community sample (n = 93) of 9-11 year olds to identify typologies of self-regulation capabilities, positive wellbeing characteristics of hope and flourishing, and social functioning that cluster with children's irritability to mitigate risk for psychopathology symptoms. Three distinct profiles of youth were derived, High Irritability/Low Self-Regulation of Negative Emotion (9%), Moderate Irritability/Low Behavioural Control (34%) and Low Irritability/High Positive Wellbeing Characteristics (57%). Profiles were empirically validated and differentially related to symptoms of anxiety, depression and conduct problems. Notably, High Irritability/Low Self-Regulation of Negative Emotion children were characterised by the highest levels of irritability and peer problems and the lowest self-regulation of negative emotion, prosocial behaviours, hope and flourishing relative to children within the other profiles, pointing to the potential utility of future targeted, transdiagnostic interventions. Within our community-based sample, a protective profile of Low Irritability/High Positive Wellbeing Characteristics children were also described by the lowest levels of irritability and peer problems and the highest positive and negative emotion self-regulation, behavioural control, prosocial behaviours, hope and flourishing. Findings demonstrate that different levels of irritability severity cluster with different self-regulation capabilities and wellbeing characteristics and predict risk for different types of psychopathology. Targeted interventions should seek to address children's irritability alongside self-regulation and positive wellbeing characteristics to further mitigate risks of psychopathology and associated problems.
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Affiliation(s)
- Olivia M Elvin
- School of Applied Psychology, Griffith University, Mount Gravatt Campus, 176 Messines Ridge Road, Mount Gravatt, QLD, 4122, Australia.
| | - Kathryn L Modecki
- School of Applied Psychology, Griffith University, Mount Gravatt Campus, 176 Messines Ridge Road, Mount Gravatt, QLD, 4122, Australia; Menzies Health Institute Queensland, Australia.
| | - Jules Finch
- School of Applied Psychology, Griffith University, Southport Campus, 1 Parklands Drive, Southport, QLD, 4215, Australia
| | | | - Lara J Farrell
- School of Applied Psychology, Griffith University, Southport Campus, 1 Parklands Drive, Southport, QLD, 4215, Australia
| | - Allison M Waters
- School of Applied Psychology, Griffith University, Mount Gravatt Campus, 176 Messines Ridge Road, Mount Gravatt, QLD, 4122, Australia.
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Waschbusch DA, Baweja R, Babinski DE, Mayes SD, Waxmonsky JG. Irritability and Limited Prosocial Emotions/Callous-Unemotional Traits in Elementary-School-Age Children. Behav Ther 2020; 51:223-237. [PMID: 32138934 DOI: 10.1016/j.beth.2019.06.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 06/13/2019] [Accepted: 06/17/2019] [Indexed: 01/06/2023]
Abstract
Affective traits, including irritability and limited prosocial emotions/callous-unemotional traits (LPE/CU), each explain significant variance in youth conduct problems but few studies have examined these constructs simultaneously. This study examined whether irritability, LPE/CU, or their combination explained significant variance in measures of internalizing or externalizing psychopathology, aggression, peer problems, impairment, or parenting. Participants were 219 elementary-school-age children, including 178 with attention-deficit/hyperactivity disorder, oppositional defiant disorder, and/or conduct disorder and 41 typically developing children. Results of analyses showed that irritability and LPE/CU had significant and sometimes unique associations with measures of child behavior, impairment, and parenting. There was also evidence that the interaction between irritability and LPE/CU was significantly associated with aggression and impairment. These findings suggest that irritability and LPE/CU should be examined together when assessing and treating conduct problems in youth.
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Affiliation(s)
- Daniel A Waschbusch
- Penn State College of Medicine and Penn State Milton S. Hershey Medical Center.
| | - Raman Baweja
- Penn State College of Medicine and Penn State Milton S. Hershey Medical Center
| | - Dara E Babinski
- Penn State College of Medicine and Penn State Milton S. Hershey Medical Center
| | - Susan D Mayes
- Penn State College of Medicine and Penn State Milton S. Hershey Medical Center
| | - James G Waxmonsky
- Penn State College of Medicine and Penn State Milton S. Hershey Medical Center
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Deveney CM, Stoddard J, Evans R, Chavez G, Harney M, Wulff R. On Defining Irritability and its Relationship to Affective Traits and Social Interpretations. PERSONALITY AND INDIVIDUAL DIFFERENCES 2019; 144:61-67. [PMID: 31097847 DOI: 10.1016/j.paid.2019.02.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Irritability has gained recognition as a clinically significant trait in youth and adults that when persistent and severe, predicts poor outcomes throughout life. However, its definition, measurement, and relationship to similar constructs remain poorly understood. In a community sample of adults (N=458; 19-74 years; M=40.5), we sought to identify a unitary irritability factor from independently constructed self-reported measures of irritability distinct from the related constructs of aggression, depression, and anxiety, and whether it was associated with face emotion identification deficits and hostile interpretation biases previously established in clinical pediatric samples. The three measures of irritability generated a common factor characterized by a rapid, angry response to provocation. This irritability factor had unique associations with tendencies to judge ambiguous stimuli as reflecting hostility, but not with face emotion identification performance. These findings clarify the nature of irritability and its associations with neurocognitive phenomenon.
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Affiliation(s)
| | | | | | - Goretty Chavez
- Department of Psychology, Wellesley College, Wellesley, MA
| | | | - Rachel Wulff
- Department of Psychology, Wellesley College, Wellesley, MA
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Parsing cyclothymic disorder and other specified bipolar spectrum disorders in youth. J Affect Disord 2018; 238:375-382. [PMID: 29909300 PMCID: PMC6322201 DOI: 10.1016/j.jad.2018.06.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 06/01/2018] [Accepted: 06/04/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Most studies of pediatric bipolar disorder (BP) combine youth who have manic symptoms, but do not meet criteria for BP I/II, into one "not otherwise specified" (NOS) group. Consequently, little is known about how youth with cyclothymic disorder (CycD) differ from youth with BP NOS. The objective of this study was to determine whether youth with a research diagnosis of CycD (RDCyc) differ from youth with operationalized BP NOS. METHOD Participants from the Course and Outcome of Bipolar Youth study were evaluated to determine whether they met RDCyc criteria. Characteristics of RDCyc youth and BP NOS youth were compared at baseline, and over eight-years follow-up. RESULTS Of 154 youth (average age 11.96 (3.3), 42% female), 29 met RDCyc criteria. RDCyc youth were younger (p = .04) at baseline. Over follow-up, RDCyc youth were more likely to have a disruptive behavior disorder (p = .01), and were more likely to experience irritability (p = .03), mood reactivity (p = .02), and rejection sensitivity (p = .03). BP NOS youth were more likely to develop hypomania (p = .02), or depression (p = .02), and tended to have mood episodes earlier in the eight-year follow-up period. LIMITATIONS RDCyc diagnoses were made retrospectively and followed stringent criteria, which may highlight differences that, under typical clinical conditions and more vague criteria, would not be evident. CONCLUSION There were few differences between RDCyc and BP NOS youth. However, the ways in which the groups diverged could have implications; chronic subsyndromal mood symptoms may portend a severe, but ultimately non-bipolar, course. Longer follow-up is necessary to determine the trajectory and outcomes of CycD symptoms.
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Puiu AA, Wudarczyk O, Goerlich KS, Votinov M, Herpertz-Dahlmann B, Turetsky B, Konrad K. Impulsive aggression and response inhibition in attention-deficit/hyperactivity disorder and disruptive behavioral disorders: Findings from a systematic review. Neurosci Biobehav Rev 2018; 90:231-246. [PMID: 29689282 DOI: 10.1016/j.neubiorev.2018.04.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/13/2018] [Accepted: 04/17/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Although impulsive aggression (IA) and dysfunctional response inhibition (RI) are hallmarks of attention-deficit/hyperactivity disorder (ADHD) and disrupted behavioral disorders (DBDs), little is known about their shared and distinct deviant neural mechanisms. AIMS AND METHODS Here, we selectively reviewed s/fMRI ADHD and DBD studies to identify disorder-specific and shared IA and RI aberrant neural mechanisms. RESULTS In ADHD, deviant prefrontal and cingulate functional activity was associated with increased IA. Structural alterations were most pronounced in the cingulate cortex. Subjects with DBDs showed marked cortico-subcortical dysfunctions. ADHD and DBDs share similar cortico-limbic structural and functional alterations. RI deficits in ADHD highlighted hypoactivity in the dorso/ventro-lateral PFC, insula, and striatum, while the paralimbic system was primarily dysfunctional in DBDs. Across disorders, extensively altered cortico-limbic dysfunctions underlie IA, while RI was mostly associated with aberrant prefrontal activity. CONCLUSION Control network deficits were evidenced across clinical phenotypes in IA and RI. Dysfunctions at any level within these cortico-subcortical projections lead to deficient cognitive-affective control by ascribing emotional salience to otherwise irrelevant stimuli. The clinical implications of these findings are discussed.
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Affiliation(s)
- Andrei A Puiu
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, RWTH Aachen University, Aachen, Germany.
| | - Olga Wudarczyk
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Aachen, Germany.
| | - Katharina S Goerlich
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Aachen, Germany; Department of Neuroscience, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Mikhail Votinov
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Aachen, Germany; JARA-Institute Brain Structure-Function Relationship, Research Center Jülich and RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany; Institute of Neuroscience and Medicine 10, Research Center Jülich, Aachen, Germany.
| | - Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, RWTH Aachen University, Aachen, Germany.
| | - Bruce Turetsky
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA.
| | - Kerstin Konrad
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, RWTH Aachen University, Aachen, Germany.
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12
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Asken BM, Sullan MJ, Snyder AR, Houck ZM, Bryant VE, Hizel LP, McLaren ME, Dede DE, Jaffee MS, DeKosky ST, Bauer RM. Factors Influencing Clinical Correlates of Chronic Traumatic Encephalopathy (CTE): a Review. Neuropsychol Rev 2016; 26:340-363. [PMID: 27561662 PMCID: PMC5507554 DOI: 10.1007/s11065-016-9327-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 08/08/2016] [Indexed: 12/14/2022]
Abstract
Chronic traumatic encephalopathy (CTE) is a neuropathologically defined disease reportedly linked to a history of repetitive brain trauma. As such, retired collision sport athletes are likely at heightened risk for developing CTE. Researchers have described distinct pathological features of CTE as well a wide range of clinical symptom presentations, recently termed traumatic encephalopathy syndrome (TES). These clinical symptoms are highly variable, non-specific to individuals described as having CTE pathology in case reports, and are often associated with many other factors. This review describes the cognitive, emotional, and behavioral changes associated with 1) developmental and demographic factors, 2) neurodevelopmental disorders, 3) normal aging, 4) adjusting to retirement, 5) drug and alcohol abuse, 6) surgeries and anesthesia, and 7) sleep difficulties, as well as the relationship between these factors and risk for developing dementia-related neurodegenerative disease. We discuss why some professional athletes may be particularly susceptible to many of these effects and the importance of choosing appropriate controls groups when designing research protocols. We conclude that these factors should be considered as modifiers predominantly of the clinical outcomes associated with repetitive brain trauma within a broader biopsychosocial framework when interpreting and attributing symptom development, though also note potential effects on neuropathological outcomes. Importantly, this could have significant treatment implications for improving quality of life.
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Affiliation(s)
- Breton M Asken
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA.
| | - Molly J Sullan
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Aliyah R Snyder
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Zachary M Houck
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Vaughn E Bryant
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Loren P Hizel
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Molly E McLaren
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Duane E Dede
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Michael S Jaffee
- Department of Neurology, University of Florida, Gainesville, FL, USA
| | - Steven T DeKosky
- Department of Neurology, University of Florida, Gainesville, FL, USA
| | - Russell M Bauer
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
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