Aggressive outbursts among adults with major depressive disorder: Results from the Collaborative Psychiatric Epidemiological Surveys

Cortical volume alterations in the limbic network in adolescents with high reactive aggression

Previous studies show aggression-related structural alterations in frontal and limbic brain regions. Most studies have focused on overall aggression, instead of its subtypes, and on specific regions instead of networks. This study aims to identify both brain networks and regions that are associated with reactive and proactive subtypes of aggression. Structural MRI data were collected from 340 adolescents (125 F/215 M) with a mean age of 16.29 (SD = 1.20). Aggression symptomology was indexed via the Reactive Proactive Aggression Questionnaire (RPQ). Freesurfer was used to estimate Cortical Volume (CV) from seven networks and regions within specific networks associated with aggression. Two multivariate analyses of covariance (MANCOVAs) were conducted on groups for low versus higher reactive and proactive RPQ scores. Our reactive aggression MANCOVA showed a main effect in CV [F(14,321) = 1.935, p = 0.022,ηp2 = 0.078] across all the 7-Networks. Unpacking this main effect revealed significant volumetric differences in the right Limbic Network (LN) (p = 0.029) and the Temporal Pole (p = 0.011), where adolescents in the higher reactive aggression group showed higher cortical volumes. Such findings are consistent with region/voxel-specific analyses that have associated atypical structure within the LN and reactive aggression. Moreover, the temporal pole is highly interconnected with regions important in the regulation and initiation of reactive aggression.

Network structure of phasic and tonic irritability in adults: A Bayesian Gaussian graphical model

BACKGROUND

Tonic (i.e., irritable mood) and phasic (i.e., temper outbursts) irritability are distinct constructs in childhood, yet there has been little work investigating their relations in adulthood. In particular, no study has examined the relations between these symptoms in the daily lives of adults. The present study seeks to address these gaps by applying a Bayesian Gaussian graphical model to daily diary data of tonic and phasic irritability in adults.

METHOD

A total of 122 participants (Mage = 34.94 [SD = 12.3] years, 52 % female) completed up to 18 days of daily diary, with questions on both tonic and phasic irritability. Contemporaneous, temporal, and between-person networks were constructed using 5 items of tonic and 11 items of phasic irritability. Predictability, centrality, density, and network loadings were also calculated.

RESULTS

Five main findings emerged. First, phasic and tonic irritability were connected in our contemporaneous and temporal networks but distinct in our between-person network. Second, phasic irritability symptoms demonstrated the most importance and influence across networks. Third, tonic irritability symptoms best connected the two subnetworks. Fourth, phasic irritability symptoms appeared to have the potential to be more responsive to interventions. Fifth, tonic irritability demonstrated robust associations with daily functional impairment.

CONCLUSIONS

Tonic and phasic irritability symptoms demonstrate unique associations in the daily lives of adults. Future work should examine the differential potential of these symptoms to respond to targeted interventions.

Exploring Gender Differences in the Relationship Between Thyroid Function and Aggressive and Impulsive Behaviors in Patients with Major Depressive Disorder

Purpose

Major depressive disorder (MDD) is a widespread mental health condition with significant global impact. Exploring the gender differences in the interplay between thyroid function, aggression, and impulsivity offers valuable insights into its multifactorial nature and management.

Patients and Methods

A cross-sectional study was conducted at Anhui Mental Health Center and included 113 MDD patients (56 males, 57 females) and 102 healthy controls (45 males and 57 females). Thyroid function was assessed through serum thyroid hormone levels, and impulsivity and aggression were measured using the Buss-Perry Aggression Questionnaire (BPAQ) and Barratt's Impulsiveness Scale version 11 (BIS). Potential confounding factors such as age, education, and Hamilton Depression Rating Scale (HAMD) scores were adjusted for.

Results

Both male and female MDD patients showed significant changes in serum thyrotropin levels (F(1,213)=10.996, p=0.001), impulsivity (F(1,213)=151.521, p<0.05), and aggression (F(1,213)=44.411, p<0.05) compared to healthy controls. MANCOVA revealed significant differences in attentional impulsivity, motor impulsivity, physical aggression, anger, hostility, and self-directed aggression (all p<0.05). Moreover, significant differences between genders were observed in these areas (all p<0.05). In males, TSH levels were inversely related to several behavioral dimensions (all p<0.05), while no such correlation was found in females.

Conclusion

This study highlights the role of thyroid function, especially TSH levels, in influencing impulsivity and aggression in male MDD patients, suggesting a gender-specific physiological-behavioral relationship. The findings contribute to the development of gender-specific treatment strategies. In the future, longitudinal studies with larger sample sizes should be conducted to explore molecular mechanisms for more personalized treatments.

Association between overt aggression and suicidal ideation in patients with major depressive disorder: the mediational role of cognitive symptoms

Suicidal ideation, under the dominion of suicidal behavior, represents the most severe consequence of depressive disorders. Overt aggressive behaviors leading to agitated symptoms, coupled with cognitive symptoms during a depressive episode, both impact suicidal ideation and behavior. However, the precise mechanisms by which cognitive symptoms and overt aggressive behaviors influence suicidal ideation in patients with depressive disorders remain unclear. This cross-sectional study analyzed 301 MDD patients from the Shanghai Mental Health Centre between May 2017 and July 2020. Depression severity and cognitive symptoms were assessed using the 17-item Hamilton Depression Rating Scale (HAMD-17), overt aggression with the Modified Overt Aggression Scale (MOAS), and suicidal ideation with the Beck Scale for Suicide Ideation (BSSI). A multivariate logistic regression was conducted to identify risk factors for suicidal ideation. Patients with suicidal ideation had higher levels of cognitive impairment and overt aggression (Z = - 5.527, P < 0.01; Z = - 3.482, P < 0.01). Overt aggressive symptoms positively correlated with suicide ideation (r = 0.177, P = 0.006) and cognitive performance scores (r = 0.173, P = 0.035). And cognitive performance scores also positively correlated with suicide ideation (r = 0.308, P < 0.001). Logistic regression identified cognitive symptoms (OR 1.47) and overt aggression (OR 1.40) as predictors of suicidal ideation in MDD patients (P < 0.05). Mediation analysis revealed that cognitive symptoms mediated the relationship between overt aggression and suicidal ideation (indirect effect: 0.1903). In MDD, cognitive symptoms and overt aggression are significant predictors of suicidal ideation, with cognitive symptoms playing a mediating role. These findings suggest potential targets for therapeutic intervention.

Investigating proactive aggression in patients with borderline personality disorder and major depressive disorder using a modified version of the Taylor aggression paradigm

Introduction

Inappropriate reactive (provoked) aggression is common in various psychiatric disorders, including Borderline Personality Disorder (BPD) and, to a lesser extent, Major Depressive Disorder (MDD). Less is known about proactive (unprovoked) aggression in these patients, with mixed findings in the literature. Drawing from the current evidence, we expect higher trait aggression in both patient groups and higher behavioral proactive aggression and physiological arousal in patients with BPD compared to both MDD and healthy participants (HC).

Methods

We investigated behavioral and psychophysiological correlates of proactive aggression in 23 patients with MDD, 20 with BPD, and 21 HC using a proactive version of the Taylor Aggression Paradigm (pTAP). The pTAP consists of reaction time games in which only the participant can interfere with the ostensible opponent's performance by modifying the blurriness of the opponent's screen. The levels of blurriness chosen by participants reflect their proactive aggression. We collected self-report measures of aggression and other personality traits. We further adopted a transdiagnostic approach by clustering participants based on proactive aggression characteristics.

Results

Both patient groups reported higher trait aggression than HC but not higher aggression in the task nor differences in the associated physiological arousal. Trial-by-trial mixed model analyses revealed that the group characterized by higher proactive aggression traits behaved more aggressively after losing, suggesting a role of frustration or sensitivity to loss.

Discussion

Our study confirms that patients with MDD and BPD report higher aggression than HC despite the absence of observable behavioral and psychophysiological differences and highlights the ubiquity of proactive aggression characteristics across diagnoses.

A novel prediction model for the probability of aggressive behavior in patients with mood disorders: Based on a cohort study

BACKGROUND

Accurately predicting the probability of aggressive behavior is crucial for guiding early intervention in patients with mood disorders.

METHODS

Cox stepwise regression was conducted to identify potential influencing factors. Nomogram prediction models were constructed to predict the probabilities of aggressive behavior in patients with mood disorders, and their performance was assessed using consistency index (C-index) and calibration plots.

RESULTS

Research findings on 321 patients with mood disorders indicated that being older (HR = 0.92, 95% CI: 0.86-0.98), single (HR = 0.11, 95% CI: 0.02-0.68), having children (one child, HR = 0.07, 95%CI: 0.01-0.87; more than one child, HR = 0.33, 95%CI: 0.04-2.48), living in dormitory (HR = 0.25, 95%CI: 0.08-0.77), non-student (employee, HR = 0.24, 95% CI: 0.07-0.88; non-employee, HR = 0.09, 95% CI: 0.02-0.35), and higher scores in subjective support (HR = 0.90, 95% CI: 0.82-0.99) were protective factors. On the contrary, minorities (HR = 5.26, 95% CI: 1.23-22.48), living alone (HR = 4.37, 95% CI: 1.60-11.94), having suicide history (HR = 2.51, 95% CI: 1.06-5.95), and having higher scores in EPQ-E (HR = 1.04, 95% CI: 1.00-1.08) and EPQ-P (HR = 1.03, 95% CI: 1.00-1.07) were identified as independent risk factors for aggressive behavior in patients with mood disorders. The nomogram prediction model demonstrated high discrimination and goodness-of-fit.

CONCLUSIONS

A novel nomogram prediction model for the probability of aggressive behavior in patients with mood disorders was developed, effective in identifying at-risk populations and offering valuable insights for early intervention and proactive measures.

Early Predictors and Concurrent Correlates of Tonic and Phasic Irritability in Adolescence

Irritability is a common presenting problem in youth mental health settings that is thought to include two components: tonic (e.g., irritable, touchy mood) and phasic (e.g., temper outbursts), each with unique correlates and outcomes, including later internalizing and externalizing problems, respectively. However, we are unaware of any studies of early predictors of tonic and phasic irritability. We utilized data from a longitudinal study of a community sample of 3-year-old children followed to age 15 (n = 444). We conducted confirmatory factor analysis (CFA) of items from several self-report irritability measures at age 15, including the Affective Reactivity Index, the International Personality Item Pool, the Schedule for Non-Adaptive and Adaptive Personality Youth Version, and the Child Depression Inventory, and examined their early childhood predictors. The CFA identified dimensions consistent with tonic and phasic irritability. Tonic irritability at age 15 was uniquely associated with concurrent internalizing disorders and suicidal behavior while phasic irritability was uniquely associated with concurrent externalizing disorders. When adolescent tonic and phasic irritability were examined together, female sex and parental depressive and substance use disorders at age 3 uniquely predicted adolescent tonic irritability. Additionally, male sex, less parental education, greater laboratory-observed anger and impulsivity, ODD symptoms, higher irritability, and no parental substance use history at age 3 uniquely predicted adolescent phasic irritability. Youth-reported tonic and phasic irritability at age 15 appear to be distinguishable constructs with distinct concurrent correlates and early antecedents. Findings have important implications for research on the etiology of irritability and developing effective treatments.

An Exploration of Depression and Aggression Among Patients with Schizophrenia in China Rural Community

Purpose

In schizophrenia, aggressive conduct is frequent. And depressed mood can also contribute to the occurrence of aggressive behaviors. The aim of this study was to investigate the risk factors for the occurrence of aggression in stable schizophrenia patients in rural China, mainly to investigate the role of depressed mood in the occurrence of aggression in schizophrenia patients.

Patients and Methods

This is a cross-sectional study conducted in the townships surrounding Chaohu City, Anhui Province, China. Patients' depressive mood was evaluated using the PHQ-9 (The 9-item Patient Health Questionnaire). Patients' aggressiveness was evaluated using the Modified Overt Aggression Scale (MOAS). A score of ≥4 was used as a threshold and divided into aggressive and non-aggressive groups.

Results

This study comprised a total of 821 schizophrenia patients. Among them, the prevalence of having aggressive behavior was 18.8%. After correcting for confounders, logistic regression analysis showed that low education level (OR=0.470, 95% CI 0.254-0.870; p=0.016), living with family (OR=0.383, 95% CI 0.174-0.845; p=0.017) depressed mood (OR=1.147, 95% CI 1.112-1.184; p<0.001) was significantly associated with the risk of aggressive behavior in patients with schizophrenia. Multivariate linear regression indicated that higher levels of aggression were linked with lower levels of education and higher depressive mood.

Conclusion

This study suggests that aggression is more common in patients with stable schizophrenia, and lower levels of education and higher levels of depression are associated risk factors for its occurrence. Living alone may be helpful in reducing the likelihood of aggression.

Characteristics of International Assaultive Psychiatric Patients: Review of Published Findings, 2017-2022

Since the 1960s, empirical research has focused on a better understanding of the characteristics of assaultive psychiatric patients. International research from 1960 to 2017 indicated that male and female patients with schizophrenia and substance use disorder presented the greatest risk for assault with nursing personnel being at higher risk. This present review of studies sought to assess the latest research findings on assaultive patients for the most recent five-year period, 2017-2022. It was hypothesized that patients with schizophrenia and substance use disorders would present the greatest assault risk for nursing personnel. The studies in this review supported this hypothesis. Assaults by patients with schizophrenia and substance abuse has been a consistent finding worldwide for 62 years of published research. Explanations for these findings, the possible role of posttraumatic stress disorder (PTSD) in assaultive patients, and an updated methodological review are presented.

Long-Term Soft-Food Rearing in Young Mice Alters Brain Function and Mood-Related Behavior

The relationship between caloric and nutrient intake and overall health has been extensively studied. However, little research has focused on the impact of the hardness of staple foods on health. In this study, we investigated the effects of a soft diet on brain function and behavior in mice from an early age. Mice fed a soft diet for six months exhibited increased body weight and total cholesterol levels, along with impaired cognitive and motor function, heightened nocturnal activity, and increased aggression. Interestingly, when these mice were switched back to a solid diet for three months, their weight gain ceased, total cholesterol levels stabilized, cognitive function improved, and aggression decreased, while their nocturnal activity remained high. These findings suggest that long-term consumption of a soft diet during early development can influence various behaviors associated with anxiety and mood regulation, including weight gain, cognitive decline, impaired motor coordination, increased nocturnal activity, and heightened aggression. Therefore, the hardness of food can impact brain function, mental well-being, and motor skills during the developmental stage. Early consumption of hard foods may be crucial for promoting and maintaining healthy brain function.

Dissecting the depressed mood criterion in adult depression: The heterogeneity of mood disturbances in major depressive episodes

BACKGROUND

Mood disturbances have historically remained a core criterion in diagnosing major depressive episode. DSMs have illustrated this criterion with depressed, hopeless, discouraged, cheerless, and irritable mood, suggesting interchangeability. Extant research has examined individual forms of mood disturbance to depression severity. Less examined is the heterogeneity in mood disturbances and its implication to their association to depression presentations and outcomes.

METHOD

The current study used a nationally representative sample of U.S. adults with unipolar major depressive disorder to study the association between specific forms of mood disturbances to depression severity, chronicity, or symptoms, above and beyond other forms, as well as their relations to functional impairment, suicidal outcomes, and psychiatric comorbidity via generalized linear models.

RESULTS

Cheerless and hopeless mood were associated with depression severity. Hopeless and irritable mood were associated with depression chronicity. Different forms of mood disturbance showed differential relations to depressive symptoms. Cheerless, hopeless, and irritable mood were associated with depression-specific functional interference, incremental to depression severity. Cheerless, hopeless, and discouraged mood were associated with passive suicidal ideation. Hopeless mood was associated with active suicidal ideation. Hopeless and irritable mood were associated with both suicide plan and suicide attempt. Different forms of mood disturbance demonstrated differential associations to comorbid psychiatric conditions.

DISCUSSION

The relations between different forms of mood disturbances and various aspects of depression are nuanced. Theoretically, these relations highlight the potential utility in acknowledging the complexity and heterogeneity in mood disturbances. Clinically, our results suggest potential utility in routinely monitoring mood disturbances.

Cognitive-Behavioral Versus Supportive Psychotherapy for Intermittent Explosive Disorder: A Randomized Controlled Trial

Few clinical trials have evaluated the efficacy of psychotherapy for Intermittent Explosive Disorder (IED). The present study tested the efficacy of a cognitive behavioral intervention (versus supportive psychotherapy) among adults with IED. In this randomized clinical trial, 44 participants with IED (22 men and 22 women) aged 20-55 years completed twelve 50-minute individual sessions of either a multi-component cognitive behavioral intervention for IED (n = 19) or a time equated supportive psychotherapy (n = 25). At baseline, posttreatment, and 3-month follow-up, all participants received the Overt Aggression Scale-Modified, which was conducted by an interviewer who was blind to the participant's study condition. During these visits, participants also completed self-report measures of relational aggression (Self-Report of Relational Aggression and Social Behavior), anger (State-Trait Anger Expression Inventory-2), cognitive biases (e.g., Social Information Processing Questionnaire Attribution and Emotional Response Questionnaire), and associated symptoms (e.g., Beck Depression Inventory). Primary study outcomes were aggressive behavior and anger. Though participants in both treatments tended to improve over time, the cognitive behavioral intervention was superior to supportive psychotherapy in decreasing aggressive behavior and relational aggression. These findings support the efficacy of a multicomponent cognitive behavioral intervention in treating aggression in IED.

Gender differences in aggression: A multiplicative function of outward anger expression

Individuals with a higher (vs. lower) tendency to outwardly express anger (i.e., greater anger-out) generally exhibit greater aggression; men (vs. women) also tend to be more aggressive. Although the general aggression model posits that multiple person variables trigger aggression, the combined effects of multiple person variables are poorly understood. Thus, the aim of this study was to examine the nature of the relation between gender, anger-out, and reactive aggression. In particular, we were interested in whether the effects of anger-out and gender are additive or multiplicative. Specifically, we tested whether men exhibit higher levels of aggression than women at a consistent ratio across all levels of anger-out (i.e., the multiplicative model) or at a fixed amount depending on the level of anger-out (i.e., the additive interaction model). To this end, undergraduate participants (N = 203) completed a task in which they were falsely instructed that their objective was to respond more quickly than a same-sex opponent. They were told that whoever responded more quickly would administer a white noise burst to the opponent and choose its intensity, which served as our measure of aggression. Compared to an additive interaction model, the multiplicative model exhibited a better fit. Specifically, men displayed proportionately more aggression than women with the same level of anger-out. Research on and treatment for aggression should consider the multiplicative effects of factors related to aggression.

The association of phasic irritability (aggressive outbursts) and tonic irritability (irritable mood) to depression occurrences, symptoms, and subtypes

BACKGROUND

Research among adults has rarely differentiated between tonic irritability (i.e., irritable mood) and phasic irritability (i.e., aggressive outbursts) with respect to multiple dimensions of depression. The current study explored both tonic and phasic irritability in relation to depression severity, depression chronicity, age of depression onset, individual depressive symptom, and depression subtypes.

METHODS

The study included participants (N = 5692) from the National Comorbidity Survey - Replication (NCS-R) part two. The NCS-R used lay-administered, fully standardized diagnostic interviews. The current study implemented linear models, generalized linear models, Cox proportional hazard model, and latent class regression.

RESULTS

Both types of irritability were significantly associated with greater risk for MDD diagnosis, as well as risk for having at least one depressive symptom, early MDE onset, and MDE chronicity. Both phasic and tonic irritability were associated with greater odds of specific depressive symptoms and were differentially related to distinct depressive symptom constellations. Phasic irritability related only to severe depression. Lastly, both phasic and tonic irritability was associated with suicidal ideation, but only phasic irritability was associated with a suicide plan and attempt, above and beyond depression subtypes.

CONCLUSIONS

Both phasic and tonic irritability differentially related to almost all aspects of depression in adults. Specifically, tonic irritability showed overall stronger associations with various depressive features, whereas phasic irritability marked higher depressive severity.

Impulsivity Scale-12 and its utilization in alcohol use disorder

INTRODUCTION

One of the core symptoms of alcohol use disorder (AUD) is impulsivity. The recently published study on the Impulsivity Scale 12 (IS-12) offers a promising tool to use in clinics working with clients with AUD due to its simplicity. IS-12 includes subscales related tocognitive impulsivity and behavioral impulsivity, which are related to different aspects of AUD symptomatology. The aim of the study was to adapt IS-12 to polish and test its utility in a sample of patients diagnosed with AUD.

METHODS

Using a Confirmatory Factor Analysis, we compared the two-factor model of the Polish adaptation of the BIS-11 and the IS-12 on a sample of 615 patients diagnosed with AUD. Additionally, we explored the association between the IS-12's cognitive impulsivity and behavioral impulsivity subscales and depressive symptoms, AUD severity, and suicidal ideation using Structural Equation Modeling on a subsample of 450 patients with AUD.

RESULTS

The IS-12 demonstrated a better model fit and good reliability compared to the BIS-11. Moreover, cognitive impulsivity predicted suicidal ideation, but not AUD severity, while behavioral impulsivity predicted AUD severity, but not suicidal ideation. Both subscales of IS-12 predicted depressive symptoms.

CONCLUSION

Consistent with prior work, findings indicate that the second-order factor model of the BIS-11 had reliability issues and evidenced poor model fit. In contrast, the IS-12 demonstrated a satisfactory model fit and was predictive of clinical symptomatology. Thus, utilizing an easy tool, such as IS-12, might be beneficial for researchers and clinicians working with patients with AUD.