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Herbein M, Barbosa S, Collet O, Khalfallah O, Navarro M, Bailhache M, IV N, Aouizerate B, Sutter-Dallay AL, Koehl M, Capuron L, Ellul P, Peyre H, Van der Waerden J, Melchior M, Côté S, Heude B, Glaichenhaus N, Davidovic L, Galera C. Cord serum cytokines at birth and children's trajectories of mood dysregulation symptoms from 3 to 8 years: The EDEN birth cohort. Brain Behav Immun Health 2024; 38:100768. [PMID: 38586283 PMCID: PMC10990861 DOI: 10.1016/j.bbih.2024.100768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 03/28/2024] [Indexed: 04/09/2024] Open
Abstract
There is growing evidence that in utero imbalance immune activity plays a role in the development of neurodevelopmental and psychiatric disorders in children. Mood dysregulation (MD) is a debilitating transnosographic syndrome whose underlying pathophysiological mechanisms could be revealed by studying its biomarkers using the Research Domain Criteria (RDoC) model. Our aim was to study the association between the network of cord serum cytokines, and mood dysregulation trajectories in offsprings between 3 and 8 years of age. We used the data of a study nested in the French birth cohort EDEN that took place from 2003 to 2014 and followed mother-child dyads from the second trimester of pregnancy until the children were 8 years of age. The 2002 mother-child dyads were recruited from the general population through their pregnancy follow-up in two French university hospitals. 871 of them were included in the nested cohort and cord serum cytokine levels were measured at birth. Children's mood dysregulation symptoms were assessed with the Strengths and Difficulties Questionnaire Dysregulation Profile at the ages 3, 5 and 8 years in order to model their mood dysregulation trajectories. Out of the 871 participating dyads, 53% of the children were male. 2.1% of the children presented a high mood dysregulation trajectory whereas the others were considered as physiological variations. We found a significant negative association between TNF-α cord serum levels and a high mood dysregulation trajectory when considering confounding factors such as maternal depression during pregnancy (adjusted Odds Ratio (aOR) = 0.35, 95% Confidence Interval (CI) [0.18-0.67]). Immune imbalance at birth could play a role in the onset of mood dysregulation symptoms. Our findings throw new light on putative immune mechanisms implicated in the development of mood dysregulation and should lead to future animal and epidemiological studies.
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Affiliation(s)
- Marie Herbein
- University of Bordeaux, France
- INSERM, Bordeaux Population Health Center, UMR1219, France
- Centre Hospitalier Perrens, Bordeaux, France
| | - Susana Barbosa
- Université Côte d’Azur, Nice, France
- Centre National de Recherche Scientifique, Institut de Pharmacologie Moléculaire et Cellulaire, Valbonne, France
| | - Ophélie Collet
- University of Bordeaux, France
- Research Unit on Children's Psychosocial Maladjustment, Montreal, Canada
| | - Olfa Khalfallah
- Université Côte d’Azur, Nice, France
- Centre National de Recherche Scientifique, Institut de Pharmacologie Moléculaire et Cellulaire, Valbonne, France
| | - Marie Navarro
- University of Bordeaux, France
- INSERM, Bordeaux Population Health Center, UMR1219, France
| | - Marion Bailhache
- University of Bordeaux, France
- INSERM, Bordeaux Population Health Center, UMR1219, France
- Centre Hospitalier Universitaire de Bordeaux, Département de Pédiatrie, France
| | - Nicolas IV
- University of Bordeaux, France
- INSERM, Bordeaux Population Health Center, UMR1219, France
| | - Bruno Aouizerate
- University of Bordeaux, France
- Centre Hospitalier Perrens, Bordeaux, France
- INRAE, Bordeaux INP, NutriNeuro, UMR 1286, Bordeaux, France
| | - Anne-Laure Sutter-Dallay
- INSERM, Bordeaux Population Health Center, UMR1219, France
- Centre Hospitalier Perrens, Bordeaux, France
| | - Muriel Koehl
- University of Bordeaux, France
- INSERM, Neurocentre Magendie, UMR1215, Bordeaux, France
| | - Lucile Capuron
- University of Bordeaux, France
- INRAE, Bordeaux INP, NutriNeuro, UMR 1286, Bordeaux, France
| | - Pierre Ellul
- Robert Debré Hospital, Child and Adolescent department, APHP, Paris University, Paris, France
- Immunology-Immunopathology-Immunotherapy (i3), UMRS 959, INSERM, Paris, France
| | - Hugo Peyre
- Robert Debré Hospital, Child and Adolescent department, APHP, Paris University, Paris, France
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'Excellence sur l'Autisme et les Troubles du Neurodéveloppement (CeAND), CHU Montpellier, Montpellier, France
- Université Paris Saclay, UVSQ, Inserm, CESP, Tem DevPsy, 94807, Villejuif, France
| | - Judith Van der Waerden
- INSERM U1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Sorbonne Université, Équipe de Recherche en Épidémiologie Sociale, Paris, France
| | - Maria Melchior
- INSERM U1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Sorbonne Université, Équipe de Recherche en Épidémiologie Sociale, Paris, France
| | - Sylvana Côté
- University of Bordeaux, France
- INSERM, Bordeaux Population Health Center, UMR1219, France
- Research Unit on Children's Psychosocial Maladjustment, Montreal, Canada
- University of Montreal, Department of Social and Preventive Medicine, Montreal, Canada
| | - Barbara Heude
- Université de Paris, Centre for Research in Epidemiology and Statistics (CRESS), INSERM, INRAE, F-75004, Paris, France
- Paris University, France
| | - Nicolas Glaichenhaus
- Université Côte d’Azur, Nice, France
- Centre National de Recherche Scientifique, Institut de Pharmacologie Moléculaire et Cellulaire, Valbonne, France
- Fondation FondaMental, Créteil, France
| | - Laetitia Davidovic
- Université Côte d’Azur, Nice, France
- Centre National de Recherche Scientifique, Institut de Pharmacologie Moléculaire et Cellulaire, Valbonne, France
- Fondation FondaMental, Créteil, France
| | - Cedric Galera
- University of Bordeaux, France
- INSERM, Bordeaux Population Health Center, UMR1219, France
- Centre Hospitalier Perrens, Bordeaux, France
- Research Unit on Children's Psychosocial Maladjustment, Montreal, Canada
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Brancati GE, De Rosa U, Acierno D, Caruso V, De Dominicis F, Petrucci A, Moriconi M, Elefante C, Gemignani S, Medda P, Schiavi E, Perugi G. Development of a self-report screening instrument for emotional dysregulation: the Reactivity, Intensity, Polarity and Stability questionnaire, screening version (RIPoSt-SV). J Affect Disord 2024; 355:406-414. [PMID: 38570039 DOI: 10.1016/j.jad.2024.03.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/27/2024] [Accepted: 03/29/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Emotional dysregulation (ED) refers to the inability to manage emotional experiences or expressions hindering goal-oriented behavior. Moderate impairment on at least two domains among temper control, affective lability, and emotional over-reactivity has been proposed to identify ED in adults with attention-deficit/hyperactivity disorder (ADHD). No screening measure designed for use in diverse psychiatric samples exists. We aimed to develop a self-report screening tool for ED based on the 40-item version of the Reactivity, Intensity, Polarity, and Stability questionnaire (RIPoSt-40). METHODS 150 adult outpatients with non-psychotic conditions were enrolled between February and July 2023 at the Second Psychiatry Unit of Pisa University Hospital. Clinically significant ED (CSED) was defined based on the previously suggested approach for ADHD. Differences between patients with and without CSED were tested. To develop our screening instrument, a decision tree algorithm was trained by hyperparameter tuning through 5-fold cross-validation in 120 subjects and tested on the remaining 30. RESULTS 75 subjects met criteria for CSED (50 %). CSED was associated with lower age and higher prevalence of psychiatric conditions, including minor mood disorders, ADHD, cannabis use disorders, and eating disorders. We identified a decision tree consisting of six items from RIPoSt-40 that effectively detected CSED, with accuracy, sensitivity, specificity, positive and negative predictive values of 80 % or higher in both the training and testing sets. LIMITATIONS Tertiary-level; no consensus on criteria; sample size. CONCLUSION The screening version of the Reactivity, Intensity, Polarity, and Stability questionnaire (RIPoSt-SV) demonstrates promise as a valuable tool for ED screening in clinical settings.
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Affiliation(s)
- Giulio Emilio Brancati
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Psychiatry Unit 2, Pisa, Italy
| | - Ugo De Rosa
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Psychiatry Unit 2, Pisa, Italy
| | - Donatella Acierno
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Psychiatry Unit 2, Pisa, Italy
| | - Valerio Caruso
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Psychiatry Unit 2, Pisa, Italy
| | - Francesco De Dominicis
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Psychiatry Unit 2, Pisa, Italy; Mental Health Centre, Local Health Unit 2, Spoleto, Italy
| | - Alessandra Petrucci
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Psychiatry Unit 2, Pisa, Italy; Mental Health Centre, Local Health Unit 2, Terni, Italy
| | - Martina Moriconi
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Psychiatry Unit 2, Pisa, Italy
| | - Camilla Elefante
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Psychiatry Unit 2, Pisa, Italy
| | - Samuele Gemignani
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Psychiatry Unit 2, Pisa, Italy
| | - Pierpaolo Medda
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Psychiatry Unit 2, Pisa, Italy
| | - Elisa Schiavi
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Psychiatry Unit 2, Pisa, Italy
| | - Giulio Perugi
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Psychiatry Unit 2, Pisa, Italy.
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Freitag GF, Coxe S, Cardinale EM, Furr JM, Herrera A, Comer JS. Phasic Versus Tonic Irritability and Associations with Family Accommodation Among Youth with Selective Mutism: A Latent Profile Analysis. Res Child Adolesc Psychopathol 2024; 52:905-917. [PMID: 38270833 DOI: 10.1007/s10802-023-01161-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2023] [Indexed: 01/26/2024]
Abstract
Clinical presentations of selective mutism (SM) vary widely across affected youth. Although studies have explored general externalizing problems in youth with SM, research has not specifically examined patterns of irritability. Relatedly, research has not considered how affected families differentially accommodate the anxiety of youth with SM as a function of the child's temper outbursts (i.e., phasic irritability) and general angry mood (i.e., tonic irritability). Data were drawn from a sample of treatment-seeking children and adolescents with a primary diagnosis of selective mutism (N = 152; Mean age = 6.12 years; 67.11% female), and their caregivers. Latent profile analysis (LPA) was used to identify distinct profiles in SM youth that were characterized by varying levels of phasic and/or tonic irritability. Analyses further examined whether these different profiles were associated with different levels of family accommodation and global impairment. LPA identified 5 profiles: SM with No irritability, SM with Low Phasic Irritability, SM with High Phasic Irritability, SM with High Phasic and Moderate Tonic Irritability, and SM with High Phasic and High Tonic Irritability. Patterns of family accommodation and global impairment were highest among youth belonging to profiles characterized by high phasic irritability. Findings highlight separable patterns of irritability across youth with SM, with phasic irritability (i.e., temper outbursts) appearing particularly linked with increased family accommodation and overall global impairment. Assessing phasic irritability is critical for optimizing treatment in youth with SM and can be useful for flagging possible patterns of family accommodation contributing to overall impairment.
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Affiliation(s)
- Gabrielle F Freitag
- Mental Health Interventions and Technology (MINT) Program, Center for Children and Families, Department of Psychology, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA.
| | - Stefany Coxe
- Mental Health Interventions and Technology (MINT) Program, Center for Children and Families, Department of Psychology, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA
| | - Elise M Cardinale
- Department of Psychology, The Catholic University of America, Washington, DC, USA
| | - Jami M Furr
- Mental Health Interventions and Technology (MINT) Program, Center for Children and Families, Department of Psychology, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA
| | - Aileen Herrera
- Mental Health Interventions and Technology (MINT) Program, Center for Children and Families, Department of Psychology, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA
| | - Jonathan S Comer
- Mental Health Interventions and Technology (MINT) Program, Center for Children and Families, Department of Psychology, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA
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Silver J, Sorcher L, Carlson GA, Dougherty LR, Klein DN. Irritability across adolescence: Examining longitudinal trajectory, stability, and associations with psychopathology and functioning at age 18. J Affect Disord 2024; 354:611-618. [PMID: 38494139 DOI: 10.1016/j.jad.2024.03.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 03/07/2024] [Accepted: 03/12/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Irritability, marked by diminished frustration tolerance, holds significant implications for youth mental health treatment. Despite prior research on irritability trajectories, understanding of individual differences during adolescence remains limited. This study examines the stability and trajectory of irritability across ages 12-18, investigating associations with psychopathology and functioning at age 18. METHODS A community sample of families with 3-year-old children (N = 518) was recruited via commercial mailing lists. Irritability was assessed at ages 12, 15, and 18 using the Affective Reactivity Index. Psychopathology at age 18 was evaluated with the Kiddie Schedule for Affective Disorders and Schizophrenia, and functioning was assessed through the UCLA Life Stress Interview. Measurement invariance analyses and latent growth curve modeling were conducted within a structural equation modeling (SEM) framework. RESULTS Configural, metric, and scalar invariance models were supported. Elevated irritability at age 12 predicted adverse outcomes at age 18, including increased psychotropic medication use, mental health treatment, suicidal ideation, self-injury, and psychiatric disorders. Importantly, these associations persisted even after accounting for corresponding variables at age 12. The trajectory of irritability during early adolescence significantly predicted heightened risks for various outcomes at age 18, including suicidal ideation, depression, anxiety, disruptive behavior disorders, and impaired interpersonal functioning. DISCUSSION Limitations include using only youth-reported data at age 18, limited generalizability from a mostly White, middle-class sample, and insufficient exploration of the broader developmental trajectory of irritability. Nevertheless, the findings emphasize the crucial role of irritability's trajectory in influencing various psychopathological and functional outcomes in late adolescence.
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Affiliation(s)
- Jamilah Silver
- Stony Brook University, Department of Psychology, Stony Brook, New York, USA.
| | - Leah Sorcher
- University of Maryland, Department of Psychology, College Park, MD, USA
| | | | - Lea R Dougherty
- University of Maryland, Department of Psychology, College Park, MD, USA
| | - Daniel N Klein
- Stony Brook University, Department of Psychology, Stony Brook, New York, USA
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Bellaert N, Morreale K, Tseng WL. Peer functioning difficulties may exacerbate symptoms of attention-deficit/hyperactivity disorder and irritability over time: a temporal network analysis. J Child Psychol Psychiatry 2024; 65:809-821. [PMID: 37859512 PMCID: PMC11026298 DOI: 10.1111/jcpp.13911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Children with attention-deficit/hyperactivity disorder (ADHD) have been consistently found to experience impairments in peer functioning. Irritability is highly prevalent in children with ADHD and may worsen social impairments given the frequent temper outbursts and low frustration tolerance characterizing irritability. However, it is still unclear how ADHD and irritability symptoms interact with peer functioning difficulties over time. Assessing these temporal dynamics using a novel longitudinal approach (i.e., temporal network analysis) may reveal precise targets for intervention. METHODS This study investigates the dynamic associations between ADHD symptoms, irritability, and peer functioning in a community sample of 739 children (ages 8-11 years, Mage = 10.06 [SD = 0.59], 47.77% females) assessed at three timepoints, 6 months apart, in a school-based study. Parents reported their child's ADHD symptoms using the Swanson, Nolan, and Pelham Rating Scale (SNAP-IV), and irritability symptoms using the Child Behavior Checklist (CBCL) irritability items. Children's peer functioning (i.e., peer acceptance, peer rejection, number of friendships, and victimization) was measured via peer nomination. To estimate the longitudinal associations between the variables, we built a graphical vector autoregression model for panel data. RESULTS The longitudinal network highlighted that poor peer functioning contributed to increases in symptoms over time. Specifically, (1) physical victimization predicted increases in inattention, hyperactivity, and irritability; (2) peer rejection predicted increases in inattention, which in turn predicted increases in irritability; (3) peer acceptance predicted decreases in inattention and irritability; and (4) higher numbers of mutual friendships increased inattention. CONCLUSIONS These results suggest that a negative social environment involving physical bullying and rejection may aggravate ADHD and irritability symptoms. Conversely, positive social interactions, such as being liked by peers, may improve inattention and irritability symptoms. Fostering social-emotional skills and positive social interactions and environments in children with ADHD and irritability may be a promising target for future interventions to reduce symptoms.
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Affiliation(s)
- Nellia Bellaert
- Cognitive Psychology and Neuropsychology Department, University of Mons, Mons, Belgium
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, United States
| | - Kristina Morreale
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, United States
- University of New Haven, New Haven, CT, United States
| | - Wan-Ling Tseng
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, United States
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Karalunas SL, Dude J, Figuracion M, Lane SP. Momentary Dynamics Implicate Emotional Features in the ADHD Phenotype. Res Child Adolesc Psychopathol 2024:10.1007/s10802-024-01206-9. [PMID: 38771497 DOI: 10.1007/s10802-024-01206-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 05/22/2024]
Abstract
Emotional dysregulation is increasingly recognized as important to the attention-deficit/hyperactivity disorder (ADHD) phenotype alongside inattention and hyperactivity-impulsivity. Studies of ADHD have relied primarily on trait-based conceptualizations that emphasize stability of symptoms across moderate developmental timescales (i.e., months to years). Trait-based conceptualizations provide a critical view but fail to account for short-term dynamic variations in the expression of ADHD symptoms and emotion. This leaves a gap in our understanding of the short-term variation in ADHD symptom expression and the dynamic relationships among ADHD symptoms and emotion. Here, we assessed caregiver report of ADHD symptoms and positive and negative emotion using ecological momentary approaches over 2 weeks in a sample of 36 children with and without ADHD between the ages of 7-12 years old. Between-person (RKF) and within-person (RC) reliability were estimated. Multilevel models tested specific covariation hypotheses between ADHD symptoms and emotion. Analyses confirmed that ADHD and emotion ratings were reliable as individual differences (i.e., between-person; RKF range 0.93-1.0) and moment-to-moment change (i.e., within-person; Rc range 0.66-0.88) measures. Multilevel models found little evidence for lagged effects between domains, but consistently identified concurrent expression of ADHD symptoms and emotions; inattention covaried most strongly with negative emotion and hyperactivity-impulsivity covaried most strongly with positive emotion. Results demonstrate the importance of complementing trait-level conceptualizations with assessment of momentary dynamics. Momentary assessment suggests important covariation of ADHD symptoms and emotion as part of the ADHD phenotype.
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Affiliation(s)
| | - Jason Dude
- Washington University in Saint Louis, Saint Louis, MO, USA
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Cotter G, Morreale K, Valdegas A, Fish M, Beebe R, Grasso D, Stover C, Tseng WL. Associations between trauma exposure and irritability within the family unit: a network approach. J Child Psychol Psychiatry 2024. [PMID: 38710637 DOI: 10.1111/jcpp.13998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/17/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Pediatric irritability is a pervasive psychiatric symptom, yet its etiology remains elusive. While trauma exposure may contribute to the development of irritability, empirical research is limited. This study examined the prevalence of irritability among trauma-exposed children, identified factors that differentiate trauma-exposed children with and without irritability, and employed a network analysis to uncover associations between irritability and trauma exposure in the family unit. METHODS Sample included 676 children (56.3% male, mean age = 9.67 ± 3.7 years) and their parents referred by the Connecticut Department of Children and Families to Fathers for Change - a psychotherapy intervention designed to reduce intimate partner violence (IPV) and child maltreatment. Child's trauma exposure, post-traumatic stress disorder (PTSD) symptoms, and irritability were assessed pre-intervention using self- and caregiver-report. Parents self-reported their childhood and adulthood trauma exposures, PTSD symptoms, irritability, psychopathology, and IPV. RESULTS Across caregiver- and child-reports, 16%-17% of children exhibited irritability. Irritable children experienced greater trauma exposure, interpersonal violence, emotional abuse, and PTSD severity. They had caregivers, particularly mothers, with greater trauma histories, IPV, and psychopathology. Network analysis revealed 10 nodes directly correlated to child's irritability including child's PTSD severity, parental IPV (specifically psychological violence), and parental psychopathology. CONCLUSIONS Results provide initial empirical evidence that pediatric irritability is linked to trauma exposure, suggesting trauma histories be considered in the diagnosis and treatment of irritability. Interventions addressing caregiver trauma, IPV, and psychopathology may ameliorate pediatric irritability. Future studies could benefit from adopting network approaches with longitudinal or time series data to elucidate causality and points of intervention.
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Affiliation(s)
- Grace Cotter
- Yale School of Medicine, Yale Child Study Center, New Haven, CT, USA
- Northeastern University, Boston, MA, USA
| | - Kristina Morreale
- Yale School of Medicine, Yale Child Study Center, New Haven, CT, USA
- Veterans Affairs Boston Healthcare System, Boston, MA, USA
| | | | - Meghan Fish
- Connecticut Children's Medical Center, Hartford, CT, USA
| | - Rebecca Beebe
- Connecticut Children's Medical Center, Hartford, CT, USA
| | - Damion Grasso
- University of Connecticut School of Medicine, Farmington, CT, USA
| | - Carla Stover
- Yale School of Medicine, Yale Child Study Center, New Haven, CT, USA
| | - Wan-Ling Tseng
- Yale School of Medicine, Yale Child Study Center, New Haven, CT, USA
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De Ronda AC, Rice L, Zhao Y, Rosch KS, Mostofsky SH, Seymour KE. ADHD-related sex differences in emotional symptoms across development. Eur Child Adolesc Psychiatry 2024; 33:1419-1432. [PMID: 37368082 PMCID: PMC10986680 DOI: 10.1007/s00787-023-02251-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/19/2023] [Indexed: 06/28/2023]
Abstract
To investigate developmental changes in emotion dysregulation (ED) and associated symptoms of emotional lability, irritability, anxiety, and depression, among girls and boys with and without ADHD from childhood through adolescence. Data were collected from a sample of 8-18-year-old children with (n = 264; 76 girls) and without (n = 153; 56 girls) ADHD, with multiple time-points from a subsample of participants (n = 121). Parents and youth completed rating scales assessing child ED, emotional lability, irritability, anxiety, and depression. Mixed effects models were employed to examine effects and interactions of diagnosis, sex [biological sex assigned at birth], age among boys and girls with and without ADHD. Mixed effects analyses showed sexually dimorphic developmental patterns between boys and girls, such that boys with ADHD showed a greater reduction in ED, irritability, and anxiety with age compared to girls with ADHD, whose symptom levels remained elevated relative to TD girls. Depressive symptoms were persistently elevated among girls with ADHD compared to boys with ADHD, whose symptoms decreased with age, relative to same-sex TD peers. While both boys and girls with ADHD showed higher levels of ED during childhood (compared to their sex-matched TD peers), mixed effects analyses revealed substantial sexually dimorphic patterns of emotional symptom change during adolescence: Boys with ADHD showed robust improvements in emotional symptoms from childhood to adolescence while girls with ADHD continued to show high and/or increased levels of ED, emotional lability, irritability, anxiety and depression.
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Affiliation(s)
- Alyssa C De Ronda
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, 716 North Broadway, Baltimore, MD, 21205, USA
| | - Laura Rice
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, 716 North Broadway, Baltimore, MD, 21205, USA
| | - Yi Zhao
- Department of Biostatistics, Indiana University School of Medicine, 410 West 10th Street, Indianapolis, IN, 46202, USA
| | - Keri S Rosch
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, 716 North Broadway, Baltimore, MD, 21205, USA
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 716 North Broadway, Baltimore, MD, 21205, USA
| | - Stewart H Mostofsky
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, 716 North Broadway, Baltimore, MD, 21205, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 716 North Broadway, Baltimore, MD, 21205, USA
- Department of Neurology, Johns Hopkins University School of Medicine , 716 North Broadway, Baltimore, MD, 21205, USA
| | - Karen E Seymour
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, 716 North Broadway, Baltimore, MD, 21205, USA.
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 716 North Broadway, Baltimore, MD, 21205, USA.
- Department of Mental Health, Johns Hopkins University School of Public Health, 6701 Rockledge Drive, Bethesda, MD, 20892, USA.
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Citrome L, Li C, Yu J, Kramer K, Nguyen HB. Effects of cariprazine on reducing symptoms of irritability, hostility, and agitation in patients with manic or mixed episodes of bipolar I disorder. J Affect Disord 2024:S0165-0327(24)00695-5. [PMID: 38657773 DOI: 10.1016/j.jad.2024.04.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 03/22/2024] [Accepted: 04/21/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Hostility, irritability, and agitation are common in patients with bipolar I disorder. Post hoc analyses evaluated the effect of cariprazine on these symptoms in patients with bipolar I mania. METHODS Data were pooled from three randomized, double-blind, placebo-controlled phase 3 cariprazine trials in adults with bipolar I manic/mixed episodes (NCT00488618, NCT01058096, NCT01058668); pooled cariprazine doses (3-12 mg/d) were analyzed. Patients were categorized into hostility/irritability and agitation subgroups by baseline scores: Young Mania Rating Scale (YMRS) irritability and disruptive-aggressive behavior items score ≥ 2; Positive and Negative Syndrome Scale (PANSS) hostility item ≥2; PANSS-Excited Component (PANSS-EC) total score ≥ 14 and score ≥ 4 on ≥1 individual item. Changes from baseline to week 3 in hostility/irritability- and agitation-related outcomes were evaluated. Adjustments were made for the presence of other manic symptoms, sedation, and akathisia. RESULTS Most patients met subgroup inclusion criteria (YMRS hostility = 930; PANSS hostility = 841, PANSS-EC agitation = 486). In the YMRS subgroup, least squares mean differences in change from baseline were statistically significant for cariprazine versus placebo on YMRS hostility/irritability-related items (irritability [-0.93], disruptive-aggressive behavior [-0.79], combined [-1.75]; P ≤ 0.001 each), YMRS total score (-5.92, P ≤ 0.0001), and all individual YMRS items (-0.25 to -0.93, P ≤ 0.0001); differences remained significant after adjustment for other manic symptoms, sedation, and akathisia. Differences in PANSS hostility and PANSS-EC subgroups were significant for cariprazine versus placebo (P ≤ 0.001). LIMITATIONS Post hoc analysis. CONCLUSION Cariprazine demonstrated specific antihostility/irritability and anti-agitation effects in patients with manic/mixed episodes of bipolar I disorder and baseline hostility, irritability, or agitation.
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Affiliation(s)
- Leslie Citrome
- New York Medical College, Valhalla, New York, United States of America.
| | - Chunshan Li
- AbbVie, Florham Park, NJ, United States of America
| | - Jun Yu
- AbbVie, Florham Park, NJ, United States of America
| | - Ken Kramer
- AbbVie, Florham Park, NJ, United States of America
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10
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Niu Y, Buzzell GA, Cosmoiu A, Fox NA, Nelson CA, Zeanah CH, Humphreys KL. Foster Care Leads to Lower Irritability Among Adolescents with a History of Early Psychosocial Deprivation. Res Child Adolesc Psychopathol 2024:10.1007/s10802-024-01193-x. [PMID: 38642277 DOI: 10.1007/s10802-024-01193-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2024] [Indexed: 04/22/2024]
Abstract
Irritability reflects a propensity for frustration and anger, and is a transdiagnostic symptom of both externalizing and internalizing psychopathology. While early adverse experiences are associated with higher levels of irritability, experiences of early psychosocial deprivation and whether family-based placements can mitigate the impact on subsequent irritability, remain underexplored. The current study examined irritability in 107 16-year-olds with a history of institutional care from a randomized controlled trial of foster care as an alternative to institutional care and 49 community comparison children. At age 16 years, irritability was assessed using parent- and self-report forms of the Affective Reactivity Index. Compared to community adolescents, those with a history of institutional care exhibited significantly elevated irritability levels. Among those who experienced institutional care, those randomized to foster care had lower levels of irritability compared to participants randomized to the care-as-usual group, and this effect persists after controlling for baseline negative emotionality. These findings suggest a causal link between high-quality foster care and lower irritability following psychosocial deprivation. Additionally, longer duration in institutional care and non-family placement at age 16 years were associated with higher levels of irritability, highlighting the role of caregiving in explaining variation in irritability in adolescence. Policies that support long-term, high-quality family placements for children without regular caregivers should be prioritized.
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Affiliation(s)
- Yanbin Niu
- Department of Psychology & Human Development, Peabody College, Vanderbilt University, 230 Appleton Place, Nashville, TN, 37203, USA
| | - George A Buzzell
- Department of Psychology, Florida International University, Miami, FL, USA
| | - Ana Cosmoiu
- Department of Psychology and Cognitive Sciences, University of Bucharest, Bucharest, Romania
| | - Nathan A Fox
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD, USA
| | - Charles A Nelson
- Boston Children's Hospital of Harvard Medical School, Boston, MA, USA
- Harvard Graduate School of Education, Cambridge, MA, USA
| | - Charles H Zeanah
- Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, LA, USA
| | - Kathryn L Humphreys
- Department of Psychology & Human Development, Peabody College, Vanderbilt University, 230 Appleton Place, Nashville, TN, 37203, USA.
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11
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Kaushik K, de Kort AM, van Dort R, van der Zwet RGJ, Siegerink B, Voigt S, van Zwet EW, van der Plas MC, Koemans EA, Rasing I, Kessels RPC, Middelkoop HAM, Schreuder FHBM, Klijn CJM, Verbeek MM, Terwindt GM, van Etten ES, Wermer MJH. Neuropsychiatric symptoms with focus on apathy and irritability in sporadic and hereditary cerebral amyloid angiopathy. Alzheimers Res Ther 2024; 16:74. [PMID: 38582898 PMCID: PMC10998371 DOI: 10.1186/s13195-024-01445-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 03/31/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) may affect cognition, but their burden in cerebral amyloid angiopathy (CAA), one of the main causes of intracerebral hemorrhage (ICH) and dementia in the elderly, remains unclear. We investigated NPS, with emphasis on apathy and irritability in sporadic (sCAA) and Dutch-type hereditary (D-)CAA. METHODS We included patients with sCAA and (pre)symptomatic D-CAA, and controls from four prospective cohort studies. We assessed NPS per group, stratified for history of ICH, using the informant-based Neuropsychiatric Inventory (NPI-Q), Starkstein Apathy scale (SAS), and Irritability Scale. We modeled the association of NPS with disease status, executive function, processing speed, and CAA-burden score on MRI and investigated sex-differences. RESULTS We included 181 participants: 82 with sCAA (mean[SD] age 72[6] years, 44% women, 28% previous ICH), 56 with D-CAA (52[11] years, 54% women, n = 31[55%] presymptomatic), and 43 controls (69[9] years, 44% women). The NPI-Q NPS-count differed between patients and controls (sCAA-ICH+:adj.β = 1.4[95%CI:0.6-2.3]; sCAA-ICH-:1.3[0.6-2.0]; symptomatic D-CAA:2.0[1.1-2.9]; presymptomatic D-CAA:1.2[0.1-2.2], control median:0[IQR:0-3]), but not between the different CAA-subgroups. Apathy and irritability were reported most frequently: n = 12[31%] sCAA, 19[37%] D-CAA had a high SAS-score; n = 12[29%] sCAA, 14[27%] D-CAA had a high Irritability Scale score. NPS-count was associated with decreased processing speed (adj.β=-0.6[95%CI:-0.8;-0.4]) and executive function (adj.β=-0.4[95%CI:-0.6;-0.1]), but not with radiological CAA-burden. Men had NPS more often than women. DISCUSSION According to informants, one third to half of patients with CAA have NPS, mostly apathy, even in presymptomatic D-CAA and possibly with increased susceptibility in men. Neurologists should inform patients and caregivers of these disease consequences and treat or refer patients with NPS appropriately.
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Affiliation(s)
- Kanishk Kaushik
- Neurology, Leiden University Medical Center (LUMC), Albinusdreef 2, 2300RC, Leiden, NL, the Netherlands.
| | - Anna M de Kort
- Neurology, Radboud University Medical Center (RUMC), Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, the Netherlands
| | - Rosemarie van Dort
- Neurology, Leiden University Medical Center (LUMC), Albinusdreef 2, 2300RC, Leiden, NL, the Netherlands
| | - Reinier G J van der Zwet
- Neurology, Leiden University Medical Center (LUMC), Albinusdreef 2, 2300RC, Leiden, NL, the Netherlands
| | - Bob Siegerink
- Clinical Epidemiology, LUMC, Leiden, the Netherlands
| | - Sabine Voigt
- Neurology, Leiden University Medical Center (LUMC), Albinusdreef 2, 2300RC, Leiden, NL, the Netherlands
- Radiology, LUMC, Leiden, the Netherlands
| | | | - Maaike C van der Plas
- Neurology, Leiden University Medical Center (LUMC), Albinusdreef 2, 2300RC, Leiden, NL, the Netherlands
| | - Emma A Koemans
- Neurology, Leiden University Medical Center (LUMC), Albinusdreef 2, 2300RC, Leiden, NL, the Netherlands
| | - Ingeborg Rasing
- Neurology, Leiden University Medical Center (LUMC), Albinusdreef 2, 2300RC, Leiden, NL, the Netherlands
| | - Roy P C Kessels
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, the Netherlands
- Medical Psychology and RUMC Alzheimer Center, Nijmegen, the Netherlands
- Vincent van Gogh Institute for Psychiatry, Venray, the Netherlands
| | - Huub A M Middelkoop
- Neurology, Leiden University Medical Center (LUMC), Albinusdreef 2, 2300RC, Leiden, NL, the Netherlands
- Institute of Psychology, Health and Neuropsychology, Leiden University, Leiden, the Netherlands
| | - Floris H B M Schreuder
- Neurology, Radboud University Medical Center (RUMC), Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, the Netherlands
| | - Catharina J M Klijn
- Neurology, Radboud University Medical Center (RUMC), Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, the Netherlands
| | - Marcel M Verbeek
- Neurology, Radboud University Medical Center (RUMC), Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, the Netherlands
- Laboratory Medicine, RUMC, Nijmegen, the Netherlands
| | - Gisela M Terwindt
- Neurology, Leiden University Medical Center (LUMC), Albinusdreef 2, 2300RC, Leiden, NL, the Netherlands
| | - Ellis S van Etten
- Neurology, Leiden University Medical Center (LUMC), Albinusdreef 2, 2300RC, Leiden, NL, the Netherlands
| | - Marieke J H Wermer
- Neurology, Leiden University Medical Center (LUMC), Albinusdreef 2, 2300RC, Leiden, NL, the Netherlands
- Neurology, University Medical Center Groningen, Groningen, the Netherlands
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12
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Johns-Mead R, Vijayakumar N, Mulraney M, Melvin G, Anderson VA, Efron D, Silk TJ. The longitudinal relationship between socioemotional difficulties and irritability in ADHD. J Affect Disord 2024; 350:573-581. [PMID: 38244802 DOI: 10.1016/j.jad.2024.01.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/12/2024] [Accepted: 01/14/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND Despite higher rates of irritability and socioemotional symptoms in ADHD, consensus is lacking regarding their developmental relationship and whether it differs by ADHD status. This longitudinal study sought to evaluate how peer and emotional difficulties relate to irritability in ADHD and control groups. METHODS A community sample of 336 participants (45 % ADHD) were recruited for the Children's Attention Project. Participants completed the Affective Reactivity Index and the Strengths and Difficulties Questionnaire's emotional and peer difficulties scales at baseline (mean age 10.5 years) and 18-month follow-up. Latent Change Score models assessed how emotional and peer difficulties related to irritability at baseline and longitudinally. RESULTS For both groups, more severe baseline difficulties were associated with higher concurrent irritability, and reductions in emotional and peer difficulties were associated with declining irritability. Baseline emotional difficulties predicted change in irritability for the ADHD group, while baseline peer difficulties predicted change in irritability for both groups. Baseline irritability did not predict change in emotional or peer difficulties for either. The ADHD group showed elevated irritability, emotional, and peer difficulties, and stronger baseline correlation between peer difficulties and irritability. LIMITATIONS Only two timepoints were captured, and associations with ADHD symptom severity and presentation were not investigated. Doing so may facilitate additional insights. CONCLUSIONS Change in irritability corresponded to change in socioemotional difficulties, and was driven by earlier levels of socioemotional difficulties. ADHD exacerbated aspects of the relationship between socioemotional difficulties and irritability. Socioemotional difficulties drive irritability, so may represent targets for clinical interventions.
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Affiliation(s)
- Rania Johns-Mead
- School of Psychology and the Centre for Social and Early Emotional Development (SEED), Deakin University, Geelong, Australia
| | - Nandita Vijayakumar
- School of Psychology and the Centre for Social and Early Emotional Development (SEED), Deakin University, Geelong, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | | | - Glenn Melvin
- School of Psychology and the Centre for Social and Early Emotional Development (SEED), Deakin University, Geelong, Australia
| | - Vicki A Anderson
- Murdoch Children's Research Institute, Melbourne, Australia; The Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Daryl Efron
- Murdoch Children's Research Institute, Melbourne, Australia; The Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Tim J Silk
- School of Psychology and the Centre for Social and Early Emotional Development (SEED), Deakin University, Geelong, Australia; Murdoch Children's Research Institute, Melbourne, Australia.
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13
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Edmunds SR, Jones A, Braverman Y, Fogler J, Rowland K, Faja SK. Irritability as a Transdiagnostic Risk Factor for Functional Impairment in Autistic and Non-autistic Toddlers and Preschoolers. Res Child Adolesc Psychopathol 2024; 52:551-565. [PMID: 38060090 DOI: 10.1007/s10802-023-01150-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2023] [Indexed: 12/08/2023]
Abstract
Trait irritability in toddlerhood is a powerful risk factor for later internalizing and externalizing challenges in non-autistic children, but the predictive clinical utility of irritability is unknown in autism. Irritability is a trait-level emotional response (i.e., frustration) to a blocked goal and is one source of disruptive behavior. Irritability has two facets: Frustration is the degree to which emotion is elevated after a blocked goal, while soothability is the rate of recovery from peak distress. We aimed to: (1) compare and describe the two facets of irritability in non-autistic and young autistic children, and (2) assess whether children's reward sensitivity and executive function moderate the relation between irritability and clinical symptoms. Participants were 90 autistic (n=43) and non-autistic (n = 47) 2- and 4-year-olds. Autistic children did not have different levels of frustration but were more difficult to soothe compared to non-autistic children, according to parents. Further, frustration and soothability were less strongly correlated for autistic compared to non-autistic children. For all children, executive function (specifically, inhibition) moderated, or ameliorated the strength of, the relation between irritability (both soothability and frustration) and externalizing challenges. This study provides evidence for irritability as a transdiagnostic risk factor for clinically significant emotion regulation challenges. Further, the effect of trait irritability may be ameliorated by children's executive function in a transdiagnostic manner. Future work should examine the unique aspects of soothability to how irritability presents within autism, as well as evaluate and modify emotion regulation interventions for autistic toddlers and preschoolers.
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Affiliation(s)
- Sarah R Edmunds
- Department of Psychology, University of South Carolina, Columbia, SC, USA.
| | - Aiko Jones
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Yael Braverman
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Jason Fogler
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA
- Leadership Education in Neurodevelopmental & Related Disabilities, Institute for Community Inclusion, Boston, MA, USA
| | - Katie Rowland
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Susan K Faja
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA
- Departments of Pediatrics & Psychiatry and Behavioral Sciences, Harvard Medical School, Boston, MA, USA
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14
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Elahi H, Iosif AM, Mukherjee P, Hinshaw SP, Schweitzer JB. Using Hot and Cool Measures to Phenotype and Predict Functional Outcomes Across Dimensions of ADHD and Typical Development in Adolescents. Res Child Adolesc Psychopathol 2024; 52:579-593. [PMID: 38038753 DOI: 10.1007/s10802-023-01149-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/02/2023]
Abstract
Multiple pathway models propose that attention deficit hyperactivity disorder (ADHD) arises from dysfunction in separate systems comprised of a "cool" or cognitive pathway versus a "hot" or emotional/reward pathway. Interactions between these pathways and the degree of maturation may further determine functional outcomes for adolescents ranging from those diagnosed with ADHD to typical development (TD). We used a latent profile analysis on rating scales and behavioral task performance assessing emotion, irritability, impulsivity, risk-taking, future orientation, and processing speed (PS) to identify subgroups of TD adolescents and adolescents with ADHD (N = 152) based on the hot and cool pathway model. We identified four classes: 1) High-Complex Challenges; 2) Moderate-Mixed Challenges; 3) Non-Emotive Impulsivity; and 4) High Regulation and Control. A multiple pathway model of ADHD is supported with classes differing in degree of emotional lability and irritability, types of impulsivity, and ability to use future consequences to modulate impulsivity and PS. The classes differed regarding functional behavior, with the High-Complex class demonstrating the most severe functional challenges in academic-related functioning. The Moderate-Mixed class also displayed significant functional challenges but with moderate emotional lability and irritability ratings. The Non-Emotive Impulsivity class exhibited low emotionality and low irritability, yet high impulsivity with limited negative functional consequences, and was composed of a mix of ADHD and TD adolescents. Differences between classes suggest ADHD symptomatology may represent both categorical and dimensional differences. Precision health interventions may be more effective in addressing the specific challenges associated with the classes rather than a one-size-fits-all approach to treating ADHD.
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Affiliation(s)
- Heather Elahi
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, 95817, USA
- MIND Institute, University of California, Davis, Sacramento, CA, USA
| | - Ana-Maria Iosif
- Department of Public Health Sciences, Division of Biostatistics, University of California, Davis, Davis, CA, USA
| | - Prerona Mukherjee
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, 95817, USA
- MIND Institute, University of California, Davis, Sacramento, CA, USA
| | - Stephen P Hinshaw
- Department of Psychology, University of California, Berkeley, Berkeley, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Julie B Schweitzer
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, 95817, USA.
- MIND Institute, University of California, Davis, Sacramento, CA, USA.
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15
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Hwang S, Suk JW, Meffert H, Lerdahl A, Garvey WF, Edwards R, Delizza A, Soltis-Vaughan B, Cordts K, Leibenluft E, Blair RJR. Neural Responses to Intranasal Oxytocin in Youths With Severe Irritability. Am J Psychiatry 2024; 181:291-298. [PMID: 38419495 PMCID: PMC10984767 DOI: 10.1176/appi.ajp.20230174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
OBJECTIVE The authors investigated the neural impact of intranasal oxytocin on emotion processing areas in youths with severe irritability in the context of disruptive mood and behavior disorders. METHODS Fifty-two participants with severe irritability, as measured by a score ≥4 on the Affective Reactivity Index (ARI), with diagnoses of disruptive behavior disorders (DBDs) and/or disruptive mood dysregulation disorder (DMDD) were randomly assigned to treatment with intranasal oxytocin or placebo daily for 3 weeks. Assessments were conducted at baseline and at the end of the trial; the primary outcomes were measures of irritability on the ARI and ratings on the Clinical Global Impressions severity scale (CGI-S) focusing on DBD and DMDD symptoms, and secondary outcomes included the CGI improvement scale (CGI-I) and ratings of proactive and reactive aggressive behavior on the Reactive-Proactive Aggression Questionnaire. Forty-three participants (22 in the oxytocin group and 21 in the placebo group) completed pre- and posttreatment functional MRI (fMRI) scans with the affective Stroop task. RESULTS Youths who received oxytocin showed significant improvement in CGI-S and CGI-I ratings compared with those who received placebo. In the fMRI data, blood-oxygen-level-dependent (BOLD) responses to emotional stimuli in the dorsomedial prefrontal cortex and posterior cingulate cortex were significantly reduced after oxytocin compared with placebo. These BOLD response changes were correlated with improvement in clinical severity. CONCLUSIONS This study provides initial and preliminary evidence that intranasal oxytocin may induce neural-level changes in emotion processing in youths with irritability in the context of DBDs and DMDD. This may lead to symptom and severity changes in irritability.
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Affiliation(s)
- Soonjo Hwang
- Department of Psychiatry (Hwang, Lerdahl, Edwards), Department of Psychology (Delizza), and Department of Neurological Sciences (Soltis-Vaughan, Cordts), University of Nebraska Medical Center, Omaha; Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea (Suk); Slimmer AI, Groningen, the Netherlands (Meffert); Cognitive Ability and Plasticity Lab, University of Sheffield, Sheffield, U.K. (Garvey); Section on Mood Dysregulation and Neuroscience, NIMH, Bethesda, Md. (Leibenluft); Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Copenhagen (Blair)
| | - Ji-Woo Suk
- Department of Psychiatry (Hwang, Lerdahl, Edwards), Department of Psychology (Delizza), and Department of Neurological Sciences (Soltis-Vaughan, Cordts), University of Nebraska Medical Center, Omaha; Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea (Suk); Slimmer AI, Groningen, the Netherlands (Meffert); Cognitive Ability and Plasticity Lab, University of Sheffield, Sheffield, U.K. (Garvey); Section on Mood Dysregulation and Neuroscience, NIMH, Bethesda, Md. (Leibenluft); Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Copenhagen (Blair)
| | - Harma Meffert
- Department of Psychiatry (Hwang, Lerdahl, Edwards), Department of Psychology (Delizza), and Department of Neurological Sciences (Soltis-Vaughan, Cordts), University of Nebraska Medical Center, Omaha; Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea (Suk); Slimmer AI, Groningen, the Netherlands (Meffert); Cognitive Ability and Plasticity Lab, University of Sheffield, Sheffield, U.K. (Garvey); Section on Mood Dysregulation and Neuroscience, NIMH, Bethesda, Md. (Leibenluft); Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Copenhagen (Blair)
| | - Arica Lerdahl
- Department of Psychiatry (Hwang, Lerdahl, Edwards), Department of Psychology (Delizza), and Department of Neurological Sciences (Soltis-Vaughan, Cordts), University of Nebraska Medical Center, Omaha; Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea (Suk); Slimmer AI, Groningen, the Netherlands (Meffert); Cognitive Ability and Plasticity Lab, University of Sheffield, Sheffield, U.K. (Garvey); Section on Mood Dysregulation and Neuroscience, NIMH, Bethesda, Md. (Leibenluft); Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Copenhagen (Blair)
| | - William F Garvey
- Department of Psychiatry (Hwang, Lerdahl, Edwards), Department of Psychology (Delizza), and Department of Neurological Sciences (Soltis-Vaughan, Cordts), University of Nebraska Medical Center, Omaha; Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea (Suk); Slimmer AI, Groningen, the Netherlands (Meffert); Cognitive Ability and Plasticity Lab, University of Sheffield, Sheffield, U.K. (Garvey); Section on Mood Dysregulation and Neuroscience, NIMH, Bethesda, Md. (Leibenluft); Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Copenhagen (Blair)
| | - Ryan Edwards
- Department of Psychiatry (Hwang, Lerdahl, Edwards), Department of Psychology (Delizza), and Department of Neurological Sciences (Soltis-Vaughan, Cordts), University of Nebraska Medical Center, Omaha; Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea (Suk); Slimmer AI, Groningen, the Netherlands (Meffert); Cognitive Ability and Plasticity Lab, University of Sheffield, Sheffield, U.K. (Garvey); Section on Mood Dysregulation and Neuroscience, NIMH, Bethesda, Md. (Leibenluft); Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Copenhagen (Blair)
| | - Alison Delizza
- Department of Psychiatry (Hwang, Lerdahl, Edwards), Department of Psychology (Delizza), and Department of Neurological Sciences (Soltis-Vaughan, Cordts), University of Nebraska Medical Center, Omaha; Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea (Suk); Slimmer AI, Groningen, the Netherlands (Meffert); Cognitive Ability and Plasticity Lab, University of Sheffield, Sheffield, U.K. (Garvey); Section on Mood Dysregulation and Neuroscience, NIMH, Bethesda, Md. (Leibenluft); Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Copenhagen (Blair)
| | - Brigette Soltis-Vaughan
- Department of Psychiatry (Hwang, Lerdahl, Edwards), Department of Psychology (Delizza), and Department of Neurological Sciences (Soltis-Vaughan, Cordts), University of Nebraska Medical Center, Omaha; Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea (Suk); Slimmer AI, Groningen, the Netherlands (Meffert); Cognitive Ability and Plasticity Lab, University of Sheffield, Sheffield, U.K. (Garvey); Section on Mood Dysregulation and Neuroscience, NIMH, Bethesda, Md. (Leibenluft); Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Copenhagen (Blair)
| | - Katrina Cordts
- Department of Psychiatry (Hwang, Lerdahl, Edwards), Department of Psychology (Delizza), and Department of Neurological Sciences (Soltis-Vaughan, Cordts), University of Nebraska Medical Center, Omaha; Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea (Suk); Slimmer AI, Groningen, the Netherlands (Meffert); Cognitive Ability and Plasticity Lab, University of Sheffield, Sheffield, U.K. (Garvey); Section on Mood Dysregulation and Neuroscience, NIMH, Bethesda, Md. (Leibenluft); Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Copenhagen (Blair)
| | - Ellen Leibenluft
- Department of Psychiatry (Hwang, Lerdahl, Edwards), Department of Psychology (Delizza), and Department of Neurological Sciences (Soltis-Vaughan, Cordts), University of Nebraska Medical Center, Omaha; Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea (Suk); Slimmer AI, Groningen, the Netherlands (Meffert); Cognitive Ability and Plasticity Lab, University of Sheffield, Sheffield, U.K. (Garvey); Section on Mood Dysregulation and Neuroscience, NIMH, Bethesda, Md. (Leibenluft); Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Copenhagen (Blair)
| | - R J R Blair
- Department of Psychiatry (Hwang, Lerdahl, Edwards), Department of Psychology (Delizza), and Department of Neurological Sciences (Soltis-Vaughan, Cordts), University of Nebraska Medical Center, Omaha; Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea (Suk); Slimmer AI, Groningen, the Netherlands (Meffert); Cognitive Ability and Plasticity Lab, University of Sheffield, Sheffield, U.K. (Garvey); Section on Mood Dysregulation and Neuroscience, NIMH, Bethesda, Md. (Leibenluft); Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Copenhagen (Blair)
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16
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Stringaris A, Silver J. Mechanism-Focused Randomized Controlled Trials in Youths: Another Step Uphill. Am J Psychiatry 2024; 181:259-261. [PMID: 38557144 DOI: 10.1176/appi.ajp.20240123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Affiliation(s)
- Argyris Stringaris
- Division of Psychiatry (Stringaris) and Division Psychology and Language Sciences (Stringaris, Silver), Faculty of Brain Sciences, University College London; First Department of Psychiatry, National and Kapodistrian University of Athens, Athens, Greece (Stringaris); Department of Psychology, Stony Brook University, Stony Brook, N.Y. (Silver)
| | - Jamilah Silver
- Division of Psychiatry (Stringaris) and Division Psychology and Language Sciences (Stringaris, Silver), Faculty of Brain Sciences, University College London; First Department of Psychiatry, National and Kapodistrian University of Athens, Athens, Greece (Stringaris); Department of Psychology, Stony Brook University, Stony Brook, N.Y. (Silver)
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17
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En-Hua Wang J, Simon NG, Brownstein MJ, Maibach HT, Maibach J, Anderson KE. The utility of the irritability scale in Huntington's disease patients with evidence of irritability or aggression. Parkinsonism Relat Disord 2024; 123:106087. [PMID: 38640832 DOI: 10.1016/j.parkreldis.2024.106087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/23/2024] [Accepted: 03/03/2024] [Indexed: 04/21/2024]
Abstract
INTRODUCTION Irritability, a common neuropsychiatric symptom in Huntington's disease (HD), lacks a standardized measurement. The Irritability Scale (IS), tailored for HD, has patient and informant versions, but variable interrater agreement has been reported frequently in previous studies. To enhance the clinical utility of the IS, this study aimed to identify the most reliable components estimating the underlying construct and develop a shortened version for time-limited contexts. METHODS Participant and informant/observer concordance and the relationship of individual items to the complete IS scale were assessed. The short-form (SF) items were selected based on interrater agreement, exploratory factor analysis (EFA), and Item Response Theory (IRT) analysis results. Pair-wise correlation and covariance models were used to examine how SF predicted total IS score in 106 participants from the STAIR (Safety, Tolerability, and Activity of SRX246 in Irritable Subjects with Huntington's Disease) trial. Item Response Theory (IRT) analysis was used to evaluate the range and function of the selected items. RESULTS IS interrater agreement was statistically significant (r = 0.33, p = .001). In combination with EFA factors and IRT analyses, five items were identified that showed good reliability and performance in differentiating levels of irritability. CONCLUSION The proposed 5-item SF IS provided a reliable measure of the full scale and may be less burdensome for use in a clinical setting.
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Affiliation(s)
| | - Neal G Simon
- Azevan Pharmaceuticals, Inc., Bethlehem, PA, USA; Department of Biological Sciences, Lehigh University, Bethlehem, PA, USA
| | | | | | - Jacob Maibach
- Indigo RDD, LLC, Potomac, MD, USA; Department of Mathematics, University of Arizona, Tucson, AZ, USA
| | - Karen E Anderson
- Department of Psychiatry and Department of Neurology, Georgetown University School of Medicine, Washington, DC, USA.
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18
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Benarous X, Walesa S, Guilé JM, Cravero C, Consoli A, Cohen D, Young H, Labelle R, Lahaye H. A systematic review of the psychometric properties of tools for measuring depression in youths with intellectual disability. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02405-x. [PMID: 38509427 DOI: 10.1007/s00787-024-02405-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/19/2024] [Indexed: 03/22/2024]
Abstract
While youths with intellectual disability (ID) have increased vulnerability for depressive disorders, cognitive problems and combined functional barriers make them less prone to receive adequate treatments. A systematic review of the literature was conducted (PROSPERO Registration number: CRD42022347703) based on several databases from 1980 to 2022 to examine the quality of tools for measuring depression in children and adolescents with ID. The COSMIN (COnsensus-based Standards for the selection of health status Measurement Instruments) checklist was used to assess several psychometric domains. Twelve studies evaluated the properties of six tools for measuring depression in youths with ID. The Center for Epidemiologic Studies Depression Scale-Intellectual Disability (CESD-ID) was the only scale with at least five domains of psychometric properties assessed to have strong or moderate evidence. Based on the reviewed findings, tools specifically developed for populations with developmental disabilities should be considered first in order to screen depression in youths with ID. Much work is required to confirm their validity in clinical samples with patients with a complex form of developmental disabilities. As a complement to self- and caregivers-report questionnaires, clinician rating scales were considered useful to catch the full picture of depression in youths with ID, in particular associated behavioral expressions. Their validity received little scrutiny and certainly deserve more attention to improve care practice of youths with ID.
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Affiliation(s)
- Xavier Benarous
- Pitié-Salpêtrière Hospital, APHP, Sorbonne Université, Paris, France.
| | | | | | - Cora Cravero
- Pitié-Salpêtrière Hospital, APHP, Sorbonne Université, Paris, France
| | - Angèle Consoli
- Pitié-Salpêtrière Hospital, APHP, Sorbonne Université, Paris, France
| | - David Cohen
- Pitié-Salpêtrière Hospital, APHP, Sorbonne Université, Paris, France
| | | | - Real Labelle
- Université du Québec À Montréal, Montréal, Canada
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19
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Lu X, Hu X, Wang L. Causal relationship between irritability and asthma: a bidirectional two-sample Mendelian randomization study. Nucleosides Nucleotides Nucleic Acids 2024:1-12. [PMID: 38506573 DOI: 10.1080/15257770.2024.2330594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/06/2024] [Indexed: 03/21/2024]
Abstract
INTRODUCTION Previous studies have suggested a relationship between bad mood and asthma. Therefore, in this study, a two-sample Mendelian randomization (MR) method was used to explore the correlation between irritability and asthma. MATERIAL AND METHODS Relevant instrumental variables (IVs) were extracted from the aggregated data of the genome-wide association studies (GWAS) database. Inverse-variance weighting (IVW) and weighted median (WME) were used for the MR analysis to evaluate the causal relationship between irritability and asthma using odds ratios (ORs) and the corresponding 95% confidence intervals (CIs), respectively. The "leave-one-out" method was used for sensitivity analysis. RESULTS The results of IVW analysis using random-effects models suggested that irritability increased the risk of asthma (OR = 1.954, 95% CI = 1.188-3.214, p = 0.008). The results of WME were consistent with this observation (OR = 1.934, 95% CI = 1.100-3.400, p = 0.021). Additionally, gastroesophageal reflux disease (GERD) might account for approximately 40% of the relationship between irritability and asthma. The sensitivity analysis revealed the stability of the results. CONCLUSION The causal relationship between irritability and asthma was analyzed through MR analysis. Irritability increased the risk of asthma. GERD might play an important mediating role in this relationship.
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Affiliation(s)
- Xiaoying Lu
- Department of Respiratory and Critical Care Medicine, Ziyang Central Hospital, Ziyang, Sichuan, China
| | - Xu Hu
- Department of Respiratory and Critical Care Medicine, Ziyang Central Hospital, Ziyang, Sichuan, China
| | - Ling Wang
- Department of Respiratory and Critical Care Medicine, Ziyang Central Hospital, Ziyang, Sichuan, China
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20
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Meigs JM, Kiderman M, Kircanski K, Cardinale EM, Pine DS, Leibenluft E, Brotman MA, Naim R. Sleepless nights, sour moods: daily sleep- irritability links in a pediatric clinical sample. J Child Psychol Psychiatry 2024. [PMID: 38355141 DOI: 10.1111/jcpp.13959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/02/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Sleep, or a lack thereof, is strongly related to mood dysregulation. Although considerable research uses symptom scales to examine this relation, few studies use longitudinal, real-time methods focused on pediatric irritability. This study leveraged an ecological momentary assessment (EMA) protocol, assessing bidirectional associations between momentary irritability symptoms and daily sleep duration in a transdiagnostic pediatric sample enriched for irritability. METHODS A total of N = 125 youth (Mage = 12.58 years, SD = 2.56 years; 74% male; 68.8% White) completed digital, in vivo surveys three times a day for 7 days. For a subset of youth, their parents also completed the EMA protocol. Trait irritability was measured using youth-, parent-, and clinician-report to test its potential moderating effect on the association between sleep duration and momentary irritability. RESULTS Results from multilevel modeling dynamically linked sleep to irritability. Specifically, according to youth- and parent-report, decreased sleep duration was associated with increased morning irritability (bs ≤ -.09, ps < .049). A bidirectional association between parent-reported nightly sleep duration and anger was found-increased evening anger related to decreased nightly sleep duration, and decreased sleep duration related to increased morning anger (bs ≤ -.17, ps < .019). Trait irritability moderated this association, which was stronger for more irritable youth (b = -.03, p < .027). CONCLUSIONS This study adds to the literature and suggests sleep-irritability dynamics as a potential treatment target.
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Affiliation(s)
- Jennifer M Meigs
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Miryam Kiderman
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Katharina Kircanski
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Elise M Cardinale
- Psychology Department, The Catholic University of America, Washington, DC, USA
| | - Daniel S Pine
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Ellen Leibenluft
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Melissa A Brotman
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Reut Naim
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
- School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
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21
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Choi H, Kim JH, Yang HS, Kim JY, Cortese S, Smith L, Koyanagi A, Dragioti E, Radua J, Fusar-Poli P, Shin JI, Cheon KA, Solmi M. Pharmacological and non-pharmacological interventions for irritability in autism spectrum disorder: a systematic review and meta-analysis with the GRADE assessment. Mol Autism 2024; 15:7. [PMID: 38263251 PMCID: PMC10807060 DOI: 10.1186/s13229-024-00585-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 01/11/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Numerous interventions for irritability in autism spectrum disorder (ASD) have been investigated. We aimed to appraise the magnitude of pharmacological and non-pharmacological interventions for irritability in ASD without any restrictions in terms of eligible interventions. METHODS We systematically searched PubMed/MEDLINE, Scopus, and Web of Science until April 15, 2023. We included randomized controlled trials (RCTs) with a parallel design that examined the efficacy of interventions for the treatment of irritability in patients of any age with ASD without any restrictions in terms of eligible interventions. We performed a random-effects meta-analysis by pooling effect sizes as Hedges' g. We classified assessed interventions as follows: pharmacological monotherapy, risperidone plus adjuvant therapy versus risperidone monotherapy, non-pharmacological intervention, and dietary intervention. We utilized the Cochrane tool to evaluate the risk of bias in each study and the GRADE approach to assess the certainty of evidence for each meta-analyzed intervention. RESULTS Out of 5640 references, we identified 60 eligible articles with 45 different kinds of interventions, including 3531 participants, of which 80.9% were males (mean age [SD] = 8.79 [3.85]). For pharmacological monotherapy, risperidone (Hedges' g - 0.857, 95% CI - 1.263 to - 0.451, certainty of evidence: high) and aripiprazole (Hedges' g - 0.559, 95% CI - 0.767 to - 0.351, certainty of evidence: high) outperformed placebo. Among the non-pharmacological interventions, parent training (Hedges' g - 0.893, 95% CI - 1.184 to - 0.602, certainty of evidence: moderate) showed a significant result. None of the meta-analyzed interventions yielded significant effects among risperidone + adjuvant therapy and dietary supplementation. However, several novel molecules in augmentation to risperidone outperformed risperidone monotherapy, yet from one RCT each. LIMITATIONS First, various tools have been utilized to measure the irritability in ASD, which may contribute to the heterogeneity of the outcomes. Second, meta-analyses for each intervention included only a small number of studies and participants. CONCLUSIONS Only risperidone, aripiprazole among pharmacological interventions, and parent training among non-pharmacological interventions can be recommended for irritability in ASD. As an augmentation to risperidone, several novel treatments show promising effects, but further RCTs are needed to replicate findings. Trial registration PROSPERO, CRD42021243965.
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Affiliation(s)
- Hangnyoung Choi
- Department of Child and Adolescent Psychiatry, Severance Hospital, Yonsei University College of Medicine, Yonsei-Ro 50, Seodaemun-Gu, Seoul, 03722, Republic of Korea
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea
| | - Jae Han Kim
- Yonsei University College of Medicine, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Hee Sang Yang
- Yonsei University College of Medicine, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Jong Yeob Kim
- Yonsei University College of Medicine, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
- Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Samsung Medical Center, Seoul, Republic of Korea
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, NY, USA
- DiMePRe-J-Department of Precision and Rigenerative Medicine-Jonic Area, University of Bari "Aldo Moro", Bari, Italy
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, CB1 1PT, UK
| | - Ai Koyanagi
- Parc Sanitari Sant Joan de Deu, Sant Boi de Llobregat ES, Barcelona, Spain
| | - Elena Dragioti
- Research Laboratory Psychology of Patients, Families and Health Professionals, Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, Greece
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University SE, Linköping, Sweden
| | - Joaquim Radua
- Imaging Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Mental Health Research Networking Center (CIBERSAM), University of Barcelona, Barcelona, Spain
| | - Paolo Fusar-Poli
- Department of Psychosis Studies, King's College London, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Outreach and Support in South-London (OASIS) Service, South London and Maudlsey (SLaM) NHS Foundation Trust, London, UK
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University Munich, Munich, Germany
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Yonsei-Ro 50, Seodaemun-Gu, Seoul, 03722, Republic of Korea.
- Severance Children's Hospital, Yonsei University Health System, Seoul, Republic of Korea.
- Severance Underwood Meta-Research Center, Institute of Convergence Science, Yonsei University, Seoul, Republic of Korea.
| | - Keun-Ah Cheon
- Department of Child and Adolescent Psychiatry, Severance Hospital, Yonsei University College of Medicine, Yonsei-Ro 50, Seodaemun-Gu, Seoul, 03722, Republic of Korea.
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea.
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- Regional Centre for the Treatment of Eating Disorders and On Track: The Champlain First Episode Psychosis Program, Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute (OHRI), Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
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22
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Dissanayake AS, Dupuis A, Arnold PD, Burton CL, Crosbie J, Schachar RJ, Levy T. Is irritability multidimensional: Psychometrics of The Irritability and Dysregulation of Emotion Scale (TIDES-13). Eur Child Adolesc Psychiatry 2024:10.1007/s00787-023-02350-1. [PMID: 38228758 DOI: 10.1007/s00787-023-02350-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 12/03/2023] [Indexed: 01/18/2024]
Abstract
Irritability is a common, impairing, and potentially multifaceted manifestation of psychopathology. We designed The Irritability and Dysregulation of Emotion Scale (TIDES-13) to determine whether various expressions of irritability in children and youth form multiple subdimensions with distinct correlates. We administered parent-report (n = 3875, mean age = 8.9) and youth self-report (n = 579, mean age = 15.1) versions of TIDES-13 in a population and community-based sample. We conducted exploratory/confirmatory factor analyses and regression analyses to examine the dimensionality of TIDES-13 and the associations of the scale with age, gender, anxiety, depression, ODD, ADHD traits, and the Affective Reactivity Index (ARI). A higher-order model with a global irritability dimension and four subdimensions, including proneness to anger (PA), internalized negative emotional reactivity (iNER), externalized negative emotional reactivity (eNER), and reactive aggression (RA), showed good to excellent fit in both parent-report and self-report. The global irritability dimension showed excellent internal reliability (⍵Total; parent-report = 0.97, ⍵Total; self-report = 0.95), explained a majority of the item variance (⍵Hierarchical; parent-report = 0.94, ⍵Hierarchical; self-report = 0.90), and was moderately correlated with the ARI (rparent = 0.68, rself = 0.77). Subdimensions PA, eNER, and RA were negatively associated with age in males, whereas iNER was positively associated with age in females. Traits of ODD and ADHD were associated primarily with the global irritability dimension, whereas iNER was strongly associated with anxiety and depression traits over and above the global irritability dimension. Our results support a unidimensional interpretation of irritability in a population sample. However, limited evidence of specific behavioral, age, and sex correlates with particular irritability subdimensions may warrant further investigation.
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Affiliation(s)
| | - Annie Dupuis
- Department of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Paul D Arnold
- Department of Child and Adolescent Psychiatry, The Mathison Centre for Mental Health Research & Education, Calgary, AB, Canada
| | - Christie L Burton
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON, Canada
- Neurosciences and Mental Health/Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jennifer Crosbie
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Neurosciences and Mental Health/Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada
| | - Russell J Schachar
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON, Canada.
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Neurosciences and Mental Health/Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada.
| | - Tomer Levy
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON, Canada
- Department of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Behavior Regulation Service, Geha Mental Health Center, Petach-Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Zhang Y, MacNeill LA, Edwards RC, Burns JL, Zola AR, Poleon RB, Nili AN, Giase GM, Ahrenholtz RM, Wiggins JL, Norton ES, Wakschlag LS. Developmental Trajectories of Irritability across the Transition to Toddlerhood: Associations with Effortful Control and Psychopathology. Res Child Adolesc Psychopathol 2024; 52:125-139. [PMID: 37410219 DOI: 10.1007/s10802-023-01098-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2023] [Indexed: 07/07/2023]
Abstract
Preschool-age irritability is a transdiagnostic marker of internalizing and externalizing problems. However, researchers have generally been reluctant to examine irritability within a clinically salient framework at younger ages due to some instability during the "terrible twos" period. Developmentally sensitive and dense measurements to capture intra- and inter-individual variability, as well as exploration of developmental processes that predict change, are needed. This study aimed to examine (1) the trajectories of irritability at the transition to toddlerhood (12-24 months of age) using repeated measures, (2) whether effortful control was associated with individual differences in level and growth rate of irritability, and (3) whether individual differences in the irritability trajectories were associated with later psychopathology. Families were recruited when the child was 12-18 months old (N = 333, 45.65% female). Mothers reported on their toddler's irritability at baseline and every two months until a follow-up laboratory assessment approximately one year later. Effortful control was measured at baseline. Clinical internalizing/externalizing symptoms were measured at the follow-up assessment. Hierarchical linear models revealed an increase in irritability over time, yet there was relatively little within-person variability. Effortful control was only associated with the level of irritability and not growth rate. Level of irritability was associated with internalizing, externalizing, and combined symptoms, but growth rate was not. Findings suggest intraindividual stability in irritability at the transition to toddlerhood and the possibility that screening for elevated irritability at toddler age is meaningful.
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Affiliation(s)
- Yudong Zhang
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA.
| | - Leigha A MacNeill
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA
| | - Renee C Edwards
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA
| | - James L Burns
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Anne R Zola
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Roshaye B Poleon
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA
| | - Amanda N Nili
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA
| | - Gina M Giase
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA
| | - Rachel M Ahrenholtz
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jillian Lee Wiggins
- Department of Psychology, San Diego State University, San Diego, USA
- San Diego State University, University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, USA
| | - Elizabeth S Norton
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, USA
| | - Lauren S Wakschlag
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA
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24
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Brænden A, Coldevin M, Zeiner P, Stubberud J, Melinder A. Executive function in children with disruptive mood dysregulation disorder compared to attention-deficit/hyperactivity disorder and oppositional defiant disorder, and in children with different irritability levels. Eur Child Adolesc Psychiatry 2024; 33:115-125. [PMID: 36680626 PMCID: PMC9867548 DOI: 10.1007/s00787-023-02143-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 01/09/2023] [Indexed: 01/22/2023]
Abstract
Addressing current challenges in research on disruptive mood dysregulation disorder (DMDD), this study aims to compare executive function in children with DMDD, children with attention-deficit/hyperactivity disorder (ADHD), and children with oppositional defiant disorder (ODD). We also explore associations between irritability, a key DMDD characteristic, and executive function in a clinical sample regardless of diagnosis. Our sample include children (6-12 years) referred to child psychiatric clinics. Measures of daily-life (parent-reported questionnaire) and performance-based (neuropsychological tasks) executive function were applied. Identifying diagnoses, clinicians administered a standardized semi-structured diagnostic interview with parents. Irritability was assessed by parent-report. First, we compared executive function in DMDD (without ADHD/ODD), ADHD (without DMDD/ODD), ODD (without DMDD/ADHD) and DMDD + ADHD (without ODD). Second, we analyzed associations between executive function and irritability using the total sample. In daily life, children with DMDD showed clinically elevated and significantly worse emotion control scores compared to children with ADHD, and clinically elevated scores on cognitive flexibility compared to norm scores. Children with DMDD had significantly less working memory problems than those with ADHD. No differences were found between DMDD and ODD. Increased irritability was positively associated with emotional dyscontrol and cognitive inflexibility. For performance-based executive function, no diagnostic differences or associations with irritability were observed. We discuss how, in daily life, children with high irritability-levels get overwhelmed by feelings without accompanying regulatory capacities.
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Affiliation(s)
- Astrid Brænden
- Division of Mental Health and Addiction, Oslo University Hospital, Sognsveien 22, 0372, Oslo, Norway.
| | - Marit Coldevin
- Lovisenberg Diaconal Hospital, Nic Waals Institute, Oslo, Norway
| | - Pål Zeiner
- Division of Mental Health and Addiction, Oslo University Hospital, Sognsveien 22, 0372, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jan Stubberud
- Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Annika Melinder
- Division of Mental Health and Addiction, Oslo University Hospital, Sognsveien 22, 0372, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
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Naik AA, Ma X, Munyeshyaka M, Leibenluft E, Li Z. A New Behavioral Paradigm for Frustrative Nonreward in Juvenile Mice. Biol Psychiatry Glob Open Sci 2024; 4:31-38. [PMID: 38045768 PMCID: PMC10689275 DOI: 10.1016/j.bpsgos.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/12/2023] [Accepted: 09/27/2023] [Indexed: 12/05/2023] Open
Abstract
Background Irritability, defined as proneness to anger, can reach a pathological extent. It is a defining symptom of disruptive mood dysregulation disorder and one of the most common reasons youths present for psychiatric evaluation and care. Aberrant responses to frustrative nonreward (FNR), the response to omission of expected reward, are central to the pathophysiology of irritability. FNR is a translational construct to study irritability across species. The development of preclinical FNR models would advance mechanistic studies of the important and relatively understudied clinical phenomenon of irritability. Methods We used FNR as a conceptual framework to develop a novel mouse behavioral paradigm named alternate poking reward omission. Juvenile mice were exposed to alternate poking reward omission and then examined with a battery of behavioral tests to determine the behavioral effect of FNR. Results FNR increased locomotion and aggression regardless of sex. These behavioral changes elicited by FNR resemble the symptoms observed in youth with severe irritability. FNR had no effect on anxiety-like, depression-like, or nonaggressive social behaviors. Conclusions Our alternate poking reward omission paradigm effectively elevated aggression and locomotion in juvenile mice. These frustration effects are directly related to behavioral symptoms of youth with severe irritability. Our novel behavioral paradigm lays the groundwork for further mechanistic studies of frustration and irritability in rodents.
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Affiliation(s)
- Aijaz Ahmad Naik
- Section on Synapse Development Plasticity, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
- Center on Compulsive Behaviors, Intramural Research Program, National Institutes of Health, Bethesda, Maryland
| | - Xiaoyu Ma
- Section on Synapse Development Plasticity, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Maxime Munyeshyaka
- Section on Synapse Development Plasticity, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Ellen Leibenluft
- Section on Mood Dysregulation and Neuroscience, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Zheng Li
- Section on Synapse Development Plasticity, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
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Thompson KI, Schneider CJ, Lopez-Roque JA, Wakschlag LS, Karim HT, Perlman SB. A network approach to the investigation of childhood irritability: probing frustration using social stimuli. J Child Psychol Psychiatry 2023. [PMID: 38124618 DOI: 10.1111/jcpp.13937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Self-regulation in early childhood develops within a social context. Variations in such development can be attributed to inter-individual behavioral differences, which can be captured both as facets of temperament and across a normal:abnormal dimensional spectrum. With increasing emphasis on irritability as a robust early-life transdiagnostic indicator of broad psychopathological risk, linkage to neural mechanisms is imperative. Currently, there is inconsistency in the identification of neural circuits that underlie irritability in children, especially in social contexts. This study aimed to address this gap by utilizing a functional magnetic resonance imaging (fMRI) paradigm to investigate pediatric anger/frustration using social stimuli. METHODS Seventy-three children (M = 6 years, SD = 0.565) were recruited from a larger longitudinal study on irritability development. Caregivers completed questionnaires assessing irritable temperament and clinical symptoms of irritability. Children participated in a frustration task during fMRI scanning that was designed to induce frustration through loss of a desired prize to an animated character. Data were analyzed using both general linear modeling (GLM) and independent components analysis (ICA) and examined from the temperament and clinical perspectives. RESULTS ICA results uncovered an overarching network structure above and beyond what was revealed by traditional GLM analyses. Results showed that greater temperamental irritability was associated with significantly diminished spatial extent of activation and low-frequency power in a network comprised of the posterior superior temporal sulcus (pSTS) and the precuneus (p < .05, FDR-corrected). However, greater severity along the spectrum of clinical expression of irritability was associated with significantly increased extent and intensity of spatial activation as well as low- and high-frequency neural signal power in the right caudate (p < .05, FDR-corrected). CONCLUSIONS Our findings point to specific neural circuitry underlying pediatric irritability in the context of frustration using social stimuli. Results suggest that a deliberate focus on the construction of network-based neurodevelopmental profiles and social interaction along the normal:abnormal irritability spectrum is warranted to further identify comprehensive transdiagnostic substrates of the irritability.
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Affiliation(s)
- Khalil I Thompson
- Department of Psychiatry, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - Clayton J Schneider
- Department of Psychiatry, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - Justin A Lopez-Roque
- Department of Psychiatry, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - Lauren S Wakschlag
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Helmet T Karim
- Department of Psychiatry, University of Pittsburg School of Medicine, Pittsburgh, PA, USA
| | - Susan B Perlman
- Department of Psychiatry, Washington University in St Louis School of Medicine, St Louis, MO, USA
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Wilson AT, Hanney WJ, Richardson RM, Klausner SH, Bialosky JE. Biopsychosocial contributors to irritability in individuals with shoulder or low back pain. J Man Manip Ther 2023:1-12. [PMID: 38108631 DOI: 10.1080/10669817.2023.2294679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 12/09/2023] [Indexed: 12/19/2023] Open
Abstract
OBJECTIVES Irritability is a foundational clinical reasoning concept in rehabilitation to evaluate reactivity of the examination and treatment. While originally theorized to reflect tissue damage, a large body of evidence supports pain is a biopsychosocial experience impacted by pain sensitivity and psychological factors. Therefore, the purpose of this study was to examine biopsychosocial contributors to irritability. METHODS 40 patients with shoulder (n = 20) and low back (n = 20) pain underwent Quantitative Sensory Testing (QST) (Pressure Pain Threshold, Heat Pain Threshold, Conditioned Pain Modulation, Temporal Summation), completed pain-related psychological questionnaires, an Exercise-Induced Hypoalgesia protocol, and standardized irritability assessment based on Clinical Practice Guidelines. Participants were then categorized as irritable or not irritable based on Maitland's criteria and by irritability level based on Clinical Practice Guidelines. An independent samples t-test examined for differences in QST and psychological factors by irritability category. A MANOVA examined for differences in QST and psychological factors by irritability level (high, moderate, low). RESULTS Significantly lower heat and pressure pain thresholds at multiple locations (p < 0.05), as well as less efficient conditioned pain modulation (p = 0.02), were demonstrated in individuals categorized as irritable. Heat and pressure pain thresholds were also significantly lower in patients with high irritability compared to other levels. Significantly higher depression and anger, as well as lower self-efficacy, were reported in individuals with an irritable presentation. DISCUSSION/CONCLUSION Biopsychosocial factors, including widespread hyperalgesia and elevated psychological factors, may contribute to an irritable presentation.
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Affiliation(s)
- Abigail T Wilson
- Division of Physical Therapy, University of Central Florida, School of Kinesiology and Rehabilitation Sciences, College of Health Professions and Sciences, Orlando, FL, USA
- Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL, USA
| | - William J Hanney
- Division of Physical Therapy, University of Central Florida, School of Kinesiology and Rehabilitation Sciences, College of Health Professions and Sciences, Orlando, FL, USA
- Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL, USA
| | - Randi M Richardson
- Division of Physical Therapy, University of Central Florida, School of Kinesiology and Rehabilitation Sciences, College of Health Professions and Sciences, Orlando, FL, USA
| | - Sheila H Klausner
- Division of Physical Therapy, University of Central Florida, School of Kinesiology and Rehabilitation Sciences, College of Health Professions and Sciences, Orlando, FL, USA
| | - Joel E Bialosky
- University of Florida Department of Physical Therapy, Gainesville, FL, USA
- Brooks-PHHP Research Collaboration, Gainesville, FL, USA
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Pascarella A, Gasparini S, Manzo L, Marsico O, Torino C, Abelardo D, Cianci V, Iudice A, Bisulli F, Bonanni P, Caggia E, D'Aniello A, Di Bonaventura C, DiFrancesco JC, Domina E, Dono F, Gambardella A, Marini C, Marrelli A, Matricardi S, Morano A, Paladin F, Renna R, Piccioli M, Striano P, Ascoli M, Ferlazzo E, Aguglia U. Perampanel as only add-on epilepsy treatment in elderly: A subgroup analysis of real-world data from retrospective, multicenter, observational study. J Neurol Sci 2023; 455:122797. [PMID: 37976793 DOI: 10.1016/j.jns.2023.122797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 10/31/2023] [Accepted: 11/12/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION Drug management of epilepsy in the elderly presents unique but data on this population are scarce. This study aimed to assess the effectiveness and tolerability of perampanel (PER) used as only add-on to a background anti-seizure medication (ASM) in the elderly in a real-world setting. METHODS We performed a subgroup analysis of patients aged ≥65 years included in a previous 12-month multicenter study on adults. Treatment discontinuation, seizure frequency, and adverse events were recorded at 3, 6 and 12 months after PER introduction. Sub-analyses by early (≤1 previous ASM) or late PER add-on were also conducted. RESULTS The sample included 65 subjects (mean age: 75.7 ± 7.2 years), with mainly focal (73.8%) epilepsy. The mean PER daily dose was ≈4 mg during all follow-up. Retention rates at 3, 6, and 12 months were 90.5%, 89.6%, and 79.4%ly. The baseline median normalized per 28-day seizure number significantly decreased at 3-, 6- and 12-month visits. One year after PER introduction, the responder rate (≥50% reduction in baseline seizure frequency) was 89.7%, with a seizure freedom rate of 72.4%. Adverse events occurred in 22 (34.9%) patients with dizziness and irritability being the most frequent. No major differences between early (41 patients, 63.1%), and late add-on groups were observed. CONCLUSION Adjunctive PER was effective and well-tolerated when used as only add-on treatment in elderly people with epilepsy in clinical practice, thus representing a suitable therapeutic option in this age category.
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Affiliation(s)
- Angelo Pascarella
- Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan "Bianchi-Melacrino-Morelli Hospital", Reggio Calabria, Italy
| | - Sara Gasparini
- Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan "Bianchi-Melacrino-Morelli Hospital", Reggio Calabria, Italy
| | - Lucia Manzo
- Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan "Bianchi-Melacrino-Morelli Hospital", Reggio Calabria, Italy
| | - Oreste Marsico
- Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan "Bianchi-Melacrino-Morelli Hospital", Reggio Calabria, Italy
| | - Claudia Torino
- Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension of Reggio Calabria, National Council of Research, Institute of Clinical Physiology, Reggio Calabria, Italy
| | - Domenico Abelardo
- Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Italy
| | - Vittoria Cianci
- Regional Epilepsy Centre, Great Metropolitan "Bianchi-Melacrino-Morelli Hospital", Reggio Calabria, Italy
| | - Alfonso Iudice
- Department of Neurosciences, Section of Neurology, University of Pisa, Pisa, Italy
| | - Francesca Bisulli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Full Member of the European Reference Network for Rare and Complex Epilepsies (EpiCARE), Bologna, Italy
| | - Paolo Bonanni
- Epilepsy and Clinical Neurophysiology Unit, Scientific Institute, IRCCS Eugenio Medea, Treviso, Italy
| | | | | | - Carlo Di Bonaventura
- Epilepsy Unit, Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy
| | | | | | - Fedele Dono
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Antonio Gambardella
- Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Italy; Neurologic Clinic, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Carla Marini
- Child Neurology and Psychiatric Unit, G. Salesi Pediatric Hospital, Azienda Ospedaliera-Universitaria delle Marche, Ancona, Italy
| | - Alfonso Marrelli
- Neurophysiopathology Unit, Epilepsy Center, San Salvatore Hospital, L'Aquila, Italy
| | | | | | | | - Rosaria Renna
- Neurological Clinic and Stroke Unit, "Cardarelli" Hospital, Naples, Italy
| | - Marta Piccioli
- UOC Neurology, PO San Filippo Neri, ASL Roma 1, Rome, Italy
| | - Pasquale Striano
- IRCCS Istituto Giannina Gaslini, Genova, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genoa, Italy
| | | | - Edoardo Ferlazzo
- Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan "Bianchi-Melacrino-Morelli Hospital", Reggio Calabria, Italy.
| | - Umberto Aguglia
- Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan "Bianchi-Melacrino-Morelli Hospital", Reggio Calabria, Italy
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Grasser LR, Erjo T, Goodwin MS, Naim R, German RE, White J, Cullins L, Tseng WL, Stoddard J, Brotman MA. Can peripheral psychophysiological markers predict response to exposure-based cognitive behavioral therapy in youth with severely impairing irritability? A study protocol. BMC Psychiatry 2023; 23:926. [PMID: 38082431 PMCID: PMC10712194 DOI: 10.1186/s12888-023-05421-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Irritability, an increased proneness to anger, is a primary reason youth present for psychiatric care. While initial evidence supports the efficacy of exposure-based cognitive behavioral therapy (CBT) for youth with clinically impairing irritability, treatment mechanisms remain unclear. Here, we propose to measure peripheral psychophysiological indicators of arousal-heart rate (HR)/electrodermal activity (EDA)-and regulation-heart rate variability (HRV)-during exposures to anger-inducing stimuli as potential predictors of treatment efficacy. The objective of this study is to evaluate whether in-situ biosensing data provides peripheral physiological indicators of in-session response to exposures. METHODS Blood volume pulse (BVP; from which HR and HRV canl be derived) and EDA will be collected ambulatorily using the Empatica EmbracePlus from 40 youth (all genders; ages 8-17) undergoing six in-person exposure treatment sessions, as part of a multiple-baseline trial of exposure-based CBT for clinically impairing irritability. Clinical ratings of irritability will be conducted at baseline, weekly throughout treatment, and at 3-month and 6-month follow-ups via the Clinical Global Impressions Scale (CGI) and the Affective Reactivity Index (ARI; clinician-, parent-, and child-report). Multilevel modeling will be used to assess within- and between-person changes in physiological arousal and regulation throughout exposure-based CBT and to determine whether individual differences are predictive of treatment response. DISCUSSION This study protocol leverages a wearable biosensor (Empatica) to continuously record HR/HRV (derived from BVP) and EDA during in-person exposure sessions for youth with clinically impairing irritability. Here, the goal is to identify changes in physiological arousal (EDA, HR) and regulation (HRV) over the course of treatment in tandem with changes in clinical symptoms. TRIAL REGISTRATION The participants in this study come from an overarching clinical trial (trial registration numbers: NCT02531893 first registered on 8/25/2015; last updated on 8/25/2023). The research project and all related materials were submitted and approved by the appropriate Institutional Review Board of the National Institute of Mental Health (NIMH).
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Affiliation(s)
- Lana Ruvolo Grasser
- Neuroscience and Novel Therapeutics Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.
| | - Trinity Erjo
- Neuroscience and Novel Therapeutics Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Matthew S Goodwin
- Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Reut Naim
- School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Ramaris E German
- Neuroscience and Novel Therapeutics Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Jamell White
- Neuroscience and Novel Therapeutics Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Lisa Cullins
- Neuroscience and Novel Therapeutics Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Wan-Ling Tseng
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Joel Stoddard
- Department of Psychiatry and Biomedical Informatics, University of Colorado, School of Medicine, Aurora, CO, USA
| | - Melissa A Brotman
- Neuroscience and Novel Therapeutics Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
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Wei E, Gao A, Mu X, Qu S, Yang C, Li F, Li S, Liu X, Song C, Guo Y. Paeonol ameliorates hippocampal neuronal damage by inhibiting GRM5/GABBR2/β-arrestin2 and activating the cAMP-PKA signaling pathway in premenstrual irritability rats. Brain Res Bull 2023; 205:110830. [PMID: 38036272 DOI: 10.1016/j.brainresbull.2023.110830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/20/2023] [Accepted: 11/26/2023] [Indexed: 12/02/2023]
Abstract
Premenstrual dysphoric disorder (PMDD) is a periodic psychiatric disorder with high prevalence in women of childbearing age, seriously affecting patients' work and life. Currently, the international first-line drugs for PMDD have low efficiency and increased side effects. Paeonol, a major component of the traditional Chinese medicine Cortex Moutan, has been applied in treating PMDD in China with satisfactory results, but the therapeutic mechanism is not fully understood. This study aims to evaluate the therapeutic effects and pharmacological mechanisms of paeonol on the main psychiatric symptoms and hippocampal damage in PMDD. We established a premenstrual irritability rat model by the resident-intruder paradigm and performed elevated plus maze and social interactions. And we employed the HE and Nissl staining techniques to observe the therapeutic effect of paeonol on hippocampal damage in PMDD rats. Subsequently, Elisa, qRT-PCR Array, Western Blotting, and cell models were utilized to elucidate the underlying molecular mechanisms through which paeonol intervenes in treating PMDD. In this study, we demonstrated the therapeutic effects of paeonol on irritability, anxiety, and social withdrawal behaviors in rats. In addition, we found that paeonol significantly reduced the serum corticosterone (CORT) level, improved hippocampal morphological structure and neuron number, and reduced hippocampal neuron apoptosis in PMDD rats. Paeonol reduced GRM5, GABBR2, β-arrestin2, and GRK3 expression levels in hippocampal brain regions of PMDD rats and activated the cAMP/PKA signaling pathway. Inhibitor cell experiments showed that paeonol specifically ameliorated hippocampal injury by modulating the β-arrestin2/PDE4-cAMP/PKA signaling pathway. The present study demonstrates, for the first time, that paeonol exerts a therapeutic effect on periodic psychotic symptoms and hippocampal injury in PMDD through inhibiting GRM5/GABBR2/β-arrestin2 and activating cAMP-PKA signaling pathway. These findings enhance our understanding of the pharmacological mechanism underlying paeonol and provide a solid scientific foundation for its future clinical application.
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Affiliation(s)
- Enhua Wei
- College of traditional Chinese medicine, Shandong University of Traditional Chinese Medicine, Jinan 250355, China
| | - Aiying Gao
- Taian Institute for Food and Drug Control (Taian Fiber Inspection Institute), Taian 271000, China
| | - Xiaofei Mu
- Department of Pharmacy, Rizhao Central Hospital, Rizhao 276800, China
| | - Songlin Qu
- College of traditional Chinese medicine, Shandong University of Traditional Chinese Medicine, Jinan 250355, China
| | - Caixing Yang
- College of traditional Chinese medicine, Shandong University of Traditional Chinese Medicine, Jinan 250355, China
| | - Fengling Li
- Taian Institute for Food and Drug Control (Taian Fiber Inspection Institute), Taian 271000, China
| | - Shujing Li
- College of traditional Chinese medicine, Shandong University of Traditional Chinese Medicine, Jinan 250355, China
| | - Xuehuan Liu
- Experimental Center, Shandong University of Traditional Chinese Medicine, Jinan 250355, China
| | - Chunhong Song
- Shandong Key Laboratory of Traditional Chinese Medicine and Stress Injury, Department of Laboratory Animal Center, Central Hospital Affiliated to Shandong First Medical University, Jinan 250013, China.
| | - Yinghui Guo
- College of traditional Chinese medicine, Shandong University of Traditional Chinese Medicine, Jinan 250355, China.
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Chung MH, Chang WP. Correlation between hemoglobin levels and depression in late-stage cancer patients with irritability as mediating variable. Eur J Oncol Nurs 2023; 67:102414. [PMID: 37804750 DOI: 10.1016/j.ejon.2023.102414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/30/2023] [Accepted: 09/07/2023] [Indexed: 10/09/2023]
Abstract
PURPOSE In late-stage cancer, the cancer itself or the side effects of cancer treatment are known to affect the hemoglobin (Hgb) levels or emotions of patients. We to investigate the relationship between Hgb levels and depression in late-stage cancer patients and verified whether irritability has a mediating effect on this relationship. METHOD The research tools included a patient basic information form, the Irritability Scale-Initial Version (TISi), and the Hamilton Depression Rating Scale (HAMD). We first compared the Hgb levels, HAMD scores, and TISi scores of the cancer patients with different attributes, performed multiple hierarchical regression analysis, and then analyzed the mediating effects of TISi scores using the Sobel test. RESULTS In the 117 late-stage cancer patients, Hgb levels of patients with a BMI<18.5 kg/m2 were lower than those of the patients with a BMI 24.0 kg/m2. Hgb levels had a negative influence on both TISi scores (B = -2.74, p = .001) and HAMD scores (B = -0.75, p = .010). TISi scores mediated the relationship between Hgb levels and HAMD scores (Z = 2.06, p = .040). CONCLUSIONS Irritability is a mediating variable of the influence of Hgb levels on depression, meaning that lower Hgb levels in late-stage cancer patients may be detrimental to emotional stability, induce irritability, and thereby cause depression. Thus, in the psychological care of late-stage cancer patients, medical teams should be more vigilant in monitoring Hgb levels and anemia treatment.
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Affiliation(s)
- Min-Huey Chung
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Wen-Pei Chang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
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Urben S, Constanty L, Lepage C, Rosselet Amoussou J, Durussel J, Turri F, Wouters E, Mürner-Lavanchy I, Plessen KJ. The added value of a micro-level ecological approach when mapping self-regulatory control processes and externalizing symptoms during adolescence: a systematic review. Eur Child Adolesc Psychiatry 2023; 32:2387-2397. [PMID: 35294631 PMCID: PMC10682160 DOI: 10.1007/s00787-022-01972-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/03/2022] [Indexed: 11/03/2022]
Abstract
Deficits in self-regulatory control (SRC) represent a core characteristic of externalizing (EXT) symptoms (e.g., rule-breaking behavior or aggressive behaviors) in adolescents. This review aims to specify the added value of ecologically valid assessments at a micro-level when examining the associations between SRC and EXT symptoms in adolescents. This systematic review was reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020. The search strategy addressed the added value of (1) naturalistic assessment for the understanding of the relationship between (2) SRC and (3) EXT symptoms in (4) adolescents. We conducted comprehensive searches in bibliographic databases. An additional search was conducted in Google Scholar and supplementary studies were identified through backward and forward citation tracking. Twenty-four studies (n = 4071 adolescents) met the inclusion criteria. The methods used to assess naturalistic aspects included the experience sampling method (ecological momentary- or ambulatory assessment) and the time-course approach (i.e., real-time assessment of SRC processes referring to situations approximating real-life experience where SRC are to be engaged such as in frustrating situations). Micro-level ecological assessments, when mapping the intra-individual relationships between SRC processes and EXT symptoms over time in adolescents within their natural context (i.e., real world) of expression in real time, added a finer-grained observation alongside with a higher ecological validity. Micro-level approaches may enhance the understanding of the complex interplay between SRC and EXT symptoms in adolescence, especially in interventional studies, allowing for the acquisition of endpoints with a higher relevance for everyday functioning.
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Affiliation(s)
- Sébastien Urben
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland.
| | - Lauriane Constanty
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Caroline Lepage
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Joëlle Rosselet Amoussou
- Psychiatry Library, Education and Research Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Julie Durussel
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Fiorella Turri
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Emilie Wouters
- Unit of Child and Adolescent Forensic Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Ines Mürner-Lavanchy
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Kerstin Jessica Plessen
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
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Levy T, Dupuis A, Andrade BF, Crosbie J, Kelley E, Nicolson R, Schachar RJ. Facial emotion recognition in children and youth with attention-deficit/hyperactivity disorder and irritability. Eur Child Adolesc Psychiatry 2023; 32:2271-2280. [PMID: 36050559 DOI: 10.1007/s00787-022-02033-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 06/20/2022] [Indexed: 11/03/2022]
Abstract
The ability to recognize emotions evident in people's faces contributes to social functioning and might be affected by ADHD and irritability. Given their high co-occurrence, we examined the relative contribution of ADHD and irritability to facial emotion recognition (FER). We hypothesized that irritability but not ADHD traits would predict increased likelihood of misrecognizing emotions as negative, and that FER performance would explain the association of ADHD and irritability traits with social skills. FER was measured using the Reading the Mind in the Eyes Test (RMET) in children (6-14 years old) referred for ADHD assessment (n = 304) and healthy controls (n = 128). ADHD, irritability and social skills were measured using parent ratings. We used repeated measure logistics regression, comparing the effects across emotion valence of images (i.e., neutral/positive/negative). High irritability but not ADHD diagnosis predicted lower RMET accuracy. ADHD traits predicted lower RMET accuracy in younger but not older participants, whereas irritability predicted poorer accuracy at all ages. ADHD traits predicted lower RMET accuracy across all emotion valences, whereas irritability predicted increased probability of misrecognizing neutral and positive but not negative emotions. Irritability did not increase the probability for erroneously recognizing emotions as negative. ADHD and irritability traits fully explained the association between RMET and social skills. ADHD and irritability traits might impact the ability to identify emotions portrayed in faces. However, irritability traits appear to selectively impair recognition of neutral and positive but not negative emotions. ADHD and irritability are important when examining the link between FER and social difficulties.
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Affiliation(s)
- Tomer Levy
- Department of Psychiatry, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Annie Dupuis
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Brendan F Andrade
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Jennifer Crosbie
- Department of Psychiatry, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Elizabeth Kelley
- Department of Psychology and Center for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Rob Nicolson
- Department of Psychiatry, Lawson Health Research Institute, University of Western Ontario, London, ON, Canada
| | - Russell James Schachar
- Department of Psychiatry, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Fregna L, Attanasio F, Colombo C. The effect of bright light therapy on irritability in bipolar depression: a single-blind randomised control trial. Int J Psychiatry Clin Pract 2023; 27:416-418. [PMID: 37306396 DOI: 10.1080/13651501.2023.2221286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/04/2023] [Accepted: 05/30/2023] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The symptom-complex irritability, widely used in descriptions of bipolar patients' manic and mixed states, also represents a common feature in depressive phases. Irritability negatively affects the clinical course of depression, leading to a higher risk of treatment non-adherence, violence, and suicide attempts. Nevertheless, proportional attention from the scientific literature seems to be scarce. We conducted the first randomised controlled trial with the aim of evaluating BLT as a possible therapeutic strategy for irritability in bipolar depression. METHODS 180 inpatients were randomly assigned to: Group A exposed to bright light therapy (BLT) daily, or Group B treated with pharmacotherapy only. A qualitative assessment of irritability was performed after a 4-week program. RESULTS Group A showed about one-third fewer cases of irritability compared to Group B, this reduction was not related to the overall remission of depressive symptoms. CONCLUSIONS The present study supports the usefulness of BLT in irritability in bipolar depression.
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Affiliation(s)
- Lorenzo Fregna
- Department of Clinical Neurosciences, Mood Disorder Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Attanasio
- Department of Clinical Neurosciences, Vita-Salute San Raffaele University, Milan, Italy
| | - Cristina Colombo
- Department of Clinical Neurosciences, Mood Disorder Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Clinical Neurosciences, Vita-Salute San Raffaele University, Milan, Italy
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Brænden A, Lebena A, Faresjö Å, Theodorsson E, Coldevin M, Stubberud J, Zeiner P, Melinder A. Excessive hair cortisol concentration as an indicator of psychological disorders in children. Psychoneuroendocrinology 2023; 157:106363. [PMID: 37573627 DOI: 10.1016/j.psyneuen.2023.106363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/08/2023] [Accepted: 08/08/2023] [Indexed: 08/15/2023]
Abstract
Cortisol in hair is a new biomarker assessing long-term hypothalamic-pituitary-adrenal (HPA) axis activity, which is related to emotion regulation. We compare hair cortisol concentrations (HCC), in clinically referred children with disruptive mood dysregulation disorder (DMDD) (n = 19), children with other types of psychological disorders (n = 48), and healthy subjects (n = 36). We also investigate the association between HCC and irritability, age, and sex. Our results show that children with DMDD or other types of psychological disorders have higher HCC than healthy subjects, p < .001, ηp2 = .39. No difference between children with DMDD and those with other types of psychological disorders was found, p = .91, nor an association between HCC and irritability in the clinical sample, p = .32. We found a significant negative correlation between HCC and age in those with DMDD, r = -0.54, p < .05, but not in the normative sample, r = -0.20, p = .25. No differences in HCC between girls and boys were found in the normative sample, p = .49. Children in need of psychological treatment, including those with DMDD, seem to have dysregulated HPA-axis activity over time. Excessive accumulated cortisol concentrations in hair could be an indicator of a psychological disorder in children.
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Affiliation(s)
- Astrid Brænden
- Oslo University Hospital, Division of Mental Health and Addiction, Oslo, Norway.
| | - Andrea Lebena
- Department of Health, Medicine and Caring Sciences, University of Linköping, Sweden
| | - Åshild Faresjö
- Department of Health, Medicine and Caring Sciences, University of Linköping, Sweden
| | - Elvar Theodorsson
- Department of Biomedical and Clinical Science, Division of Clinical Chemistry and Pharmacology, Linköping University, Linköping, Sweden
| | - Marit Coldevin
- Lovisenberg Diaconal Hospital, Nic Waals Institute, Oslo, Norway
| | - Jan Stubberud
- Lovisenberg Diaconal Hospital, Department of Research, Oslo, Norway; University of Oslo, Department of Psychology, Oslo, Norway
| | - Pål Zeiner
- Oslo University Hospital, Division of Mental Health and Addiction, Oslo, Norway; University of Oslo, Institute of Clinical Medicine, Oslo, Norway
| | - Annika Melinder
- Oslo University Hospital, Division of Mental Health and Addiction, Oslo, Norway; University of Oslo, Department of Psychology, Oslo, Norway
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Li Y, Tian W, Liu P, Geng F. A cross-sectional analysis of the relationships between anxiety sensitivity and youth irritability: the mediated roles of insomnia and selective attention for threat. BMC Psychiatry 2023; 23:782. [PMID: 37880675 PMCID: PMC10598902 DOI: 10.1186/s12888-023-05280-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 10/13/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Irritability is common in multiple psychiatric disorders and is hallmark of disruptive mood dysregulation disorder. Child irritability is associated with higher risk of suicide and adulthood mental health problems. However, the psychological mechanisms of irritability are understudied. This study examined the relationship between anxiety sensitivity and irritability among youth, and further explored three possible mediated factors: selective attention for threat, delayed reward discounting, and insomnia. METHODS Participants were 1417 students (51.7% male; mean age 13.83 years, SD = 1.48) recruited from one high school in Hunan province, China. Self-report questionnaires were used to measure irritability (The Affective Reactivity Index and The Brief Irritability Test), anxiety sensitivity (The Childhood Anxiety Sensitivity Index), selective attention for threat (The Davos Assessment of Cognitive Biases Scale-attention for threat bias subscale), insomnia (The Youth Self-Rating Insomnia Scale), and delayed reward discounting (The 27-item Monetary Choice Questionnaire). Structural equation modal (SEM) was performed to examine mediated relations. RESULTS Anxiety sensitivity was modestly related to irritability and insomnia (r from 0.25 to 0.54) and slightly correlated with selective attention for threat (r from 0.12 to 0.28). However, there is no significant relationship of delayed rewards discounting with anxiety sensitivity and irritability. The results of SEM showed that selective attention for threat (indirect effect estimate = 0.04) and insomnia (indirect effect estimate = 0.20) partially mediate the relationship between anxiety sensitivity and irritability, which explained 34% variation. CONCLUSIONS Anxiety sensitivity is an important susceptibility factor for irritability. Selective attention for threat and insomnia are two mediated mechanisms to understand the relationship between anxiety sensitivity and irritability.
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Affiliation(s)
- Yalin Li
- School of Psychology, Jiangxi Normal University, 99 Ziyang Ave, Nanchang, Jiangxi, 330022, China
| | - Wanfu Tian
- Chenzhou Xiangnan Middle School, Chenzhou, China
| | - Ping Liu
- Chenzhou Xiangnan Middle School, Chenzhou, China
| | - Fulei Geng
- School of Psychology, Jiangxi Normal University, 99 Ziyang Ave, Nanchang, Jiangxi, 330022, China.
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Stoddard J, Haller SP, Costa V, Brotman MA, Jones M. A Computational Model Reveals Learning Dynamics During Interpretation Bias Training With Clinical Applications. Biol Psychiatry Cogn Neurosci Neuroimaging 2023; 8:1033-1040. [PMID: 37062362 PMCID: PMC10576009 DOI: 10.1016/j.bpsc.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/04/2023] [Accepted: 03/29/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND Some psychopathologies, including anxiety and irritability, are associated with biases when judging ambiguous social stimuli. Interventions targeting these biases, or interpretation bias training (IBT), are amenable to computational modeling to describe their associative learning mechanisms. Here, we translated ALCOVE (attention learning covering map), a model of category learning, to describe learning in youths with affective psychopathology when training on more positive judgments of ambiguous face emotions. METHODS A predominantly clinical sample comprised 71 youths (age range, 8-22 years) representing broad distributions of irritability and anxiety symptoms. Of these, 63 youths were included in the test sample by completing an IBT task with acceptable performance for computational modeling. We used a separate sample of 28 youths to translate ALCOVE for individual estimates of learning rate and generalization. In the test sample, we assessed associations between model learning estimates and irritability, anxiety, their shared variance (negative affectivity), and age. RESULTS Age and affective symptoms were associated with category learning during IBT. Lower learning rates were associated with higher negative affectivity common in anxiety and irritability. Lower generalization, or improved discrimination between face emotions, was associated with increasing age. CONCLUSIONS This work demonstrates a functional consequence of age- and symptom-related learning during interpretation bias. Learning measured by ALCOVE also revealed learning types not accounted for in the prior literature on IBT. This work more broadly demonstrates the utility of measurement models for understanding trial-by-trial processes and identifying individual learning styles.
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Affiliation(s)
- Joel Stoddard
- Pediatric Mental Health Institute, Department of Psychiatry, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
| | - Simone P Haller
- Neuroscience and Novel Therapeutics Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Vincent Costa
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, Oregon
| | - Melissa A Brotman
- Neuroscience and Novel Therapeutics Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Matt Jones
- Department of Psychology and Neuroscience, University of Colorado at Boulder, Boulder, Colorado
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Fekih-Romdhane F, Azzi V, Hallit R, Malaeb D, Dabbous M, Sakr F, Obeid S, Hallit S. Validation of the Arabic version of the brief irritability test (Ar-BITe) in non-clinical adolescents. BMC Psychiatry 2023; 23:701. [PMID: 37752461 PMCID: PMC10521430 DOI: 10.1186/s12888-023-05211-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/22/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Despite the substantial clinical relevance of irritability in the development and maintenance of several mental disorders and its negative effects on functioning, no valid and reliable measures are available yet to identify the presence and consequences of irritability as a distinct construct among the Arabic-speaking populations. To bridge this gap, and help advance this field in the under-researched Arab region, we aimed to validate an Arabic-language version of the Brief Irritability Test (BITe). METHODS Eligible participants were native Arabic-speaking non-clinical adolescents from Lebanon; 527 participants aged 15.73 ± 1.81 years (56% females) completed the survey. RESULTS Utilizing the Confirmatory Factor Analysis approach, we found that the five items of the Arabic BITe loaded into a single factor structure. The scale showed excellent reliability, as both Cronbach's alpha and McDonald's omega coefficient values were of 0.88. Multi-group analyses showed invariance across sex groups in our sample at the configural, metric, and scalar levels. Female adolescents exhibited higher BITe scores than their male counterparts (14.01 vs. 13.25), but this difference did not reach the statistical significance. Good concurrent validity was supported based on positive correlations between irritability scores and measures of aggression, anger and hostility (r Pearson's coefficients ranging from 0.35 to 0.42), as well as positive correlations with insomnia symptoms scores. CONCLUSION The present findings allow us to conclude that the Arabic version of the BITe is a unidimensional, reliable, valid, brief, and economic self-report measure of the irritability construct for both male and female Arabic-speakers. Providing an Arabic validated version of the BITe will hopefully foster the research efforts of the Arab scientific community in this area, and promote the implementation of timely, evidence-informed and culturally-sensitive mental health interventions that appropriately address irritability-related problems and consequences among Arab young populations.
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Affiliation(s)
- Feten Fekih-Romdhane
- The Tunisian Center of Early Intervention in Psychosis, Department of psychiatry "Ibn Omrane", Razi hospital, Manouba, 2010, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Vanessa Azzi
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Rabih Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
- Department of Infectious Disease, Bellevue Medical Center, Mansourieh, Lebanon
- Department of Infectious Disease, Notre Dame des Secours, University Hospital Center, Byblos, Lebanon
| | - Diana Malaeb
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
| | - Mariam Dabbous
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Fouad Sakr
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
- École Doctorale Sciences de la Vie et de la Santé, Université Paris-Est Créteil, Institut Mondor de Recherche Biomédicale, Créteil, France
| | - Sahar Obeid
- Social and Education Sciences Department, School of Arts and Sciences, Lebanese American University, Jbeil, Lebanon.
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon.
- Psychology Department, College of Humanities, Effat University, Jeddah, 21478, Saudi Arabia.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.
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Sorcher LK, Mennies RJ, Robeson M, Seeley JR, Klein DN, Dougherty LR, Olino TM. Offspring irritability: associations with parental psychopathology and personality. Eur Child Adolesc Psychiatry 2023; 32:1691-1699. [PMID: 35416605 DOI: 10.1007/s00787-022-01985-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/02/2022] [Indexed: 12/01/2022]
Abstract
Although there are well-established correlates and outcomes of irritability, there are fewer studies reporting on predictors of the longitudinal course of irritability in youth. The current report examined parent internalizing and externalizing psychopathology and dimensions of personality as predictors of the developmental course of irritability in youth. Offspring irritability was assessed between ages 2 and 10 years using the Irritability Factor from the parent-reported Child Behavior Checklist (N = 570, 53.51% female). Parental psychopathology was assessed with a clinical interview; parents also completed the General Temperament Survey as a measure of personality. Results demonstrated that offspring irritability decreased with age. Offspring irritability was associated with parental depressive and anxiety disorders, higher levels of negative emotionality/neuroticism (NE) and disinhibition, and lower levels of positive emotionality; parental NE and disinhibition remained unique predictors of offspring irritability in a multivariate model. Finally, parental externalizing disorders were associated with more stable trajectories of offspring irritability, whereas offspring of parents without a history of externalizing disorders showed decreasing irritability across time. Findings demonstrate that different aspects of parental personality and psychopathology have differential impacts on levels and course of offspring irritability.
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Affiliation(s)
- Leah K Sorcher
- Department of Psychology, University of Maryland, College Park, MD, 20742, USA
| | - Rebekah J Mennies
- Department of Psychology, Temple University, Philadelphia, PA, 19122, USA
| | - Mackenzie Robeson
- Department of Psychology, University of Maryland, College Park, MD, 20742, USA
| | - John R Seeley
- Department of Special Education and Clinical Sciences, University of Oregon, Eugene, USA
| | - Daniel N Klein
- Department of Psychology, Stony Brook University, Stony Brook, USA
| | - Lea R Dougherty
- Department of Psychology, University of Maryland, College Park, MD, 20742, USA.
| | - Thomas M Olino
- Department of Psychology, Temple University, Philadelphia, PA, 19122, USA.
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Zhang Y, Silver JI, Perlman G, Kotov R, Klein DN, Eaton NR. Longitudinal Stability and Interrelations of Tonic and Phasic Irritability in Adolescent Girls. Res Child Adolesc Psychopathol 2023; 51:1343-1355. [PMID: 37155026 DOI: 10.1007/s10802-023-01072-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2023] [Indexed: 05/10/2023]
Abstract
Irritability is a transdiagnostic feature and a common mental health problem in adolescence. Prior studies indicate that irritability is composed of two correlated but separable dimensions, tonic irritability (i.e., irritable mood) and phasic irritability (i.e., temper outbursts), which are respectively associated with internalizing and externalizing outcomes. However, little is known about the stability and interrelations of tonic and phasic irritability. The current study examined the longitudinal interplay between tonic and phasic irritability during adolescence. A community sample of 544 girls (age 13.5-15.5 years) was assessed at 5 waves (over 3 years, in 9-month intervals). A random-intercept cross-lagged panel model was used to examine the within-person stability and longitudinal interrelations of tonic and phasic irritability. Pseudo-indicator models were used to help analyze all available data. Results suggest that tonic and phasic irritability had distinct patterns of development and co-development. Between individuals, tonic and phasic irritability showed moderate rank-order stability and high concurrent correlations. Within individuals, phasic irritability was found to positively predict both tonic and phasic irritability at the subsequent wave, whereas tonic irritability did not predict later phasic irritability and showed weaker within-person stability. These results suggest that increased or decreased phasic irritability in adolescent girls may signify continued increase or decrease in both tonic and phasic irritability. The study was among the first to demonstrate the discriminant validity of tonic and phasic irritability from a developmental perspective.
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Affiliation(s)
- Yinghao Zhang
- Department of Psychology, Stony Brook University, Stony Brook, NY, 11794, USA
| | - Jamilah I Silver
- Department of Psychology, Stony Brook University, Stony Brook, NY, 11794, USA
| | - Greg Perlman
- Department of Psychiatry, Stony Brook University, Stony Brook, USA
| | - Roman Kotov
- Department of Psychiatry, Stony Brook University, Stony Brook, USA
| | - Daniel N Klein
- Department of Psychology, Stony Brook University, Stony Brook, NY, 11794, USA
| | - Nicholas R Eaton
- Department of Psychology, Stony Brook University, Stony Brook, NY, 11794, USA
- Department of Psychiatry, Stony Brook University, Stony Brook, USA
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Mohamed Ali O, Vandermeer MRJ, Liu P, Joanisse MF, Barch DM, Hayden EP. Associations between childhood irritability and neural reactivity to maternal feedback in adolescence. Biol Psychol 2023; 182:108645. [PMID: 37596151 DOI: 10.1016/j.biopsycho.2023.108645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/16/2023] [Accepted: 07/16/2023] [Indexed: 08/20/2023]
Abstract
Early irritability, a transdiagnostic vulnerability for psychopathology, is associated with alterations in neural reactivity to emotional stimuli and reward; however, associations between childhood irritability and neural markers of risk may be mitigated by the quality of caregiving youth receive. We examined longitudinal relationships between irritability in childhood and young adolescents' neural activity of regions typically associated with emotion regulation and reward processing during processing of maternal feedback and tested whether these associations were moderated by youth's perceptions of the parent-child relationship quality. Eighty-one adolescents (Mage = 11.1 years) listened to maternal critical and praising feedback while undergoing functional magnetic resonance imaging. Age 3 irritability, assessed observationally, was negatively associated with age 11 neural reactivity to maternal criticism in a cluster in the right dorsolateral prefrontal cortex (dlPFC), particularly for youths who reported more positive maternal parenting. Given the role of the dlPFC activation in the effortful processing of emotional stimuli, decreased activation may reflect disengagement from negatively valenced interpersonal feedback in the context of a positive caregiving environment, thereby mitigating psychopathology risk associated with irritability.
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Affiliation(s)
- Ola Mohamed Ali
- Department of Psychology, Brain and Mind Institute, University of Western Ontario, London, ON N6A 5B7, Canada.
| | - Matthew R J Vandermeer
- Department of Psychology, Brain and Mind Institute, University of Western Ontario, London, ON N6A 5B7, Canada; St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada
| | - Pan Liu
- Department of Psychology, Brain and Mind Institute, University of Western Ontario, London, ON N6A 5B7, Canada; Department of Psychology, North Dakota State University, Fargo, ND 58102, USA
| | - Marc F Joanisse
- Department of Psychology, Brain and Mind Institute, University of Western Ontario, London, ON N6A 5B7, Canada
| | - Deanna M Barch
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Elizabeth P Hayden
- Department of Psychology, Brain and Mind Institute, University of Western Ontario, London, ON N6A 5B7, Canada
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Silver J, Bufferd SJ, Dougherty LR, Goldstein BL, Carlson GA, Klein DN. Is the distinction between tonic and phasic irritability meaningful in 3-year-old children? Eur Child Adolesc Psychiatry 2023; 32:1755-1763. [PMID: 35523899 DOI: 10.1007/s00787-022-01995-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/16/2022] [Indexed: 11/24/2022]
Abstract
Irritability encompasses both normative misbehavior in early childhood and clinically significant problems across development. Recent studies have distinguished between tonic (i.e., persistently angry or grumpy mood) and phasic (i.e., temper tantrums or outbursts) forms of irritability and shown that they have different implications for psychopathology and functioning. However, data on this distinction in young (i.e., preschool aged) children are nonexistent. We utilized data from a longitudinal study of a community sample of 462 3-year-olds followed to age 15. We conducted confirmatory factor analysis (CFA) using items from a diagnostic interview and several parent-report inventories and examined concurrent and prospective associations with clinically relevant variables. The CFA identified dimensions consistent with tonic and phasic irritability. Tonic irritability was independently associated with concurrent parent-reported temperamental negative affectivity and surgency, and depressive and oppositional defiant (ODD) disorders, and predicted higher rates of disruptive behavior disorders (DBD) and suicidal behavior in later childhood and adolescence. Phasic irritability was independently associated with concurrent laboratory observations of child impulsivity, parent-reported temperamental negative affectivity, surgency, and low effortful control, maladaptive parenting, and generalized anxiety disorder (GAD), attention-deficit hyperactivity disorder (ADHD), and ODD, but it did not predict later psychopathology. Tonic and phasic irritability are separable in 3-year-old children, but their correlates and outcomes are not as distinct as in older youth. This may reflect the greater difficulty characterizing normative and pathological irritability in the preschool period.
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Affiliation(s)
- Jamilah Silver
- Department of Psychology, Stony Brook University, Stony Brook, NY, 11794, USA.
| | | | | | | | | | - Daniel N Klein
- Department of Psychology, Stony Brook University, Stony Brook, NY, 11794, USA
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Tseng WL, Naim R, Chue A, Shaughnessy S, Meigs J, Pine DS, Leibenluft E, Kircanski K, Brotman MA. Network analysis of ecological momentary assessment identifies frustration as a central node in irritability. J Child Psychol Psychiatry 2023; 64:1212-1221. [PMID: 36977629 PMCID: PMC10615387 DOI: 10.1111/jcpp.13794] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Irritability presents transdiagnostically, commonly occurring with anxiety and other mood symptoms. However, little is known about the temporal and dynamic interplay among irritability-related clinical phenomena. Using a novel network analytic approach with smartphone-based ecological momentary assessment (EMA), we examined how irritability and other anxiety and mood symptoms were connected. METHODS Sample included 152 youth ages 8-18 years (M ± SD = 12.28 ± 2.53; 69.74% male; 65.79% White) across several diagnostic groups enriched for irritability including disruptive mood dysregulation disorder (n = 34), oppositional defiant disorder (n = 9), attention-deficit/hyperactivity disorder (n = 47), anxiety disorder (n = 29), and healthy comparisons (n = 33). Participants completed EMA on irritability-related constructs and other mood and anxiety symptoms three times a day for 7 days. EMA probed symptoms on two timescales: "since the last prompt" (between-prompt) versus "at the time of the prompt" (momentary). Irritability was also assessed using parent-, child- and clinician-reports (Affective Reactivity Index; ARI), following EMA. Multilevel vector autoregressive (mlVAR) models estimated a temporal, a contemporaneous within-subject and a between-subject network of symptoms, separately for between-prompt and momentary symptoms. RESULTS For between-prompt symptoms, frustration emerged as the most central node in both within- and between-subject networks and predicted more mood changes at the next timepoint in the temporal network. For momentary symptoms, sadness and anger emerged as the most central node in the within- and between-subject network, respectively. While anger was positively related to sadness within individuals and measurement occasions, anger was more broadly positively related to sadness, mood lability, and worry between/across individuals. Finally, mean levels, not variability, of EMA-indexed irritability were strongly related to ARI scores. CONCLUSIONS This study advances current understanding of symptom-level and temporal dynamics of irritability. Results suggest frustration as a potential clinically relevant treatment target. Future experimental work and clinical trials that systematically manipulate irritability-related features (e.g. frustration, unfairness) will elucidate the causal relations among clinical variables.
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Affiliation(s)
- Wan-Ling Tseng
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Reut Naim
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Amanda Chue
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Shannon Shaughnessy
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Jennifer Meigs
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Daniel S. Pine
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Ellen Leibenluft
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Katharina Kircanski
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Melissa A. Brotman
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
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Lee KS, Gau SSF, Tseng WL. Autistic Symptoms, Irritability, and Executive Dysfunctions: Symptom Dynamics from Multi-Network Models. J Autism Dev Disord 2023:10.1007/s10803-023-05981-0. [PMID: 37453959 DOI: 10.1007/s10803-023-05981-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 07/18/2023]
Abstract
Socio-cognitive difficulties in individuals with autism spectrum disorder (ASD) are heterogenuous and often co-occur with irritability symptoms, such as angry/grouchy mood and temper outbursts. However, the specific relations between individual symptoms are not well-represented in conventional methods analyzing aggregated autistic symptoms and ASD diagnosis. Moreover, the cognitive-behavioral mechanisms linking ASD to irritability are largely unknown. This study investigated the dynamics between autistic (Social Responsiveness Scale) and irritability (Affective Reactivity Index) symptoms and executive functions (Cambridge Neuropsychological Test Automated Battery) in a sample of children and adolescents with ASD, their unaffected siblings, and neurotypical peers (N = 345, aged 6-18 years, 78.6% male). Three complementary networks across the entire sample were computed: (1) Gaussian graphical network estimating the conditional correlations between symptom nodes; (2) Relative importance network computing relative influence between symptoms; (3) Bayesian directed acyclic graph estimating predictive directionality between symptoms. Networks revealed numerous partial correlations within autistic (rs = .07-.56) and irritability (rs = .01-.45) symptoms and executive functions (rs = -.83 to .67) but weak connections between clusters. This segregated pattern converged in all directed and supplementary networks. Plausible predictive paths were found between social communication difficulties to autism mannerisms and between "angry frequently" to "lose temper easily." Autistic and irritability symptoms are two relatively independent families of symptoms. It is unlikely that executive dysfunctions explain elevated irritability in ASD. Findings underscore the need for researching other mood and cognitive-behavioral bridge symptoms, which may inform individualized treatments for co-occurring irritability in ASD.
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Affiliation(s)
- Ka Shu Lee
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Susan Shur-Fen Gau
- Department of Psychiatry, National Taiwan University Hospital & College of Medicine, No. 7, Chung-Shan South Road, Taipei, 10002, Taiwan.
- Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan.
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Wan-Ling Tseng
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, USA
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45
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Yang R, Takarae Y, Adney H, Swineford C, Walker JC, Cheng P, Negash S, Wiggins JL. Neural correlates of irritability symptom relief in adolescents pre- and post-trauma-focused cognitive behavioral therapy: A pilot study on reward processing. Psychiatry Res Neuroimaging 2023; 332:111645. [PMID: 37087811 PMCID: PMC10901248 DOI: 10.1016/j.pscychresns.2023.111645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/23/2023] [Accepted: 04/13/2023] [Indexed: 04/25/2023]
Abstract
Despite that Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is a first-line, evidence-based treatment for youths experiencing trauma-related symptoms, treatment responses vary and it remains unclear for whom and how this treatment works. In this context, we examined pre-treatment neural reward processing and pre- vs. post-treatment changes in neural reward processing, in relation to irritability - a transdiagnostic and dimensional feature present in multiple trauma-related syndromes, following TF-CBT. Adolescents (N = 22) with childhood trauma history completed a child-friendly monetary incentive delay task during fMRI acquisition, prior to and after the treatment, and irritability symptoms were assessed at five time points over the course of the treatment. Individual irritability slopes (i.e., irritability change rate) and intercepts (i.e., initial irritability level), generated by linear growth curve modeling, were integrated with fMRI data. Repeated ANCOVAs demonstrated that both pre-treatment neural response to reward and pre- vs. post-treatment changes in neural reward processing correlated with irritability symptom relief, such that opposite baseline neural reward processing profiles and differential changing patterns were observed in individuals showing irritability symptom relief vs. not. Together, our findings provide proof of concept that integrating brain information with clinical information has the potential to identify predictors and mechanisms of symptom relief.
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Affiliation(s)
- Ruiyu Yang
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, United States; Department of Psychology, San Diego State University, United States.
| | - Yukari Takarae
- Department of Psychology, San Diego State University, United States
| | - Hailey Adney
- Department of Psychology, San Diego State University, United States
| | - Conner Swineford
- Department of Psychology, San Diego State University, United States
| | - Johanna C Walker
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, United States; Department of Psychology, San Diego State University, United States
| | - Philip Cheng
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Hospital, United States
| | - Sesen Negash
- Department of Counseling & School Psychology, San Diego State University, United States
| | - Jillian Lee Wiggins
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, United States; Department of Psychology, San Diego State University, United States
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46
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Losiewicz OM, Metts AV, Zinbarg RE, Hammen C, Craske MG. Examining the indirect contributions of irritability and chronic interpersonal stress on symptoms of anxiety and depression in adolescents. J Affect Disord 2023; 329:350-358. [PMID: 36863468 DOI: 10.1016/j.jad.2023.02.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Chronic interpersonal stress has been identified as predictive of anxiety and depression. However, more research is needed to understand predictors of chronic interpersonal stress and mediators of its relationship with anxiety and depression. Irritability, a transdiagnostic symptom closely related to chronic interpersonal stress, may provide more insight into this relationship. While some research has demonstrated that irritability is related to chronic interpersonal stress, directionality is unknown. A bidirectional relationship between irritability and chronic interpersonal stress was hypothesized, such that irritability mediates the relationship between chronic interpersonal stress and internalizing symptoms and chronic interpersonal stress mediates the relationship between irritability and internalizing symptoms. METHODS This study used three cross-lagged panel models to investigate the indirect effects of irritability and chronic interpersonal stress on anxiety and depression symptoms using data from 627 adolescents (68.9 % female, 57.7 % white) over a six-year period. RESULTS In partial support for our hypotheses, we found that the relationships between chronic interpersonal stress and both fears and anhedonia were mediated by irritability, and that the relationship between irritability and anhedonia was mediated by chronic interpersonal stress. LIMITATIONS Study limitations include some temporal overlap in symptom measurements, an irritability measure that has not been previously validated to measure the construct, and lack of a lifespan perspective. CONCLUSIONS More targeted approaches in intervention for both chronic interpersonal stress and irritability may improve prevention and intervention efforts to address anxiety and depression.
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Affiliation(s)
- Olivia M Losiewicz
- University of California, Department of Psychology, 1285 Franz Hall, Los Angeles, CA 90025, USA
| | - Allison V Metts
- University of California, Department of Psychology, 1285 Franz Hall, Los Angeles, CA 90025, USA
| | - Richard E Zinbarg
- Northwestern University, Department of Psychology, 2029 Sheridan Road, Swift Hall 102, Evanston, IL 60208, USA; The Family Institute, Northwestern University, Evanston, IL, USA
| | - Constance Hammen
- University of California, Department of Psychology, 1285 Franz Hall, Los Angeles, CA 90025, USA
| | - Michelle G Craske
- University of California, Department of Psychology, 1285 Franz Hall, Los Angeles, CA 90025, USA.
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Qi A, Jiao L, Zhang Y, Zhou H, He Y, Gong Y, Xu L, Bi L. Irritability and risk of lung cancer: a Mendelian randomization and mediation analysis. J Cancer Res Clin Oncol 2023:10.1007/s00432-023-04791-2. [PMID: 37103569 DOI: 10.1007/s00432-023-04791-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 04/15/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND There is no research to prove the association between irritability and lung cancer, our study performed a Mendelian randomization (MR) approach to elucidate the causal relationship of irritability with lung cancer risk. METHODS Genome-wide association studies (GWAS) data of irritability, lung cancer and gastroesophageal reflux disease (GERD) were downloaded from a public database for two-sample MR analysis. Independent single-nucleotide polymorphisms (SNPs) associated with irritability and GERD were selected as instrumental variables (IVs). Inverse variance weighting (IVW) and weighted median method were used to analyze causality. RESULTS There is an association between irritability and lung cancer risk (ORIVW = 1.01, 95% CI = [1.00, 1.02], P = 0.018; ORweighted median = 1.01, 95% CI = [1.00, 1.02], P = 0.046), and GERD might account for about 37.5% of the association between irritability and lung cancer. CONCLUSIONS This study confirmed the causal effect between irritability and lung cancer through MR analysis, and found that GERD played an essential mediating role in this relationship, which can partly indicate the role of the "inflammation-cancer transformation" process in lung cancer.
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Affiliation(s)
- Ao Qi
- Department of Oncology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lijing Jiao
- Department of Oncology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Cancer Institute of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yilu Zhang
- Department of Oncology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Huiling Zhou
- Department of Oncology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yiyun He
- Department of Oncology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yabin Gong
- Department of Oncology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Translational Cancer Research for integrated Chinese and Western Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ling Xu
- Department of Oncology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
- Cancer Institute of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
- Institute of Translational Cancer Research for integrated Chinese and Western Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
| | - Ling Bi
- Department of Oncology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
- Cancer Institute of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
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48
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Yan M, Clarkson T, Walker JC, Alam T, Brock P, Kirk N, Wiggins JL, Jarcho JM. Neural correlates of peer evaluation in irritable adolescents: Linking anticipation to receipt of social feedback. Biol Psychol 2023; 179:108564. [PMID: 37061084 DOI: 10.1016/j.biopsycho.2023.108564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 04/03/2023] [Accepted: 04/12/2023] [Indexed: 04/17/2023]
Abstract
Elevated irritability during adolescence predicts mental health issues in adulthood. Social interactions commonly elicit symptoms of irritability. Prior research has traditionally examined neural activity during the anticipation of, and immediate reaction to, social feedback separately in irritable adolescents. However, studies suggest that irritable adolescents demonstrate altered brain activation when anticipating feedback, and these alterations may have downstream effects on the neural activity when actually presented with feedback. Thus, the goal of this study was to characterize the influence of irritability on the relationship between brain function during anticipation and receipt of social feedback. We leveraged the Virtual School task to mimic social interactions using dynamic stimuli. Parallel region of interest (ROI) analyses tested effects of anticipatory bilateral amygdala (or dorsal anterior cingulate cortex; dACC) activation on the dACC (or bilateral amygdala) activation during receipt of peer feedback. Parallel exploratory whole-brain analyses were conducted to identify the effects of anticipatory bilateral amygdala or dACC activation on other regions during receipt of peer feedback. In ROI analyses, more vs. less irritable adolescents showed distinct relationships between anticipatory bilateral amygdala activation and dACC activation when receiving predictably mean feedback. Across both whole-brain analyses, anticipatory bilateral amygdala and dACC activation were separately associated with activation in socioemotional regions of the brain during subsequent feedback. These relationships were modulated by irritability, and the valence and predictability of the feedback. This suggests that irritable adolescents may engage in altered emotion processing and regulation strategies, depending on the valence and predictability of social feedback.
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Affiliation(s)
- M Yan
- Department of Psychology, San Diego State University, San Diego, CA 92120, United States of America
| | - T Clarkson
- Department of Psychology, Temple University, Philadelphia, PA 19122, United States of America
| | - J C Walker
- Department of Psychology, San Diego State University, San Diego, CA 92120, United States of America; Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA 92120, United States of America
| | - T Alam
- Department of Psychology, San Diego State University, San Diego, CA 92120, United States of America
| | - P Brock
- San Diego State University Research Foundation, San Diego, CA 92182, United States of America
| | - N Kirk
- San Diego State University Research Foundation, San Diego, CA 92182, United States of America
| | - J L Wiggins
- Department of Psychology, San Diego State University, San Diego, CA 92120, United States of America; Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA 92120, United States of America
| | - J M Jarcho
- Department of Psychology, Temple University, Philadelphia, PA 19122, United States of America
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Mallidi A, Meza-Cervera T, Kircanski K, Stringaris A, Brotman MA, Pine DS, Leibenluft E, Linke JO. Robust caregiver-youth discrepancies in irritability ratings on the affective reactivity index: An investigation of its origins. J Affect Disord 2023; 332:185-193. [PMID: 37030330 PMCID: PMC10170868 DOI: 10.1016/j.jad.2023.03.091] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/03/2023] [Accepted: 03/29/2023] [Indexed: 04/10/2023]
Abstract
OBJECTIVE The Affective Reactivity Index (ARI) is widely used to assess young people's irritability symptoms, but youth and caregivers often diverge in their assessments. Such informant discrepancy might be rooted in poor psychometric properties, the differential conceptualization of irritability across informants, or reflect sociodemographic and clinical characteristics. We use an out-of-sample replication approach and leverage longitudinal data, available for a subset of the participants, to test these hypotheses. METHOD Across two independent samples (NCohort-1 = 765, 8-21 years; NCohort-2 = 1910, 6-21 years), we investigate the reliability and measurement invariance of the ARI, examine sociodemographic and clinical predictors of discrepant reporting and probe the utility of a bifactor model for cross-informant integration. RESULTS Despite good internal consistency and 6-week-retest-reliability of parent (Cohort-1: α = 0.92, ICC = 0.85; Cohort-2: α = 0.93) and youth forms (Cohort-1: α = 0.88, ICC = 0.78; Cohort-2: α = 0.82), we confirm substantial informant discrepancy in ARI ratings (3 points on a scale from 0 to 12), which is stable over six weeks (ICC = 0.53). Measurement invariance across informants was weak, indicating that parents and youth may interpret ARI items differently. Irritability severity and diagnostic status predicted informant-discrepancy, albeit in opposing directions: higher severity was linked to relative, higher irritability-ratings by youth (Cohort-1: β = -0.06, p < .001; Cohort-2: β = -0.06, p < .001), while diagnoses of Disruptive Mood Dysregulation Disorder (Cohort-1: β = 0.44, p < .001; Cohort-2: β = 0.84, p < .001) and Oppositional Defiant Disorder (Cohort-1: β = 0.41, p < .001; Cohort-2: β = 0.42, p < .001) predicted relative higher irritability-ratings by caregivers. In both datasets, a bifactor model parsing informant-specific from shared irritability-related variance fit the data well (CFI = 0.99, RMSEA = 0.05; N2: CFI = 0.99; RMSEA = 0.04). CONCLUSION Parent and youth ARI reports and their discrepancy are reliable and reflect different interpretations of the scale items; hence they should not be averaged. This finding also suggests that irritability is not a unitary construct. Future work should investigate and model how different aspects of irritability might differ in their impact on the responses of specific informants.
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Affiliation(s)
- Ajitha Mallidi
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States of America
| | - Tatiana Meza-Cervera
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States of America
| | - Katharina Kircanski
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States of America
| | - Argyris Stringaris
- Divisions of Psychiatry and Psychology and Language Sciences, University College London, United Kingdom
| | - Melissa A Brotman
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States of America
| | - Daniel S Pine
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States of America
| | - Ellen Leibenluft
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States of America
| | - Julia O Linke
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States of America.
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50
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Li S, Mu X, Ma S, Li X, Gao J, Liu X, Wang H, Wu J, Guo Y, Song C. Xiangshao Granules reduce the aggressive behavior and hippocampal injury of premenstrual irritability in rats by regulating JIK/JNK/p38 signal pathway. J Ethnopharmacol 2023; 305:116061. [PMID: 36577489 DOI: 10.1016/j.jep.2022.116061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/17/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE As a typical prescription for soothing the liver, Xiangshao granule has a good effect on the symptoms of irritability and anxiety. Clinical evidence suggests that it has significant efficacy in the treatment of Premenstrual dysphoria disorder (PMDD). However, the underlying mechanism remains unclear. AIM OF THE STUDY PMDD is a common disease in women of childbearing age, seriously affecting their family, society, and daily work life. The registered herbal medicine, Xiangshao granules, is used for relieving PMDD dysphoria and irritability symptoms with excellent efficacy in China. This study was focused on the deep intervention mechanism of Xiangshao granules in treating PMDD. MATERIALS AND METHODS The vaginal smear and open field test were used to screen rats in nonreception phase of estrus cycle with similar macroscopic behaviors and regular estrus cycle. The rat model of PMDD irritability was established through social isolation and residential invasion, with which, the irritability symptoms of PMDD patients with menstrual cycle dependence was also well simulated. Elevated plus Maze Test and Social interaction activities were used to measure the anxiety-like behavior of rats. TUNEL Staining and Hematoxylin-Eosin staining were used to measure apoptosis of hippocampal neurons. RT-PCR, Western blot and immunofluorescence were used to measure the expression of GR, JIK, p-JIK, p38, P-P38, JNK, caspase 3, and caspase 12. RESULTS In this study, Xiangshao granules showed consistent therapeutic effects similar with those in clinic, significantly reducing aggressive and anxiety-like behaviors with improved social skills in PMDD rats. In mechanism, Xiangshao granules lowered the apoptosis of hippocampal neurons and weakened the morphological damage of the hippocampal brain evidenced by the decreased mRNA and protein expression of glucocorticoid receptor, caspase-3, and caspase-12. In addition, administration of Xiangshao granules led to the decreased expression of JIK in the PMDD irritability rat model which agreed well with the previous studies. The JNK/p38 mitogen-activated protein kinases (MAPKs) signaling pathway is abnormally activated in the hippocampal brain region of PMDD rats, while treated with Xiangshao granules could increase JIK expression and inhibit the abnormal activation of the JNK/p38 MAPK signaling pathway, effectively reducing the stress damage in the hippocampus. CONCLUSIONS Xiangshao Granules Reduce the Aggressive Behavior and Hippocampal Injury of Premenstrual Irritability in Rats by Regulating JIK/JNK/p38 Signal Pathway.
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Affiliation(s)
- Shujing Li
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China.
| | - Xiangyu Mu
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China.
| | - Sufen Ma
- Academic Administration, Shandong University of Traditional Chinese Medicine, Jinan, China.
| | - Xin Li
- Department of Pharmacology & Chemical Biology, Baylor College of Medicine, Houston, TX, USA.
| | - Jie Gao
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China.
| | - Xiaoju Liu
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China.
| | - Haijuan Wang
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.
| | - Junling Wu
- Department of Science and Technology, Shandong University of Traditional Chinese Medicine, Jinan, China.
| | - Yinghui Guo
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China.
| | - Chunhong Song
- Shandong Key Laboratory of Traditional Chinese Medicine and Stress Injury, Department of Laboratory Animal Center, Central Hospital Affiliated to Shandong First Medical University, Jinan, China.
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