Overt Irritability/Anger in Unipolar Major Depressive Episodes Past and Current Characteristics and Implications for Long-term Course
Overt Irritability/Anger in Unipolar Major Depressive Episodes Past and Current Characteristics and Implications for Long-term Course
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DOI：
10.1001/jamapsychiatry.2013.1957
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发表时间：
2013-11-01
期刊：
影响因子：
25.8
通讯作者：
Fiedorowicz, Jess G.
中科院分区：
文献类型：
--
作者：
Judd, Lewis L.;Schettler, Pamela J.;Fiedorowicz, Jess G.
虽然易怒或愤怒的症状不是单极重性抑郁发作（MDEs）诊断的核心，但在横断面研究中发现，这些症状非常普遍，并与增加的合并症和抑郁症负担相关。目的了解公开表达易怒/愤怒的患病率及其对摄入表现和长期病程的影响。设计：对单极MDEs患者进行前瞻性、自然的调查，系统地研究了入院时和长达31年的随访。5个美国学术医疗中心。患者在1978年、1979年、1980年或1981年的MDE期间进入国家精神卫生研究所合作抑郁症研究。服药时患有单极MDE的患者（n = 536）分为有和没有当前共病的明显表达烦躁/愤怒的患者。在这项观察性的纵向研究中，患者接受的治疗是有记录的，但没有控制。主要结局和测量组比较疾病严重程度和慢性程度、社会心理障碍、生活质量、自杀行为、终生共病诊断、冲动控制和与双相情感障碍相关的测量。结果：536名单极MDE参与者中有292名（54.5%）在研究开始时出现明显的易怒/愤怒。它与显著增加的抑郁严重程度、更长的MDE指数持续时间、更差的冲动控制、更慢性和更严重的长期病程、更高的终生共病药物滥用和焦虑症发生率、更多的反社会人格障碍、更大的心理社会障碍在摄入前和随访期间、更低的生活满意度以及亲属中更高的双相情感障碍发生率相关。没有发现与自杀意念或行为增加有关。结果不能用合并症或其他躁狂症状来解释。结论和相关性本研究扩展了横断面调查的结果，表明MDEs期间的易怒/愤怒是一种更严重、慢性和复杂的抑郁症的高度普遍的临床标志。研究结果对评估和治疗具有重要意义。
IMPORTANCE Although symptoms of irritability or anger are not central to the diagnosis of unipolar major depressive episodes (MDEs), these symptoms have been found, in cross-sectional studies, to be highly prevalent and associated with increased comorbidity and depressive illness burden.OBJECTIVE To determine the prevalence of overtly expressed irritability/anger and its effect on intake presentation and the long-term course of illness.DESIGN A prospective, naturalistic investigation of patients with unipolar MDEs, studied systematically at intake and during up to 31 years of follow-up.SETTING Five US academic medical centers.PARTICIPANTS Patients entered the National Institute of Mental Health Collaborative Depression Study during an MDE in 1978, 1979, 1980, or 1981. Patients with unipolar MDE at intake (n = 536) were divided into those with and those without current comorbid overtly expressed irritability/anger.EXPOSURE In this observational, longitudinal study, patients received treatment that was recorded but not controlled.MAIN OUTCOMES AND MEASURES Groups were compared on illness severity and chronicity, psychosocial impairment, quality of life, suicidal behavior, lifetime comorbid diagnoses, impulse control, and measures associated with bipolarity.RESULTS Overt irritability/anger was present in 292 of 536 participants with a unipolar MDE at study intake (54.5%). It was associated with significantly increased depressive severity, longer duration of the index MDE, poorer impulse control, a more chronic and severe long-term course of illness, higher rates of lifetime comorbid substance abuse and anxiety disorder, more antisocial personality disorders, greater psychosocial impairment before intake and during follow-up, reduced life satisfaction, and a higher rate of bipolar II disorder in relatives. No association was found with increased suicidal ideation or behavior. Results were not explained by comorbidity or other manic spectrum symptoms.CONCLUSIONS AND RELEVANCE This study extends results of cross-sectional investigations and indicates that irritability/anger during MDEs is a highly prevalent clinical marker of a more severe, chronic, and complex depressive illness. Findings have important implications for assessment and treatment.