The Status of Irritability in Psychiatry: A Conceptual and Quantitative Review.
The Status of Irritability in Psychiatry: A Conceptual and Quantitative Review.
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DOI：
10.1016/j.jaac.2016.04.014
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发表时间：
2016-07
影响因子：
13.3
通讯作者：
Stringaris A
中科院分区：
文献类型：
--
作者：
Vidal-Ribas P;Brotman MA;Valdivieso I;Leibenluft E;Stringaris A
近年来，对易激惹的研究和临床兴趣一直在上升。然而，关于烦躁在精神病学中的地位仍然存在一些问题，包括烦躁是否可以与其他症状区分开来，它是否形成一种独特的疾病，以及它是否是临床结果的有意义的预测因子。在本文中，我们试图通过回顾有关如何可靠地测量烦躁性及其有效性的证据来回答这些问题。我们将叙述性、系统性的回顾以及研究的荟萃分析结合起来。为了进行系统评价和荟萃分析，我们根据预先选定的标准在 PubMed 和 Web of Science 中检索了研究。总共审阅了 163 篇文章，纳入了 24 篇文章。我们发现，烦躁形成了一个独特的维度，随着时间的推移具有很大的稳定性，并且在纵向研究中它与抑郁和焦虑特别相关。遗传学研究的证据表明，易怒具有一定程度的遗传性，其与抑郁症的重叠主要是由遗传因素解释的。行为和神经影像学研究表明，与年龄匹配的健康志愿者相比，持续烦躁的青少年杏仁核、纹状体和额叶区域的激活发生了改变。大多数关于治疗烦躁的知识都是基于治疗对相关病症的影响或试验数据的事后分析。我们确定了许多研究重点，包括创新的实验设计和治疗研究的重点，最后为研究人员和临床医生提出了评估烦躁性的建议。
Research and clinical interest in irritability have been on the rise in recent years. Yet several questions remain about the status of irritability in psychiatry, including whether irritability can be differentiated from other symptoms, whether it forms a distinct disorder, and whether it is a meaningful predictor of clinical outcomes. In this article, we try to answer these questions by reviewing the evidence on how reliably irritability can be measured and its validity. We combine a narrative and systematic review and meta-analysis of studies. For the systematic review and meta-analysis, we searched studies in PubMed and Web of Science based on preselected criteria. A total of 163 articles were reviewed, and 24 were included. We found that irritability forms a distinct dimension with substantial stability across time, and that it is specifically associated with depression and anxiety in longitudinal studies. Evidence from genetic studies reveals that irritability is moderately heritable, and its overlap with depression is explained mainly by genetic factors. Behavioral and neuroimaging studies show that youth with persistent irritability exhibit altered activations in the amygdala, striatum, and frontal regions compared with age-matched healthy volunteers. Most knowledge about the treatment of irritability is based on effects of treatment on related conditions or post hoc analyses of trial data. We identify a number of research priorities including innovative experimental designs and priorities for treatment studies, and conclude with recommendations for the assessment of irritability for researchers and clinicians.