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Abstract
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Aims: Correct classification of irritability is extremely important to assess prognosis and treatment indications of juvenile mood disorders. We conducted the present study to characterize differences in the expression of irritability in both unipolar and bipolar mood disorders in children and adolescents.
Methods: We assessed factors associated with Parent and Youth rated irritability using the Affective Reactivity Index rating scale (respectively PARI and YARI) in a sample of 289 adolescents diagnosed with a bipolar or a major depressive disorder. Association of categorical variables were tested with Pearson or Fisher test, as appropriate. Correlation between continuous variables was tested with Pearson correlation. Bivariate analyses were followed by multivariable linear regression models.
Results: Correlation between PARI and YARI score was moderate (r=0.40; p < 0.001). PARI score was significantly greater in subjects with bipolar vs unipolar disorders (5.61 vs 4.63; p=0.029). Correlation with the ARI impairment item was r=0.655 for PARI and r=0.470 for YARI (p > 0.001). Factors significantly and independently associated with PARI score in a linear regression model were a] hypomanic or mixed features at index mood episode, b] parent rated emotional dysregulation with Child Behavior Checklist (CBCL), and c] clinician rated general functioning with Clinical Global Assessment Scale. Factors significantly and independently associated with YARI score in a linear regression model were a] current or lifetime history of non-suicidal self-injury, b] clinician rated hypomanic symptoms with K-SADS Mania Rating Scale, c] parent rated overall behavioral and emotional problems with CBCL, and d] self-rated depressive symptoms with Children Depression Inventory.
Conclusions: High parent-rated irritability was significantly correlated with diagnosis of bipolar versus unipolar mood disorder and mixed symptoms. High youth-rated irritability was significantly correlated with non-suicidal self-injury, self-rated depressive symptoms and clinician rated mixed symptoms. Parent and self-rated irritability differently correlated with relevant psychopathological features, subtending different qualitative and quantitative aspects of irritability, with implications for early diagnosis of pediatric bipolar disorder.
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