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Cited by 22Bipolar Disorder and TreatmentSchizophrenia research and treatmentPersonality Disorders and Psychopathology

Impact of irritability: a 2‐year observational study of outpatients with bipolar I or schizoaffective disorder

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Berk, Lesley, Hallam, Karen T, Venugopal, Kamalesh, Lewis, Andrew James, Austin, David W, Kulkarni, Jayashri, Dodd, Seetal, de Castella, Anthony +2 more·2017·Bipolar Disorders
DOI 10.1111/bdi.12486
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Abstract

Objectives: Many people experience irritability when manic, hypomanic, or depressed, yet its impact on illness severity and quality of life in bipolar and schizoaffective disorders is poorly understood. This study aimed to examine the relationship between irritability and symptom burden, functioning, quality of life, social support, suicidality, and overall illness severity in a naturalistic cohort of people with bipolar I or schizoaffective disorder. Methods: We used data from 239 adult outpatients with bipolar I or schizoaffective disorder in the Bipolar Comprehensive Outcomes Study (BCOS) – a non‐interventional observational study with a 2‐year follow‐up period. Baseline demographic and clinical characteristics of participants with and without irritability were compared. A mixed‐model repeated measures analysis was conducted to examine the longitudinal effect of irritability on clinical and quality‐of‐life variables over follow‐up using significant baseline variables. Results: At baseline, 54% of participants were irritable. Baseline irritability was associated with illness severity, mania, depression, psychotic symptoms, suicidality, poor functioning, and quality of life, but not diagnosis (schizoaffective/bipolar disorder). Participants with irritability were less likely to have a partner and perceived less adequate social support. On average, over follow‐up, those with irritability reported more symptoms, functional impairment, and suicidality. Furthermore, the effects of irritability could not be fully explained by illness severity. Conclusions: Irritability was associated with more negative symptomatic, functional, and quality‐of‐life outcomes and suicidality. The identification, monitoring, and targeted treatment of irritability may be worth considering, to enhance health and wellbeing outcomes for adults with bipolar and schizoaffective disorders.

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  • There remains controversy around the inclusion of irritability, which is a far more non-specific phenomenon with much overlap with disorders such as ADHD, conduct disorder, and personality disorders.

    “There remains controversy around the inclusion of irritability, which is a far more non-specific phenomenon with much overlap with disorders such as ADHD, conduct disorder, and personality disorders [38].”

    From Mental, behavioral and neurodevelopmental disorders in the ICD-11: an international perspective on key changes and controversies (2020) · cites this paper as [38]

    The Introduction describes irritability as transdiagnostic and non-specific. The Comorbidity section says personality disorders may involve irritability and discusses conduct problems, but it does not establish overlap with ADHD or specifically describe controversy over irritability’s inclusion. Page numbers are unavailable in our copy. (LLM, conf=0.84)

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  1. I. Conceptual framework and item selection. Medical care. 1992; 30:473-83.
  2. Berk, L., Hallam, K. T., Venugopal, K., Lewis, A. J., Austin, D. W., Kulkarni, J., Dodd, S., de Castella, A., Fitzgerald, P. B. & Berk, M. (2017). Impact of irritability: a 2-year observational study of outpatients with bipolar I or schizoaffective disorder. BIPOLAR DISORDERS, 19 (3), pp.184-197. https://doi.org/10.1111/bdi.12486. Persistent Link: http://hdl.handle.net/11343/292837

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Authors
Berk, L., Hallam, K. T., Venugopal, K., Lewis, A. J., Austin, D. W., Kulkarni, J., Dodd, S., de Castella, A., Fitzgerald, P. B., & Berk, M.
Affiliations
  • Barwon Health (AU)
  • The University of Melbourne (AU)
  • SA Health (AU)
  • Murdoch University (AU)
  • Deakin University (AU)
  • The Alfred Hospital (AU)
  • Monash Alfred Psychiatry Research Centre (MAPrc) Monash University Central Clinical School and The Alfred Melbourne Vic. Australia
Corresponding author
Berk, Lesley
ORCID
Venue
Bipolar Disorders
Publisher
Wiley
Published
2017-05
Volume
19
Issue
3
Pages
184-197
ISSN
  • 1398-5647 (ISSN-L)
  • 1399-5618
DOI
10.1111/bdi.12486
OpenAlex
W2611493211
Cited by
22
References
109
Citations by year
2026: 1 · 2025: 1 · 2024: 2 · 2023: 4 · 2021: 4 · 2020: 6 · 2019: 2 · 2018: 2
FWCI
2.25
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor, 2 d)
Locations
  • Bipolar Disorders (publishedVersion)
  • PubMed (publishedVersion)
  • Murdoch University Research Portal (submittedVersion)
  • Figshare (submittedVersion, cc-by)
  • Figshare (submittedVersion)
  • Minerva Access (University of Melbourne) (submittedVersion)
Funders
  • National Health and Medical Research Council (1059660, 606907)
  • National Institutes of Health
  • Geelong Region Medical Research Foundation
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
Keywords
irritability, bipolar I disorder, schizoaffective disorder, disease severity, quality of life, suicidality, functional disability, social support, psychotic symptoms, mania, depression, symptom burden
MeSH terms
Activities of Daily Living, Adult, Australia, Bipolar Disorder, Female, Humans, Irritable Mood, Male, Middle Aged, Outpatients, Psychotic Disorders, Quality of Life, Severity of Illness Index, Social Support, Cohort Studies, Outcome Assessment, Health Care, Cost of Illness, Diagnostic and Statistical Manual of Mental Disorders, Suicidal Ideation

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