Article

Adult Outcomes of Youth Irritability: A 20-Year Prospective Community-Based Study

Section on Bipolar Spectrum Disorders, Emotion and Development Branch, Mood and Anxiety Program, NIMH Bldg. 15K, MSC-2670, Bethesda, MD 20892-2670,USA.
American Journal of Psychiatry (Impact Factor: 12.3). 08/2009; 166(9):1048-54. DOI: 10.1176/appi.ajp.2009.08121849
Source: PubMed

ABSTRACT

Irritability is a widely occurring DSM-IV symptom in youths. However, little is known about the relationship between irritability in early life and its outcomes in mid-adulthood. This study examines the extent to which youth irritability is related to adult psychiatric outcomes by testing the hypothesis that it predicts depressive and generalized anxiety disorders.
The authors conducted a longitudinal community-based study of 631 participants whose parents were interviewed when participants were in early adolescence (mean age=13.8 years [SD=2.6]) and who were themselves interviewed 20 years later (mean age=33.2 years [SD=2.9]). Parent-reported irritability in adolescence was used to predict self-reported psychopathology, assessed by standardized diagnostic interview at 20-year follow-up.
Cross-sectionally, irritability in adolescence was widely associated with other psychiatric disorders. After adjustment for baseline emotional and behavioral disorders, irritability in adolescence predicted major depressive disorder (odds ratio=1.33, 95% confidence interval [CI]=1.00-1.78]), generalized anxiety disorder (odds ratio=1.72, 95% CI=1.04-2.87), and dysthymia (odds ratio=1.81, 95% CI=1.06-3.12) at 20-year follow-up. Youth irritability did not predict bipolar disorder or axis II disorders at follow-up.
Youth irritability as reported by parents is a specific predictor of self-reported depressive and anxiety disorders 20 years later. The role of irritability in developmental psychiatry, and in the pathophysiology of mood and anxiety disorders specifically, should receive further study.

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Available from: Daniel S Pine, Dec 16, 2013
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    • "DMDD at age six also predicted a greater likelihood of using psychological (outpatient psychosocial and pharmacological) and educational services, and the association with later educational services persisted after accounting for all age six psychiatric disorders. The link between DMDD and academic problems is consistent with longitudinal findings demonstrating that DMDD and chronic irritability in older youth predicted lower educational attainment in adults (Copeland et al., 2014;Stringaris et al., 2009). Studies have found that children with SMD perform poorly on tasks of cognitive flexibility (Adleman et al., 2011;Leibenluft & Stoddard, 2013); this may contribute to the educational problems observed in children with DMDD. "
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    • "Second, as will also be detailed below, youth with chronic irritability have deficits in labeling face emotions. Finally, chronic, severe irritability in youth shares concurrent, longitudinal, and genetic associations with depression and anxiety (Brotman et al. 2006; Stringaris et al. 2009; Leibenluft 2011; Copeland et al. 2014; Stringaris et al. 2014; Savage et al. 2015) for which interpretation biases of ambiguous cues are established targets for cognitive bias modification training (Hallion and Ruscio 2011; MacLeod and Mathews 2012). HIB has been associated with irritability-related phenomena such as dispositions toward anger (Wilkowski and Robinson 2010) and verbally or physically aggressive reactions (Crick and Dodge 1996; Orobio de Castro et al. 2002). "
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