Clinical Utility of Measuring Irritability in Adults with Psychiatric Disorders
Dr. Manish Jha is an Associate Professor of Psychiatry at the Center for Depression Research and Clinical Care (CDRC) and O’Donnell Clinical Neuroscience Scholar at UT Southwestern Medical Center, Dallas, TX. Prior to joining UT Southwestern, he was an Assistant Professor of Psychiatry and Neuroscience, and the Assistant Director of Depression and Anxiety Center at Icahn School of Medicine at Mount Sinai. He has substantial expertise in the conduct of clinical trials, extensive clinical experience in providing care to patients with treatment-refractory psychiatric illnesses, and a deep commitment to psychiatric neuroscience and patient-oriented research. His research has focused on developing novel interventions for psychiatric disorders and bringing these scientific discoveries to clinical practice. He has authored/co-authored over 140 manuscripts.
Learning objectives
1. Identify the long-term consequences of elevated irritability in patients with psychiatric disorders.
2. Implement a measurement-based care approach that assesses irritability to inform clinical decision-making.
Irritability and related constructs such as anger attacks are often overlooked as features of psychiatric disorders in adults. In fact, irritability is considered as one of the criterion symptoms of major depressive episode in children and adolescents but not in adults.
Yet, epidemiological studies have shown that 40-50% of adults with major depressive disorder report significant irritability. Similarly, 35-50% of adults with mood and anxiety disorders experience anger attacks which are situationally-inappropriate sudden bouts of anger that are accompanied by autonomic arousal and/or aggression.
Work from our group and others have shown that the presence of irritability is associated with poorer long-term outcomes such as lower quality of life, persistently elevated suicidal ideation, and lower likelihood of symptomatic remission.
The goal of the proposed presentation is to provide clinicians with knowledge and tools that will allow them to optimally manage irritability in their patients and to engage researchers in systematically studying irritability and related constructs.
In the proposed session, I will
(1) describe the symptoms and behaviors that are associated with irritability;
(2) review the prevalence of these features in individuals suffering from common psychiatric disorders;
(3) present recent data on the clinical consequences of irritability on key illness features;
(4) discuss strategies to utilize measures of irritability in guiding clinical decision-making;
(5) and evaluate the efficacy of currently available drugs in improving irritability.
Educating the attendees about irritability has the potential to inform their research and clinical practice and to improve the clinical outcomes of their patients.
Two scientific citations
1. Jha, M.K., Minhajuddin, A., South, C., Rush, A.J., Trivedi, M.H., 2019. Irritability and Its Clinical Utility in Major Depressive Disorder: Prediction of Individual-Level Acute-Phase Outcomes Using Early Changes in Irritability and Depression Severity. The American Journal of Psychiatry 176, 358-366
2. Jha, M.K., Minhajuddin, A., Fatt, C.C., Kircanski, K., Stringaris, A., Leibenluft, E., Trivedi, M., 2020. Association between irritability and suicidal ideation in three clinical trials of adults with major depressive disorder. Neuropsychopharmacology 45(13), 2147-2154.