Irritability characteristics and parameters in an international sample.

BACKGROUND: Irritability is a symptom of fifteen psychiatric disorders and is widely known to scholars and the public. However, little is known about irritability as an individual construct. The purpose of the current study is to identify conceptualizations of specific characteristics of irritability. METHODS: In this study, 402 participants from 10 countries answered nine qualitative questions about their personal causes, experience, and consequences of irritability as well as how they perceived the relationship between irritability and anger. They also answered three quantitative questions about the frequency, intensity, and duration of their irritability. RESULTS: Results indicated that 99.3% of participants reported a lifetime incidence of irritability. On average, participants reported feeling irritable approximately one to two times per week for 30 min with an intensity that was somewhat bothersome. Women reported feeling irritable for a longer duration than men, and residents of China, Singapore, and the USA generally reported having a longer duration than residents of Ireland and the UK. Some themes that appeared unique to irritability were the physiological/biological/internal aspects of irritability and treatments that address emotional and physiological coping such as relaxation and recreation. LIMITATIONS: Many participants equated irritability with anger, and generalizations by countries should be interpreted with caution due to a small sample within each country. CONCLUSIONS: These findings support the conceptualization of irritability as a universal construct. It is recommended that future research continue to explore irritability to better help understand it as an independent construct in the context of diagnosis, assessment, research, and treatment.

Defining and measuring irritability: Construct clarification and differentiation.

Irritability is a symptom of 15 disorders in the DSM-5 and is included in Mood Disorders, Addictive Disorders, Personality Disorders, and more (American Psychiatric Association, 2013). However, the term irritability is defined and measured inconsistently in the scholarly literature. In this article, we reviewed the scholarly definitions of irritability and the item content of irritability measures. Components of definitions and items measuring irritability were divided into three categories: a) causes, b) experience, and c) consequences. We also reviewed potential causes and biomarkers of irritability. We found much overlap between definitions and measures of irritability and related constructs such as anger and aggression. Consequently, the validity of research on irritability needs to be questioned including the role of irritability in psychopathology and the presence of irritability as a symptom in any disorder. Research on irritability's role in behavioral disorders needs to be repeated after more well defined measures are developed. We proposed a more precise definition of irritability that clearly differentiates it from related constructs. Suggested items for measuring irritability are also provided.

Caregiver Positive and Negative Appraisals: Effects of the National Alliance on Mental Illness Family-to-Family Intervention.

The 3-month-long Family-to-Family intervention (FTF) has been shown to increase empowerment, knowledge, and coping and to reduce distress among caregivers of people with serious mental illness. We sought to determine the influence of FTF on caregivers' appraisal of their caregiving experience. Family members of individuals with mental illness who sought enrollment in FTF (n = 318) were randomly assigned to FTF or a waitlist condition. Positive and negative appraisals were measured using the Experiences of Caregiving Inventory at baseline and 3 months later; 259 participants completed both assessments. Regression analyses found significant increases in positive appraisal but no significant decreases in negative appraisals for those in the FTF condition. In the context of overall benefits from taking FTF, these relationships reflect the FTF curriculum's emphasis on positive coping (e.g., strength and empowerment) and the potential value of strategies that help caregivers increase positive appraisal.

Anger and its Association with Substance Use Treatment Outcomes in a Sample of Adolescents.

Anger is a common affective experience, yet it is relatively understudied in the substance use treatment literature. This study explored anger as a predictor of treatment outcomes in a large sample of adolescents. Data were extracted from the Drug Abuse Treatment Outcome Study for Adolescents (DATOS-A). An anger profile was created based on adolescents' pre-treatment responses to four items assessing history of temper outbursts and aggression. Individuals were classified as High Anger (n = 506) and Normal/Low Anger (n = 2,326) based on their pattern of responses to these items. High Anger at baseline was associated with several poor outcomes at the 12-month follow-up point, including a greater likelihood of experiencing delirium tremens, relapsing on drugs due to alcohol use, having difficulty controlling temper and behavior, and being arrested for attacks on persons.

An adapted, four-week mind-body skills group for medical students: reducing stress, increasing mindfulness, and enhancing self-care.

OBJECTIVE: Despite the well-known stress of medical school, including adverse consequences for mental and behavioral health, there is little consensus about how to best intervene in a way that accommodates students׳ intense training demands, interest in science, and desire to avoid being stigmatized. The objective of this study, therefore, was to evaluate the feasibility, acceptability, and initial effectiveness of an adapted, four-week stress management and self-care workshop for medical students, which was based on the science and practice of mind-body medicine. METHODS: The current study used a prospective, observational, and mixed methods design, with pretest and posttest evaluations. Participants (n = 44) included medical and physician-scientist (MD/PhD) students from a large, southeastern medical school. Feasibility was assessed by rates of workshop enrollment and completion. Acceptability was assessed using qualitative ratings and open-ended responses that queried perceived value of the workshop. Quantitative outcomes included students׳ ratings of stress and mindfulness using validated self-report surveys. RESULTS: Enrollment progressively increased from 6 to 15 to 23 students per workshop in 2007, 2009, and 2011, respectively. Of the 44 enrolled students, 36 (82%) completed the workshop, indicating that the four-session extracurricular format was feasible for most students. Students reported that the workshop was acceptable, stating that it helped them cope more skillfully with the stress and emotional challenges of medical school, and helped increase self-care behaviors, such as exercise, sleep, and engaging in social support. Students also reported a 32% decrease in perceived stress (P < .001; d = 1.38) and a 16% increase in mindfulness (P < .001; d = 0.92) following the workshop. Changes in stress and mindfulness were significantly correlated (r = -0.42; P = .01). CONCLUSION: Together, these findings suggest that a brief, voluntary mind-body skills workshop specifically adapted for medical students is feasible, acceptable, and effective for reducing stress, increasing mindfulness, and enhancing student self-care.