Elation and irritability increase BD risk

By Mark Cowen, Senior MedWire Reporter

Symptoms of elation and irritability are significantly associated with an increased likelihood for developing bipolar disorder (BD), researchers report.

The risk is particularly elevated if elation and irritability are accompanied by trouble concentrating, racing thoughts, or hyperactivity, observe Steven Dubovsky (University at Buffalo, New York, USA) and colleagues.

They say the co-occurrence of such symptoms "may represent a prodrome of formal BD that indicate close follow-up and cautious use of antidepressants."

The findings, published in the Journal of Affective Disorders, come from a study of 40,512 individuals who participated in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) who did not meet criteria for mania/hypomania at baseline in 2001‑2002.

All of the participants were assessed for elation and irritability at baseline, as well as for trouble concentrating, racing thoughts, increased activity, restlessness, and sexual activity, decreased sleep, pressured speech, "getting into trouble," and grandiosity.

Overall, 1.8% reported elation only, 4.4% reported irritability only, and 0.6% reported both elation and irritability at baseline.

Follow-up assessments in 2004‑2005 revealed that 8.0% of participants who reported elation or irritability at baseline had experienced an episode of mania/hypomania compared with just 2.6% of those without such symptoms.

After controlling for age, gender, and ethnicity, the team found that the presence of elation or irritability at baseline was significantly associated with an increased risk for mania/hypomania at follow up, at an odds ratio (OR) of 2.8.

Furthermore, the presence of both elation and irritability at baseline was associated with an even higher adjusted risk for mania/hypomania at follow up, at an OR of 4.6.

Among patients with elation and/or irritability at baseline, the presence of the additional symptoms, including trouble concentrating, racing thoughts, and increased activity, further increased the risk for mania/hypomania, while decreased sleep, pressured speech, getting into trouble, and grandiosity did not.

Dubovsky and team conclude: "Patients with elation and/or irritability, particularly if accompanied by trouble concentrating, racing thoughts or hyperactivity, should be observed closely over time for evidence of additional diagnostic criteria for bipolar disorder."

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