Differentiating irritable mood and disruptive behavior in adults

Introduction: Irritability has both mood and behavioral manifestations. These frequently co-occur, and it is unclear to what extent they are dissociable domains. We used confirmatory factor analysis and external validators to investigate the independence of mood and behavioral components of irritability. Methods: The sample comprised 246 patients (mean age 45 years; 63% female) from four outpatient programs (depression, anxiety, bipolar, and schizophrenia) at a tertiary hospital. A clinical instrument rated by trained clinicians was specifically designed to capture irritable mood and disruptive behavior dimensionally, as well as current categorical diagnoses i.e., intermittent explosive disorder (IED); oppositional defiant disorder (ODD); and an adaptation to diagnose disruptive mood dysregulation disorder (DMDD) in adults. Confirmatory factor analysis (CFA) was used to test the best fitting irritability models and regression analyses were used to investigate associations with external validators. Results: Irritable mood and disruptive behavior were both frequent, but diagnoses of disruptive syndromes were rare (IED, 8%; ODD, 2%; DMDD, 2%). A correlated model with two dimensions, and a bifactor model with one general dimension and two specific dimensions (mood and behavior) both had good fit indices. The correlated model had root mean square error of approximation (RMSEA) = 0.077, with 90% confidence interval (90%CI) = 0.071-0.083; comparative fit index (CFI) = 0.99; and Tucker-Lewis index (TLI) = 0.99, while the bifactor model had RMSEA = 0.041; CFI = 0.99; and TLI = 0.99 respectively). In the bifactor model, external validity for differentiation of the mood and behavioral components of irritability was also supported by associations between irritable mood and impairment and clinical measures of depression and mania, which were not associated with disruptive behavior. Conclusions: Psychometric and external validity data suggest both overlapping and specific features of the mood vs. disruptive behavior dimensions of irritability

Irritabilidade em adultos : distinção entre comportamento e humor disruptivo

A irritabilidade é um sintoma frequente tanto em transtornos externalizantes quanto internalizantes. Pode ser definida como propensão à raiva em relação aos pares manifestando-se através de humor irritável e/ou ataques de raiva. Embora humor irritável e ataques de raiva ocorram muitas vezes de forma simultânea, trata-se de uma questão empírica investigar se humor e comportamento irritável são parte de um construto único ou se constituem-se em componentes distintos. O objetivo deste trabalho é analisar a diferença dos construtos humor e comportamento disruptivo em adultos em uma amostra de pacientes com transtornos mentais graves. A análise dos dados foi realizada através de análise fatorial confirmatória e de validações externas com outros instrumentos clínicos. Além disso foi nosso objetivo avaliar a prevalência das principais síndromes disruptivas no adulto: o Transtorno Explosivo Intermitente (TEI), o Transtorno Opositor Desafiante (TOD) e o Transtorno da Desregulação Disruptiva do Humor (TDDH). A coleta de dados foi realizada nos ambulatórios de esquizofrenia, transtorno bipolar, depressão e ansiedade do Hospital de Clínicas de Porto Alegre totalizando 246 pacientes (idade média 45 anos, 63% do sexo feminino). Sintomas de comportamento e humor disruptivos foram frequentes na amostra, embora o diagnóstico DSM-5 das síndromes disruptivas apresentaram prevalência baixa (TEI, 8%, TOD, 2% TDDH, 2%). O modelo unidimensional, que envolve os fatores humor e comportamento como um construto único não apresentou bons índices de ajuste na amostra. Os modelos que apresentaram índices de ajuste adequados foram os modelos correlacionado (com as dimensões humor e comportamento) e o modelo bifatorial com uma dimensão geral de irritabilidade e duas específicas (humor e comportamento). A avaliação psicométrica demonstrou que os sintomas de humor já estão presentes em casos mais leves de irritabilidade, enquanto que os sintomas de comportamento aparentam indicar níveis de irritabilidade mais elevados. Análises com os validadores externos demonstraram que o humor irritável mesmo após retirar o componente comum entre humor e comportamento esteve especificamente associado com prejuízo e com medidas clínicas de depressão e mania, o que não aconteceu com o componente comportamento. Este estudo fornece suporte para estudar os componentes comuns e específicos do humor e comportamento irritado no adulto, sendo evidência inédita de validade para o construto de humor disruptivo no adulto.Irritability is a common symptom in both externalizing and internalizing disorders. It can be defined as a propensity to anger toward peers manifested through irritable mood and/or anger attacks. Although irritable mood and anger attacks often occur simultaneously, it is and empirical question to investigate whether mood and irritable behavior are part of a single construct or if they constitute distinct components. The purpose of this paper is to analyze the difference of mood and disruptive behavior constructs in adults in a sample of patients with severe mental disorders. Data analysis was performed through confirmatory factor analysis and external validations with clinical instruments. In addition, it was our objective to evaluate the prevalence of the main disruptive syndromes in adults: Intermittent Explosive Disorders (IED), Oppositional Defiant Disorder (ODD) and Disruptive Mood Dysregulation Disorder (DMDD). Data collection was performed at the outpatient units of schizophrenia, bipolar disorder, depression and anxiety at the Hospital de Clínicas de Porto Alegre, totalizing 246 patients (mean age 45 years old, 63% female). Symptoms of disruptive mood and behavior were frequent in the sample, although the DMS 5 diagnosis of disruptive syndromes presented low prevalence (IED, 8%, ODD, 2%, DMDD, 2%). The unidimensional model encompassing mood and behavior factors as a single construct, did not provide a good fit to our data. The models who presented proper fit indexes were the correlated model (with mood and behavior dimensions) and the bifactor model with a general irritability dimension and two specific ones (mood and behavior). Psychometric evaluation has shown that mood symptoms are present in milder cases of irritability, while behavioral symptoms are present in higher levels of irritability. External validators analysis demonstrated that irritable mood even after removing the common component between mood and behavior was specifically associated with impairment and with clinical measures of depression and mania, which did not happen with the behavior component. This study provides support for studying the common and specific components of irritable mood and behavior in adults, being unprecedented evidence of validity for the adult disruptive mood construct

Irritabilidade em adultos : distinção entre comportamento e humor disruptivo

A irritabilidade é um sintoma frequente tanto em transtornos externalizantes quanto internalizantes. Pode ser definida como propensão à raiva em relação aos pares manifestando-se através de humor irritável e/ou ataques de raiva. Embora humor irritável e ataques de raiva ocorram muitas vezes de forma simultânea, trata-se de uma questão empírica investigar se humor e comportamento irritável são parte de um construto único ou se constituem-se em componentes distintos. O objetivo deste trabalho é analisar a diferença dos construtos humor e comportamento disruptivo em adultos em uma amostra de pacientes com transtornos mentais graves. A análise dos dados foi realizada através de análise fatorial confirmatória e de validações externas com outros instrumentos clínicos. Além disso foi nosso objetivo avaliar a prevalência das principais síndromes disruptivas no adulto: o Transtorno Explosivo Intermitente (TEI), o Transtorno Opositor Desafiante (TOD) e o Transtorno da Desregulação Disruptiva do Humor (TDDH). A coleta de dados foi realizada nos ambulatórios de esquizofrenia, transtorno bipolar, depressão e ansiedade do Hospital de Clínicas de Porto Alegre totalizando 246 pacientes (idade média 45 anos, 63% do sexo feminino). Sintomas de comportamento e humor disruptivos foram frequentes na amostra, embora o diagnóstico DSM-5 das síndromes disruptivas apresentaram prevalência baixa (TEI, 8%, TOD, 2% TDDH, 2%). O modelo unidimensional, que envolve os fatores humor e comportamento como um construto único não apresentou bons índices de ajuste na amostra. Os modelos que apresentaram índices de ajuste adequados foram os modelos correlacionado (com as dimensões humor e comportamento) e o modelo bifatorial com uma dimensão geral de irritabilidade e duas específicas (humor e comportamento). A avaliação psicométrica demonstrou que os sintomas de humor já estão presentes em casos mais leves de irritabilidade, enquanto que os sintomas de comportamento aparentam indicar níveis de irritabilidade mais elevados. Análises com os validadores externos demonstraram que o humor irritável mesmo após retirar o componente comum entre humor e comportamento esteve especificamente associado com prejuízo e com medidas clínicas de depressão e mania, o que não aconteceu com o componente comportamento. Este estudo fornece suporte para estudar os componentes comuns e específicos do humor e comportamento irritado no adulto, sendo evidência inédita de validade para o construto de humor disruptivo no adulto.Irritability is a common symptom in both externalizing and internalizing disorders. It can be defined as a propensity to anger toward peers manifested through irritable mood and/or anger attacks. Although irritable mood and anger attacks often occur simultaneously, it is and empirical question to investigate whether mood and irritable behavior are part of a single construct or if they constitute distinct components. The purpose of this paper is to analyze the difference of mood and disruptive behavior constructs in adults in a sample of patients with severe mental disorders. Data analysis was performed through confirmatory factor analysis and external validations with clinical instruments. In addition, it was our objective to evaluate the prevalence of the main disruptive syndromes in adults: Intermittent Explosive Disorders (IED), Oppositional Defiant Disorder (ODD) and Disruptive Mood Dysregulation Disorder (DMDD). Data collection was performed at the outpatient units of schizophrenia, bipolar disorder, depression and anxiety at the Hospital de Clínicas de Porto Alegre, totalizing 246 patients (mean age 45 years old, 63% female). Symptoms of disruptive mood and behavior were frequent in the sample, although the DMS 5 diagnosis of disruptive syndromes presented low prevalence (IED, 8%, ODD, 2%, DMDD, 2%). The unidimensional model encompassing mood and behavior factors as a single construct, did not provide a good fit to our data. The models who presented proper fit indexes were the correlated model (with mood and behavior dimensions) and the bifactor model with a general irritability dimension and two specific ones (mood and behavior). Psychometric evaluation has shown that mood symptoms are present in milder cases of irritability, while behavioral symptoms are present in higher levels of irritability. External validators analysis demonstrated that irritable mood even after removing the common component between mood and behavior was specifically associated with impairment and with clinical measures of depression and mania, which did not happen with the behavior component. This study provides support for studying the common and specific components of irritable mood and behavior in adults, being unprecedented evidence of validity for the adult disruptive mood construct