A Fagiolini

A Koukopoulos

AC Swann

AH Young

American Psychiatric Association

E Kraepelin

E Solé

E Vieta

EG Hantouche

F Cassidy

GM Goodwin

HS Akiskal

IH Shim

J Eberhard

J Scott

JM Azorin

K Muralidharan

LN Yatham

M Barbuti

M Tohen

MK Spearing

R Machado-Vieira

RC Young

RS McIntyre

S Miller

SA Montgomery

SD Targum

SL McElroy

SM Stahl

SR Kay

T Perich

T Suppes

U Feske

W Guy

International Journal of Bipolar Disorders

English

Abstract
                Background
                Symptoms of anxiety, irritability, and agitation (AIA) are prevalent among patients with bipolar I disorder (BD-I) mania with depressive symptoms, and could potentially be used to aid physicians in the identification of this more severe form of BD-I. Using data from two clinical trials, the aims of this post hoc analysis were to describe the phenomenology of bipolar mania in terms of AIA and depressive symptoms, and to evaluate the influence of these symptoms on the likelihood of remission during treatment.
              
                Methods
                Patients with a BD-I manic or mixed episode (Diagnostic and Statistical Manual of Mental Disorders IV criteria) were randomised to 3 weeks of double-blind treatment with asenapine, placebo, or olanzapine (active comparator). Anxiety was defined as a score of ≥3 on the Positive and Negative Syndrome Scale ‘anxiety’ item, irritability as a score of ≥4 on the Young Mania Rating Scale (YMRS) ‘irritability’ item, and agitation as a score of ≥3 on the YMRS ‘increased motor activity–energy’ item. Depressive symptoms were defined as a score of ≥1 on three or more individual Montgomery–Åsberg Depression Rating Scale (MADRS) items, or a MADRS Total score of ≥20.
              
                Results
                A total of 960 patients with BD-I were analysed, 665 with a manic episode and 295 with a mixed episode. At baseline, 61.4% had anxiety, 62.4% had irritability, 76.4% had agitation, and 34.0% had all three AIA symptoms (‘severe AIA’); 47.3% had three or more depressive symptoms, and 13.5% had a MADRS total score of ≥20. Anxiety, irritability, and severe AIA (but not agitation) were statistically significantly more common in patients with depressive symptoms. Patients with anxiety or severe AIA at baseline were statistically significantly less likely to achieve remission (YMRS total &lt;12). In general, remission rates were higher with asenapine and olanzapine than with placebo, irrespective of baseline AIA or depressive symptoms.
              
                Conclusions
                Assessment of AIA symptoms in bipolar mania could enable physicians to identify patients with more severe depressive symptoms, allowing for appropriate intervention. Assessment and monitoring of AIA may help physicians to predict which patients may be harder to treat and at risk for self-harm.
                Trial registration ClinicalTrials.gov NCT00159744, NCT00159796. Registered 8 September 2005 (retrospectively registered)
              </jats:sec

Trisha Suppes

Jonas Eberhard

Ole Lemming

Allan H. Young

Roger S. McIntyre

Crossref

Anxiety, irritability, and agitation as indicators of bipolar mania with depressive symptoms: a post hoc analysis of two clinical trials

https://journalbipolardisorders.springeropen.com/track/pdf/10.1186/s40345-017-0103-7?site=journalbipolardisorders.springeropen.com

Anxiety, irritability, and agitation as indicators of bipolar mania with depressive symptoms: a post hoc analysis of two clinical trials

Abstract

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