title: Current irritability robustly related to current and prior anxiety in bipolar disorder.
abstract: Although current irritability and current/prior anxiety have been associated in unipolar depression, these relationships are less well understood in bipolar disorder (BD). We investigated relationships between current irritability and current/prior anxiety as well as other current emotions and BD illness characteristics.
  
  
  
  Outpatients referred to the Stanford Bipolar Disorders Clinic during 2000-2011 were assessed with the Systematic Treatment Enhancement Program for BD (STEP-BD) Affective Disorders Evaluation. Prevalence and clinical correlates of current irritability and current/prior anxiety and other illness characteristics were examined.
  
  
  
  Among 497 BD outpatients (239 Type I, 258 Type II; 58.1% female; mean ± SD age 35.6 ± 13.1 years), 301 (60.6%) had baseline current irritability. Patients with versus without current irritability had significantly higher rates of current anxiety (77.1% versus 42.9%, p < 0.0001) and history of anxiety disorder (73.1% versus 52.6%, p < 0.0001). Current irritability was more robustly related to current anxiety than to current anhedonia, sadness, or euphoria (all p < 0.001), and current irritability-current anxiety associations persisted across current predominant mood states. Current irritability was more robustly related to past anxiety than to all other assessed illness characteristics, including 1° family history of mood disorder, history of alcohol/substance use disorder, bipolar subtype, and current syndromal/subsyndromal depression (all p < 0.05).
  
  
  
  Limited generalizability beyond our predominately white, female, educated, insured American BD specialty clinic sample.
  
  
  
  In BD, current irritability was robustly related to current/prior anxiety. Further studies are warranted to assess longitudinal clinical implications of relationships between irritability and anxiety in BD.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Laura D
authors.initials: LD
authors.lastname: Yuen
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Shefali
authors.initials: S
authors.lastname: Miller
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Po W
authors.initials: PW
authors.lastname: Wang
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Farnaz
authors.initials: F
authors.lastname: Hooshmand
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Jessica N
authors.initials: JN
authors.lastname: Holtzman
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Kathryn C
authors.initials: KC
authors.lastname: Goffin
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Saloni
authors.initials: S
authors.lastname: Shah
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA. Electronic address: tketter@stanford.edu.
authors.forename: Terence A
authors.initials: TA
authors.lastname: Ketter
mesh_terms: D000328:Adult; D001007:Anxiety / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology*; D001714:Bipolar Disorder / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology*; D015897:Comorbidity; D005260:Female; D006801:Humans; D007508:Irritable Mood; D008297:Male; D010045:Outpatients; D011569:Psychiatric Status Rating Scales; D011619:Psychotropic Drugs / Q000627:therapeutic use
chemical_list: D011619:Psychotropic Drugs
keywords: Anxiety; Anxiety disorder; Bipolar disorder; Comorbidity; Irritability