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Chronic Cough
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A key neuropsychiatric symptom of Huntington's disease, irritability, contributes to a decline in functioning and to great distress in both patients and their caregivers. To identify mutation carriers prone to the development of irritability, this study aimed to investigate the course and temporal relationships between irritability and other neuropsychiatric symptoms. A cohort of 90 mutation carriers was followed for 2 years. Using the Irritability Scale, the incidence of irritability was 23%, whereas irritability persisted in 70% of the mutation carriers with irritability at baseline. An increase in irritability was strongly associated with an increase in apathy.
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Article AbstractBecause this piece has no abstract, we have provided for your benefit the first 3 sentences of the full text.Sir: Perlis et al.1 found that irritability was present in 40% ofoutpatients with major depressive disorder (MDD). The findingmirrors DSM-IV-TR,2 which lists irritability not only as a coresymptom of mania and hypomania, but also as a commonsymptom of MDD. Kraepelin3 classified irritability as a manic(excitement) symptom. The bipolar nature of irritability inMDD can have an important impact on treatment of MDD.Although a study4 on MDD with irritability showed that fluoxetinewas effective in reducing irritability, clinical observationssuggest adding mood-stabilizing agents to antidepressantsin MDD with irritability because antidepressants alone mayworsen irritability.5-9†‹
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This study was undertaken to identify the clinical and pathoanatomical correlates of irritability in patients with closed head injuries. A consecutive series of 66 patients was assessed in hospital and at 3, 6, 9, and 12-month follow-ups. Patients fulfilling criteria for irritability were divided into 2 groups based on the immediate or delayed onset of their irritability and compared with patients without irritability for background characteristics, impairment variables, and lesion characteristics. There were 12 patients (18.2%) with acute onset irritability and 10 (15.1%) with delayed onset irritability. Acute onset irritability patients had a higher frequency of left cortical lesions. Delayed onset irritability patients showed a strong association with poor social functioning and greater impairment in activities of daily living. The findings suggest that post-brain injury irritability may have different causes and treatment in the acute and chronic stages.
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Objective: To determine the impact of clustered maintenance transcranial magnetic stimulation (TMS) on irritability occurring in treatment-resistant major depressive disorder (MDD). Method: A naturalistic study of 106 courses that includes pre- and posttreatment assessments of subjective and objective depression and a subjective measure of irritability developed for this study. Results: Forty-six participants (35 females), mean age 43.2 years (14.3), completed 106 courses. There was a significant reduction in irritability and depression scores ( p < .001). The change in irritability scores was significantly correlated with the change in depression scores, r = .40, p < .001. Conclusion: TMS has the capacity to reduce the irritability co-occurring with treatment-resistant MDD, known to be responsive to TMS. This increases the possibility of using TMS in the treatment of irritability co-occurring with other disorders or standing alone (should irritability be categorized as a stand-alone disorder).
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Overcoming Anger and Irritability is a self-help manual for those who find that they are harming the quality of their lives and the lives of those around them with recurring irritability and flashes of anger. It has been writen to help the reader to understand why bouts of anger occur and what can be done to overcome them. The guide takes a positive approach for which the long-term goal is lasting good temper, and also provides methods for best handling taxing situations.-Contains a complete self-help program and work sheets-Is based on clinically proven techniques of cognitive therapy
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Abstract Irritability is not uncommon after traumatic brain injury (TBI). Unfortunately, no instruments are available to directly measure this clinical feature. This study thus aimed to develop a specific scale to evaluate the irritability for patients with TBI. A total of 144 participants, which include 80 healthy participants and 64 patients suffering from TBI, were recruited. Irritability was assessed by the National Taiwan University Irritability Scale (NTUIS). Our results showed the NTUIS has good reliability. The factor analysis further revealed 2 different components: annoyance, and verbal aggression. Moreover, both self-reported and family-reported irritability postinjury were significantly higher than the irritability reported by the healthy participants. Indeed patients with TBI have significant problems with irritability after injuries, and thus a more specific assessment tool to carefully evaluate patients' irritability should be used.
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Background: Irritability is a common long-term sequelae of traumatic brain injury (TBI). In a prior study on TBI irritability, relational interactions were one of four dimensions of irritability occurrence and precipitation. This present analysis examines these same data in greater detail.Methods: Fifty focus group transcripts from a study on irritability were re-analysed to examine: (1) irritability in spousal relationships following TBI, (2) retrospective accounts of spousal interactions contributing to irritability and (3) impact of irritability on marital relationships. Grounded Theory was used to develop themes, metacodes and theories.Results: Several theories emerged regarding irritability with respect to spousal relations, all based on the overarching theory that irritability in people with TBI has a strong relational component involved in triggering, experiencing and preventing irritability. Sub-theories supporting this include: (1) irritability breeds further irritability, (2) spousal responses can trigger irritability among persons with TBI and vice versa, (3) difficulties making emotional connections may incite negative interactions, (4) expectations of others may contribute to irritable behaviour, and (5) communication breakdowns may provoke irritability.Conclusions: Irritability associated with TBI resides in the family system as well as the individual. In treating irritability one should include comprehensive assessment and assistance to improve interpersonal interactions.
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Abstract Background This report tests the association of self-reported symptoms of irritability with overt behavior of anger attacks (uncharacteristic sudden bouts of anger that are disproportionate to situation and associated with autonomic activation). Methods Participants of the Establishing Moderators and Biosignatures of Antidepressant Response in Clinical Care study who completed Massachusetts General Hospital Anger Attacks questionnaire were included ( n = 293). At each visit, the 17-item Hamilton Depression Rating Scale and the 16-item Concise Associated Symptom Tracking scale were used to measure depression, anxiety, and irritability. In those with anger attacks present v. those without anger attacks, separate t tests and mixed model analyses compared afore-mentioned symptoms at baseline and changes with treatment respectively. As anger attacks may occur without aggressive behaviors, analyses were repeated based only on the presence of aggressive behaviors. Results At baseline, those with anger attacks ( n = 109) v. those without anger attacks ( n = 184) had similar levels of depression but higher levels of irritability [effect size ( d ) = 0.80] and anxiety ( d = 0.32). With acute-phase treatment, participants with anger attacks experienced a greater reduction in irritability ( p < 0.001) but not in depression ( p = 0.813) or anxiety ( p = 0.771) as compared to those without anger attacks. Yet, irritability levels at week-8 were higher in those with anger attacks ( d = 0.32) than those without anger attacks. Similar results were found in participants with aggressive behaviors. Conclusions The presence of anger attacks in outpatients with major depressive disorder may identify a sub-group of patients with persistently elevated irritability.
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Objectives: We hypothesized that people in Morocco are more irritable during the month of Ramadan than during the rest of the year. Our objectives were to measure irritability in fasting Muslims during the month of Ramadan, to describe its various modes of expression, and to examine risk factors for this irritability. Methods and Subjects: We studied 100 healthy volunteers during the month of Ramadan for two successive years (1994 and 1995). All subjects were male (mean age, 32 ± 5.8 years), and 51% of them were smokers. Irritability was assessed over a 6-week period (before, four times during, and after the end of Ramadan). We assessed both subjective (visual analog scale) and objective irritability. We also recorded the consumption of psychostimulants, duration of sleep, and anxiety level as measured by the Hamilton Anxiety Scale. Results: Irritability was significantly higher in smokers than in nonsmokers before the beginning of Ramadan. It was higher in both groups during the Ramadan month. Irritability increased continuously during Ramadan and reached its peak at the end of the month. Consumption of psychostimulants (coffee and tea) and anxiety level followed the same pattern. Smokers and nonsmokers had a similar pattern of irritability over time, but irritability increased more in smokers than in nonsmokers.
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