Objective: Irritability is a highly burdensome complaint, commonly, but not universally, linked with depressive symptoms. While increased variability in estradiol has been associated with... Show moreObjective: Irritability is a highly burdensome complaint, commonly, but not universally, linked with depressive symptoms. While increased variability in estradiol has been associated with depressive symptoms during perimenopause, more insight is needed into reproductive hormone dynamics and other factors that predispose perimenopausal women to irritable mood. Methods: Among 50 mildly depressed perimenopausal women (mean (SD) age 48.4 (3.9) years), severity of irritability symptoms (on Symptom Questionnaire Hostility subscale, range 0-23) was assessed weekly for eight weeks, concurrent with potential predictors. Associations between these were examined using generalized estimating equating models.Results: Most women (82.0%) reported having moderate to severe irritability at least once. However, the severity of irritability was highly variable from week-to-week (between-subject mean coefficient of variation [CV] 72.9% and within-subject mean CV 63.7%). In multivariate analyses, less variable serum estradiol levels (standardized beta within-person CV-0.23 95%CI [-0.32,-0.14], p < 0.001), greater depression severity (0.45 [0.35, 0.56], p < 0.001), younger age (-0.23, [-0.28,-0.09], p < 0.001), and more frequent vasomotor symptoms (0.14 [0.05, 0.23], p = 0.002) were associated with more irritability. Depression severity explained the largest portion of the variance in irritability, but still not more than 20.3%. Neither crude values, weekly change in, or variability of progesterone or FSH levels were associated with irritability.Conclusions: Irritability was highly prevalent among mildly depressed perimenopausal women. In contrast to depressive symptoms, decreased rather than increased variability in estradiol levels was associated with more irritability. This highlights that irritable mood can be disentangled from depressive symptoms in perimenopausal women and might be linked with different estradiol dynamics. Show less
This thesis describes a study on neuropsychiatric symptoms in Huntington’s Disease (HD). This cohort study was performed in HD mutation carriers (both pre-motor symptomatic and motor symptomatic),... Show moreThis thesis describes a study on neuropsychiatric symptoms in Huntington’s Disease (HD). This cohort study was performed in HD mutation carriers (both pre-motor symptomatic and motor symptomatic), and a control group of non-carriers that had an a-priori 50% risk for HD. The study started in may 2004 and a second measurement was performed 2 years later. The aim of this study was to study the presence and course of both formal psychiatric disorders and neuropsychiatric symptoms, and to find correlates and predictors associated with the psychiatric phenomena. This cohort study confirms that neuropsychiatric symptoms frequently occur in patients with HD. We expected a diminished insight in patients with a neuropsychiatric symptoms like irritability, but most patients were aware of their irritability. A strong relationship was found between the presence of psychopathology, cognitive functioning and global daily functioning. Irritability may be an early sign of the disease, but only apathy was closely related to the progression of HD indicating a relationship with the progressive neurodegenerative nature of the disease. However, we also found associations with apathy and irritability, and the use of psychotropic medications. Show less
Duijn, E. van; Reedeker, N.; Giltay, E.J.; Eindhoven, D.; Roos, R.A.C.; Mast, R.C. van der 2014
Since heterogeneity in depressed patients makes treatment decisions difficult and treatment often unsuccessful, we seek to identify certain subtypes of depression. 30 to 40% of depressed patients... Show moreSince heterogeneity in depressed patients makes treatment decisions difficult and treatment often unsuccessful, we seek to identify certain subtypes of depression. 30 to 40% of depressed patients have anger regulation problems; from irritability to anger attacks. What is the significance of anger in depression? Does it signify a subtype of depression? In the NESDA cohort, we compared a large sample of currently depressed patients with irritability to currently depressed patients without irritability. Irritable depressed patients had more symptoms of depression, more often had comorbid anxiety and had more often attempted suicide than non-irritable depressed patients. In a student sample, we investigated the role of the MAOA genotype and found that women with the high expression variant are possibly more vulnerable to anger or aggression during depression. Using acute tryptophan depletion we temporarily lowered serotonin in remitted depressed patients with and without anger regulation problems during their depression. We found no cognitive differences between the two groups, but the experiment did show us that depressed patients with anger regulation problems may be more serotonergically vulnerable. Further research is needed to elucidate best suited treatment strategies for anger regulation problems in depression Show less
