Why does anger lead to sadness
Anger and anger are a bad sign
SAN DIEGO. US psychiatrists working with Lewis Judd from the University of California examined the importance of irritability and aggressiveness in major depression in a study with more than 500 patients (JAMA Psychiatry 2013, online September 11).
In the long-term study, the researchers can now look back on up to 31 years of follow-up of their patients.
Of the 536 participants with unipolar major depression, 292 (55 percent) were irritable or angry / aggressive when they entered the study.
The mean age in the irritable group was significantly lower (37.5 vs. 41.5 years). They were also previously ill with major depression (MD) (at 27.6 vs. 30.4 years). Women were overrepresented in this group (66 vs. 56 percent).
Severe courses in irritable depressives
Even the episode of major depression that ultimately led to their participation in the study lasted significantly longer in the irritable patients than in those who did not report irritability or anger (91 weeks vs. 49 weeks).
Depressives with irritability and anger during the admission episode showed more severe courses in the follow-up observation. They had poor impulse control up to and including anti-social actions (18 vs. 10 percent).
A whole range of concomitant disorders occurred more frequently in irritable and aggressive patients with MD, for example alcoholism or substance abuse (53 vs. 37 percent) and anxiety disorders (40 vs. 26 percent).
Addictive behavior or some form of mental disorder occurred during follow-up in 88 percent of irritable patients and 73 percent of MD patients with no anger or anger.
It is important to identify those affected
"Irritability and anger are highly prevalent during flare-ups," write Judd and his co-workers.
As clinical markers, these symptoms suggest a severe, chronic and complex further course. It is therefore important to identify such patients.
Therapy must also be tailored to this constellation and aimed specifically at coping with aggression. In addition to close supervision, strategies are also required to counter the frequent accompanying problems - anxiety disorders, substance abuse, lack of impulse control and psychosocial impairment. (rb)
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