Anger Episodes Research Articles

怒りの維持過程──認知および行動の媒介的役割──

Relationships were investigated between the sense of unintegration of thoughts, recurrent thinking, and avoidance behavior, which are considered to be factors in maintaining anger. Undergraduate students (N = 990) were asked to write about anger episodes that they had experienced a week or more ago. Then, they completed a questionnaire assessing their sense of unintegration of thoughts at the present time and just after the episode, their present recurrent thinking, their avoidance behavior after the episode, and their present degree of anger. The results of covariance structure analysis indicated that the sense of unintegration of thoughts just after the episode maintained anger through recurrent thinking. Recurrent thinking also intensified their present sense of unintegration of thoughts, which directly maintained anger. Moreover, the sense of unintegration of thoughts just after the episode led to an increase in avoidance behavior, which was related to recurrent thinking.

The Impact of Mindfulness Meditation on Anger

This study explores the impact of mindfulness meditation on anger. A meditation group (N = 37) attended 5-10 minutes of mindfulness meditation daily for a week. They were assessed with self-report scales measuring three aspects of anger (rumination, arousal, and lengthiness) before, just after, and four weeks after their one-week participation. Their scores were compared to a control group (N = 27), which was assessed at the same intervals as the meditation group. The meditation group was also asked to evaluate their current mood using the Affect Grid before and after each meditation. The results indicated that participants in the meditation group who continued meditation voluntarily after the week of their participation had decreased anger rumination scores just after and four weeks after their participation. Additionally, the pleasant score on the Affect Grid increased after meditation for almost all the participation days. These findings suggest the efficacy of mindfulness meditation on improving the tendency to ruminate about anger episodes in the medium-term to long-term, and also on improving mood in the short-term.

Culture and the Anxiety Disorders: Recommendations for DSM-V

Background: The anxiety disorders specified in the fourth edition, text revision, of The Diagnostic and Statistical Manual (DSM-IV-TR) are identified universally in human societies, and also show substantial cultural particularities in prevalence and symptomatology. Possible explanations for the observed epidemiological variability include lack of measurement equivalence, true differences in prevalence, and limited validity or precision of diagnostic criteria. One central question is whether, through inadvertent “over-specification” of disorders, the post-DSM-III nosology has missed related but somewhat different presentations of the same disorder because they do not exactly fit specified criteria sets. This review canvases the mental health literature for evidence of cross-cultural limitations in DSM-IV-TR anxiety disorder criteria. Methods: Searches were conducted of the mental health literature, particularly since 1994, regarding cultural or race/ethnicity-related factors that might limit the universal...

Stress ECG utilization in the evaluation of patients with chest pain: The real practice in Hungary with 10 million inhabitants

temperature on the incidence ofmyocardial infarction. Heart 2009;95(21):1760–9. [4] Buskirk ER, Kollias J, Akers RF, Prokop EK, Reategui EP.Maximal performance at altitude and on return fromaltitude in conditioned runners. J Appl Physiol 1967;23(2):259–66. [5] Tofler GH, Muller JE. Triggering of acute cardiovascular disease and potential preventive strategies. Circulation 2006;114(17):1863–72. [6] Mittleman MA, Maclure M, Sherwood JB, Mulry RP, Tofler GH, Jacobs SC, et al. Triggering of acute myocardial infarction onset by episodes of anger. Determinants ofMyocardial Infarction Onset Study Investigators. Circulation 1995;92(7):1720–5. [7] D'Agostino Sr RB, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, et al. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation 2008;117(6):743–53. [8] Graham I, Atar D, Borch-Johnsen K, Boysen G, Burell G, Cifkova R, et al. European guidelines on cardiovascular disease prevention in clinical practice: full text. Fourth Joint Task Force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts). Eur J Cardiovasc Prev Rehabil 2007;14(Suppl 2):S1–S113. [9] Mittleman MA, Maclure M, Tofler GH, Sherwood JB, Goldberg RJ, Muller JE. Triggering of acute myocardial infarction by heavy physical exertion. Protection against triggering by regular exertion. Determinants of Myocardial Infarction Onset Study Investigators. N Engl J Med 1993;329(23):1677–83. [10] Schmid JP, Noveanu M, Gaillet R, Hellige G, Wahl A, Saner H. Safety and exercise tolerance of acute high altitude exposure (3454 m) among patients with coronary artery disease. Heart 2006;92(7):921–5. [11] Klug G, Zwick RH, Frick M, Wolf C, Schocke MF, Conci E, et al. Impact of exercise capacity onmyocardial high-energy phosphate metabolism. Int J Sports Med 2007;28(8):667–72. [12] Burtscher M, Faulhaber M, Flatz M, Likar R, Nachbauer W. Effects of short-term acclimatization to altitude (3200 m) on aerobic and anaerobic exercise performance. Int J Sports Med 2006;27(8):629–35. [13] Cold exposure and winter mortality from ischaemic heart disease, cerebrovascular disease, respiratory disease, and all causes inwarm and cold regions of Europe. The Eurowinter Group. Lancet 1997;349(9062):1341–6. [14] Shewan L, Coats A. Ethics in the authorship and publishing of scientific articles. Int J Cardiol 2010;144:1–2.

A Composite Case Study of an Individual With Anger as a Presenting Problem

This article presents a composite case study of a 45-year-old Caucasian male with anger as a presenting problem. Mr. P is technically self-referred but admits that he ultimately decided to seek treatment at his girlfriend's insistence. He reports experiencing frequent, intense anger episodes, usually occasioned by minor inconveniences. These anger episodes have been associated with distress and lifelong impairment in functioning in various domains, including work and relationships with family members. Mr. P has a previous history of treatment for general stress, although he states that he did not find this to be helpful. Current symptoms, relevant personal history, and details regarding previous treatment are discussed.

Application of a Flexible, Clinically Driven Approach for Anger Reduction in the Case of Mr. P

We treat maladaptive anger in adults with a program based on traditional behavior therapy and cognitive behavior therapy. To these, we add client-centered motivational interviewing techniques. With the goal of modifying maladaptive stimulus-response relationships, our specific aim is to reduce anger reactivity to aversive triggers. Thus, in daily clinical work we have found it useful to focus on individual episodes of anger rather than underlying personality dimensions. Episodes include the trigger, the appraisal, the private experience, the public expression, and the outcome. This episode model is taught psychoeducationally. The treatment program itself has four stages: engagement and preparation, use of specific change strategies, learning to accept difficult life situations, and maintaining change and enhancing happiness. Since Mr. P had difficulties with his previous therapist, we would delay using specific interventions and would spend more time in the engagement phase so as to build the therapeutic bond and enhance awareness of his own reasons for change. We would also administer a standardized anger test and would provide feedback to help him see where he stands as compared to others. Although this would be done in the spirit of exploration, without evaluative judgments, verbalizations that favor better anger control would be encouraged. Once engaged, we would use strategies that allow for the repeated examination of solutions to individual anger episodes. Use of avoidance and escape, imaginal and in-vivo barb exposure, limited cognitive restructuring, and techniques to enhance happiness would be considered. Decision guidelines, roadblocks to success, and potential solutions are also discussed.

Social anxiety and the experience of positive emotion and anger in everyday life: an ecological momentary assessment approach

A few recent studies have found evidence showing that social anxiety is associated with diminished positive affect and elevated anger. However, prior work has relied on trait self-report measures of global positive mood or anger. In this preliminary study, we examined how trait social anxiety relates to moment-to-moment positive and angry emotional states as people navigate through their natural environment in a given day. Of additional interest was whether any associations were limited to social situations or were evident more broadly in non-social situations as well. For 14 days, 38 non-clinical community adults carried electronic diaries to assess their experience of positive emotions, anger, and their current social context and activity. Participants were randomly prompted up to four times per day, leading to 1702 observations. Results showed that social anxiety was associated with less time spent feeling happy and relaxed and more time spent feeling angry throughout the day. In general, people felt happier when they were with other people compared to being alone. Interestingly, people with relatively higher levels of social anxiety reported fewer and less intense positive emotions and greater anger episodes across social and non-social situations.

An Open Trial of a Comprehensive Anger Treatment Program on an Outpatient Sample

This pilot study was designed to investigate the efficacy of a cognitive behavioral treatment for anger. Twelve (5 men and 7 women) outpatient adults completed 2-hour group sessions for 16 sessions. Participants were diagnosed with 29 Axis I and 34 Axis II disorders with high rates of comorbidity. Empirically supported techniques of skills training, cognitive restructuring, and relaxation were utilized. In this protocol, cognitive restructuring emphasized the use of the ABC model to understand anger episodes and the Rational Emotive Behavior Therapy (REBT) techniques of disputing irrational beliefs and rehearsing rational coping statements, but additional cognitive techniques were used, e.g. self-instructional training (SIT). Skills training included problem-solving and assertiveness. Relaxation training was paced respiration. Motivational interviewing, imaginal exposure with coping, and relapse prevention were also included. Significant improvements were found from pre- to post-treatment on the following measures: the Trait Anger Scale of the State-Trait Anger Expression Inventory-II; and Anger Disorder Scale total scores; idiosyncratic anger measurements of situational intensity and symptom severity; and the Beck Depression Inventory-II. In order to extend the significant research findings of this pilot study, future investigations should involve larger sample sizes, populations drawn from various settings, and contact control groups.

Clinical phenomenology and phenotype variability in Tourette syndrome

Tourette syndrome (TS) is a neurodevelopmental disorder with a rich phenomenology that includes simple and complex motor and vocal tics as well as multiple comorbidities. From a nosological perspective, it is evident that a continuum of tic severity exists, of which TS is the most severe and rare form, while transient tics and chronic tics represent milder forms. From a psychopathology perspective, TS is often concurrent with obsessive–compulsive disorder (OCD) and attention deficit hyperactivity disorder (ADHD); these disorders appear to define TS “types” TS only, TS+OCD, and TS+OCD+ADHD. Additional clinical aspects of TS include more frequent than expected occurrence of anger episodes, anxiety disorders, mood disorders, impulse control disorders, learning disorders, and pervasive developmental disorders. Data reduction techniques have been used more recently to define a “simple” and “complex” tic symptom clusters or factors. Phenomenologic approaches can be used in TS to guide future pathophysiologic research.

Anger, PTSD, and the nuclear family: A study of Cambodian refugees

This study profiles the family-directed anger of traumatized Cambodian refugees, all survivors of the Pol Pot genocide (1975-1979), who were patients at a psychiatric clinic in Lowell, MA, USA. We focus on the nuclear family (NF) unit, the NF unit defined as the patient's (i.e. spouse or boyfriend/girlfriend) and children. Survey data were collected from a convenience sample of 143 Cambodian refugee patients from October 2006 to August 2007. The study revealed that 48% (68/143) of the patients had anger directed toward a NF member in the last month, with anger directed toward children being particularly common (64 of the 143 patients, or 49% [64/131] of the patients with children). NF-type anger was severe, for example, almost always resulting in somatic arousal (e.g., causing palpitations in 91% [62/68] of the anger episodes) and often in trauma recall and fears of bodily dysfunction. Responses to open-ended questions revealed the causes of anger toward a significant other and children, the content of anger-associated trauma recall, and what patients did to gain relief from anger. A type of cultural gap, namely, a linguistic gap (i.e., the parent's lack of English language skills and the child's lack of Khmer language skills), seemingly played a role in generating conflict and anger. NF-type anger was associated with PTSD presence. The effect of anger on PTSD severity resulted in part from anger-associated trauma recall and fears of bodily dysfunction, with 54% of the variance in PTSD severity explained by that regression model. The study: 1) suggests that among traumatized refugees, family-related anger is a major clinical concern; 2) illustrates how family-related anger may be profiled and investigated in trauma-exposed populations; and 3) gives insights into how family-related anger is generated in such populations.

Intensity profiles of emotional experience over time

A full understanding of emotions and emotion characteristics can only be reached when their dynamic nature is taken into account. As such, a primary objective of the present study is to describe and account for variability in temporal profiles of experienced emotional intensity. Participants were asked to make detailed drawings of intensity profiles of recently experienced episodes of anger, sadness, joy and affection. Functional data analysis revealed three features that together accounted for 84% of the total variability: (i) steepness at onset; (ii) skewness; and (iii) the number of peaks. Emotions differed with regard to the first two features, with the rise at onset being steeper for sadness and joy and affection being the most negatively skewed emotion under study. Individual differences regarding each of the three features were found, however, they did not strongly generalise across emotions.

Anger, PTSD, and the nuclear family: A study of Cambodian refugees

This study profiles the family-directed anger of traumatized Cambodian refugees, all survivors of the Pol Pot genocide (1975-1979), who were patients at a psychiatric clinic in Lowell, MA, USA. We focus on the nuclear family (NF) unit, the NF unit defined as the patient's "significant other" (i.e. spouse or boyfriend/girlfriend) and children. Survey data were collected from a convenience sample of 143 Cambodian refugee patients from October 2006 to August 2007. The study revealed that 48% (68/143) of the patients had anger directed toward a NF member in the last month, with anger directed toward children being particularly common (64 of the 143 patients, or 49% [64/131] of the patients with children). NF-type anger was severe, for example, almost always resulting in somatic arousal (e.g., causing palpitations in 91% [62/68] of the anger episodes) and often in trauma recall and fears of bodily dysfunction. Responses to open-ended questions revealed the causes of anger toward a significant other and children, the content of anger-associated trauma recall, and what patients did to gain relief from anger. A type of cultural gap, namely, a linguistic gap (i.e., the parent's lack of English language skills and the child's lack of Khmer language skills), seemingly played a role in generating conflict and anger. NF-type anger was associated with PTSD presence. The effect of anger on PTSD severity resulted in part from anger-associated trauma recall and fears of bodily dysfunction, with 54% of the variance in PTSD severity explained by that regression model. The study: 1) suggests that among traumatized refugees, family-related anger is a major clinical concern; 2) illustrates how family-related anger may be profiled and investigated in trauma-exposed populations; and 3) gives insights into how family-related anger is generated in such populations.

The Influence of Anger Expressions on Outcomes in Organizations

AbstractAnger can lead to positive organizational outcomes. Anger is an important emotion in negotiations and organizations create situations that promote anger, yet little research has examined the conditions under which anger expressions can lead to positive outcomes in organizations. We analyzed 129 anger episodes across six organizations. In these episodes we link the form of anger expression, characteristics of the expresser, and the organizational norms surrounding anger expressions with the valence of individual, relationship, and organizational outcomes. We find that outcomes are better when anger expressions are of low intensity, expressed verbally rather than in a physical way, and expressed in settings where anger expressions are normatively appropriate. Compared to expressions of anger by men, expressions of anger by women are associated with less positive organizational outcomes.

Appraisal ratings in diary reports of reasonable and unreasonable anger

AbstractForty‐eight undergraduate students completed diaries reporting on up to five episodes of anger experienced over the course of a week. Ratings of motivational relevance, motivational incongruence and other‐accountability appraisals were significantly lower for relatively less reasonable instances of anger. Multilevel modelling confirmed that rated reasonableness of anger was a significant continuous predictor of the same three appraisal dimensions, even after controlling for reported anger. These results extend earlier findings obtained using retrospective questionnaires, suggesting that reportable other‐blame‐related appraisals are generally weaker when anger is perceived as unreasonable. Copyright © 2007 John Wiley & Sons, Ltd.

Depression in adults with intellectual disability: symptoms and challenging behaviour

Psychiatric evaluation of adults with intellectual disability (ID) remains complex because of limitations in verbal abilities, atypical clinical presentation and challenging behaviour. This study examines the clinical presentation of adults with depression compared with bipolar disorder, anxiety disorders and non-psychiatric control patients. This study is a retrospective record review of the initial psychiatric diagnostic evaluation for 300 adult patients with ID drawn from a clinic population. Patients with major depression (n = 85) were compared with those with bipolar disorder (n = 70), anxiety disorders (n = 30) and control patients without psychiatric disorder (n = 27). Key symptoms of depression assessed during the interview were examined as well as challenging behaviour. Three symptoms were useful in differentiating depressed patients from all other groups: sad mood, crying, and anhedonia. Withdrawal, suicidality, and awakening during the night were significant compared with anxiety patients and controls; however, few patients reported suicidality. Bipolar patients were significantly different from depressed patients for elevated mood, acute anger episodes, increase in verbalization, pressure of speech, talk of sexual themes, increase in appetite and poor concentration. Anxiety patients had more fearfulness without withdrawal, sad mood, crying, anhedonia and suicidality. Challenging behaviour was most pronounced in bipolar patients; for depressed patients, aggression and impulsivity were significant compared with anxiety patients and controls. Overall, the control patients presented with few symptoms in any category. Sad mood, crying and anhedonia are key significant features of depression. Most patients with ID cannot meet the required number of DSM criteria or suggested DM-ID adapted criteria for major depression. Many depressive symptoms were reported in modest numbers and this was probably related to deficiencies in self-report or observational skills of caregivers. Challenging behaviour is not diagnostically specific. It is, however, a key atypical feature of depression.

Lamotrigine for the Treatment of Impulsive Aggression and Affective Symptoms in a Patient with Borderline Personality Disorder Comorbid with Body Dysmorphic Disorder

Back to table of contents Previous article Next article LETTERFull AccessLamotrigine for the Treatment of Impulsive Aggression and Affective Symptoms in a Patient with Borderline Personality Disorder Comorbid with Body Dysmorphic DisorderZoran M. Pavlovic M.D.,Zoran M. Pavlovic M.D.Search for more papers by this author,Published Online:1 Jan 2008AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Many psychiatric disorders are characterized by impulsive auto-hetero-aggression and violence which are manifested as suicide attempts, self-injurious behavior, or physician-directed violence or domestic violence. The consequences of these behaviors significantly increase costs as they often lead to the patient’s hospitalization and/or property destruction. Borderline personality disorder and body dysmorphic disorder share some similarities such as impulsive aggression, anger, hostility, and irritability associated with moderate to severe depressive symptoms. Pharmacological approaches to borderline personality disorder have focused mostly on the mood and impulsive aggressive domains, thus leading to the frequent use of combination treatments, mainly selective serotonin reuptake inhibitors (SSRIs), atypical antipsychotics, and mood stabilizers such as carbamazepine or valproate. 1 As for body dysmorphic disorder, SSRIs like fluvoxamine have proven to be beneficial in reducing depressive symptoms, anxiety symptoms, and anger outbursts. 2Lamotrigine is a mood stabilizer with antidepressant properties which has been approved for acute treatment maintenance of bipolar depression; as an anticonvulsant it might possess an anti-aggressive effect.Our patient was a 26-year-old man diagnosed with borderline personality disorder disorder at the age of 19. He was twice hospitalized mainly due to frequent episodes of inappropriate anger or rage, aggression toward parents, and self-injurious behavior. During our interview we also diagnosed presence of body dysmorphic disorder. His major complaints were depressed mood, loss of interest, irritability, impulsive behavior, and anger outbursts. His depressive symptoms were rated moderately severe—18 points on Hamilton Depression Rating Scale (HAM-D)—while his impulsive aggression was measured with the Overt Aggression Scale (total score=35). We initiated treatment with lamotrigine, 200 mg/day, in order to reduce both symptom domains. We made this decision as the patient responded poorly to the treatment with SSRI and serotonin-norepinephrine reuptake inhibitor antidepressants and second generation antipsychotics.After 4 weeks of continuous lamotrigine, 200 mg/day, we observed a 50% decrease on the HAM-D, with prominent antiagressive effectiveness (Overt Aggression Scale total score =9). Major benefits were noted on the verbal assault subscale and irritability (4 point decrease). There were no treatment-emergent adverse events.Our case report suggests that lamotrigine might be an appropriate bimodal-action drug, targeting simultaneously impulsive aggression and depressive symptoms. Larger controlled trials are necessary to establish its exact value and effect size for each of these two symptom clusters often present together in various Axis I and Axis II disorders.Private Psychiatry Practice, Belgrade, SerbiaReferences1 . Hollander E, Tracy KA, Swann AC, et al: Divalproex in the treatment of impulsive aggression: efficacy in Cluster B personality disorders. Neuropsychopharmacology 2003; 28:1186–1197Google Scholar2 . Phillips KA, Siniscalchi JM, McElroy SL: Depression, anxiety, anger and somatic symptoms in patients with body dysmorphic disorder. Psychiatr Q 2004; 75:309–320Google Scholar FiguresReferencesCited byDetailsCited byLamotrigine Abolished Aggression in a Patient With Treatment-Resistant Posttraumatic Stress DisorderClinical Neuropharmacology, Vol. 36, No. 3 Volume 20Issue 1 Winter, 2008Pages 121-122 Metrics PDF download History Published online 1 January 2008 Published in print 1 January 2008

Lamotrigine for the Treatment of Impulsive Aggression and Affective Symptoms in a Patient with Borderline Personality Disorder Comorbid with Body Dysmorphic Disorder

Back to table of contents Previous article Next article LETTERFull AccessLamotrigine for the Treatment of Impulsive Aggression and Affective Symptoms in a Patient with Borderline Personality Disorder Comorbid with Body Dysmorphic DisorderZoran M. Pavlovic M.D.,Zoran M. Pavlovic M.D.Search for more papers by this author,Published Online:1 Jan 2008AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Many psychiatric disorders are characterized by impulsive auto-hetero-aggression and violence which are manifested as suicide attempts, self-injurious behavior, or physician-directed violence or domestic violence. The consequences of these behaviors significantly increase costs as they often lead to the patient’s hospitalization and/or property destruction. Borderline personality disorder and body dysmorphic disorder share some similarities such as impulsive aggression, anger, hostility, and irritability associated with moderate to severe depressive symptoms. Pharmacological approaches to borderline personality disorder have focused mostly on the mood and impulsive aggressive domains, thus leading to the frequent use of combination treatments, mainly selective serotonin reuptake inhibitors (SSRIs), atypical antipsychotics, and mood stabilizers such as carbamazepine or valproate. 1 As for body dysmorphic disorder, SSRIs like fluvoxamine have proven to be beneficial in reducing depressive symptoms, anxiety symptoms, and anger outbursts. 2Lamotrigine is a mood stabilizer with antidepressant properties which has been approved for acute treatment maintenance of bipolar depression; as an anticonvulsant it might possess an anti-aggressive effect.Our patient was a 26-year-old man diagnosed with borderline personality disorder disorder at the age of 19. He was twice hospitalized mainly due to frequent episodes of inappropriate anger or rage, aggression toward parents, and self-injurious behavior. During our interview we also diagnosed presence of body dysmorphic disorder. His major complaints were depressed mood, loss of interest, irritability, impulsive behavior, and anger outbursts. His depressive symptoms were rated moderately severe—18 points on Hamilton Depression Rating Scale (HAM-D)—while his impulsive aggression was measured with the Overt Aggression Scale (total score=35). We initiated treatment with lamotrigine, 200 mg/day, in order to reduce both symptom domains. We made this decision as the patient responded poorly to the treatment with SSRI and serotonin-norepinephrine reuptake inhibitor antidepressants and second generation antipsychotics.After 4 weeks of continuous lamotrigine, 200 mg/day, we observed a 50% decrease on the HAM-D, with prominent antiagressive effectiveness (Overt Aggression Scale total score =9). Major benefits were noted on the verbal assault subscale and irritability (4 point decrease). There were no treatment-emergent adverse events.Our case report suggests that lamotrigine might be an appropriate bimodal-action drug, targeting simultaneously impulsive aggression and depressive symptoms. Larger controlled trials are necessary to establish its exact value and effect size for each of these two symptom clusters often present together in various Axis I and Axis II disorders.Private Psychiatry Practice, Belgrade, SerbiaReferences1 . Hollander E, Tracy KA, Swann AC, et al: Divalproex in the treatment of impulsive aggression: efficacy in Cluster B personality disorders. Neuropsychopharmacology 2003; 28:1186–1197Google Scholar2 . Phillips KA, Siniscalchi JM, McElroy SL: Depression, anxiety, anger and somatic symptoms in patients with body dysmorphic disorder. Psychiatr Q 2004; 75:309–320Google Scholar FiguresReferencesCited byDetailsCited byLamotrigine Abolished Aggression in a Patient With Treatment-Resistant Posttraumatic Stress DisorderClinical Neuropharmacology, Vol. 36, No. 3 Volume 20Issue 1 Winter, 2008Pages 121-122 Metrics PDF download History Published online 1 January 2008 Published in print 1 January 2008

Who Are the Children With Severe Mood Dysregulation, a.k.a. “Rages”?

Who Are the Children With Severe Mood Dysregulation, a.k.a. “Rages”?

Antecedents, concomitants and consequences of anger attacks in depression

Anger attacks are episodes of intense anger with autonomic arousal, which occur in response to often trivial provocations. This study explores some of the antecedents, concomitants, and consequences of anger attacks in patients with depression. The sample comprised three groups: depression with anger attacks ( n = 20), depression without anger attacks ( n = 20) and normal controls ( n = 20). Subjects were administered the Mini International Neuropsychiatric Interview, the Anger Attack Questionnaire, Irritability, the Depression Anxiety Scale, the State-Trait Anger Expression Inventory, the Psychoticism Extraversion Neuroticism Inventory, the Hassles Scale, the World Health Organization Quality of Life-BREF Version and the Dysfunctional Analysis Questionnaire. Depressed patients with anger attacks exhibited more suicide-related phenomena and dysfunction scores in comparison to depressed patients without anger attacks. Depressed patients with anger attacks also had higher scores of anxiety, irritability, trait-anger, anger-out, anger expression, psychoticism, hassles, and poor quality of life in comparison to the other two groups. In conclusion, anger attacks adversely affect the lives of depressed patients and their family members and may serve as a qualifier for partially distinct syndrome of depression.

A Randomized Controlled Trial of a Cognitive Behavioural Intervention for Anger Management in Children Diagnosed with Asperger Syndrome

The purpose of the study described was to evaluate the effectiveness of a cognitive behavioural intervention for anger management with children diagnosed with Asperger syndrome. Forty-five children and their parents were randomly assigned to either intervention or wait-list control conditions. Children in the intervention participated in six 2-h weekly sessions while parents participated in a larger parent group. Parent reports indicated a significant decrease in episodes of anger following intervention and a significant increase in their own confidence in managing anger in their child. Qualitative information gathered from parents and teachers indicated some generalization of strategies learned in the clinic setting to both home and school settings. Limitations of the study and suggestions for future research are also discussed.