Irritative Symptoms Research Articles

Within-person pathways among maternal depressive symptoms and offspring internalizing problems from early childhood through adolescence.

The report examined reciprocal within-person associations among maternal depressive symptoms and offspring depressive, anxiety and irritability symptoms from early childhood to adolescence using a random intercept cross-lagged panel model (RI-CLPM). Participants were 609 mother-child dyads participating in the Stony Brook Temperament Study. Child and maternal internalizing symptoms were assessed every 3 years from ages 3 to 15 using maternal report on the Child Behavior Checklist (CBCL) and Diagnostic Inventory for Depression, respectively. At the between-person level, maternal depressive symptoms, and child depressive, anxiety, and irritability symptoms were all positively associated with one another. At the within-person level, greater within-person child anxiety symptoms at age 3 predicted both greater child anxiety and depressive symptoms at age 15 via greater child anxiety from ages 6 to 12, and greater within-person child irritability at age 3 predicted greater maternal depressive symptoms at age 15 via greater child irritability from ages 6 to 12. Findings reveal novel within-person developmental pathways from early childhood internalizing problems to later internalizing problems in both the child and mother. Intervention and prevention efforts should thus focus on early identification and prevention of childhood internalizing symptoms to reduce negative effects on both child and parent symptoms.

The impact of COVID-19 lockdown restrictions on the short-term association between in-vehicle particulate pollutants and the respiratory health of Parisian taxi drivers.

This study assessed the short-term associations between in-vehicle ultrafine particles (UFP) and black carbon (BC) concentrations and irritation symptoms and lung parameters of taxi drivers, pre- and post-lockdown. As part of PUF-TAXI project, 33 taxi drivers were followed up during two typical working days. In-vehicle UFP and BC were continuously measured by monitoring instruments. Irritation symptoms during the working day were reported via an auto-questionnaire and lung function was assessed by a portable spirometer, pre- and post- work shift. Generalized estimating equations, adjusted for potential confounders, were used to study the association between air pollutants and health outcomes. Effect modification by measurement period (pre- and post-lockdown) was investigated. UFP and BC concentrations inside taxi vehicles decreased significantly post- compared to pre-lockdown. Incidence of nose irritation was positively associated with in-vehicle UFP and BC levels pre-lockdown, when pollutant levels were higher, whereas no significant association was found post-lockdown. The decrease in the FEF25-75% (forced expiratory flow at 25-75% of the forced vital capacity) during the working day was significantly associated with in-taxi UFP levels before but not after lockdown. No association was found with BC. By contrast, incidence of eye irritation was significantly inversely associated with in-vehicle humidity, regardless of pollutant concentrations and the measurement period. Our findings indicate that an upgrade in in-vehicle air quality could improve respiratory health. This study showed that the magnitude of the incidence of nasal irritation and decrease in lung function depends on UFP concentrations the commuters are exposed to.

Symptoms of major depressive disorder and post-traumatic stress disorder in veterans with mild traumatic brain injury: A network analysis.

Mild Traumatic Brain Injury (mTBI, or concussion) is a debilitating condition that often leads to persistent cognitive and mental health problems post-injury. Post-traumatic Stress Disorder (PTSD) and Major Depressive Disorder (MDD) are two most commonly occurring mental health problems following mTBI and are suggested to be strong contributors to the persistent post-concussion symptoms. Thus, it is important to understand the symptomatology of PTSD and MDD post-mTBI, to better inform targets for behavioral health interventions. Therefore, the current study examined the symptom structure of post-mTBI co-morbid PTSD and MDD through network approaches; we compared the network structure of participants with a positive mTBI screen (N = 753) to the network structure of participants with a negative mTBI screen (N = 2044); lastly, we examined a network of PTSD and MDD symptoms with clinical covariates in a positive mTBI sample. We found that feeling distant/cutoff (P10) and difficulty concentrating (P15) were the most central symptoms in the positive mTBI network and sleep problems were the most prominent bridge nodes across the disorders. No significant difference between the positive and negative mTBI network were found through network comparison tests. Moreover, anxiety and insomnia were strongly associated with sleep symptoms and irritability symptoms, and emotional support and resilience were potential buffers against most of the PTSD and MDD symptoms. The results of this study might be particularly useful for identifying targets (i.e., feeling distant, concentration and sleep problems) for screening, monitoring and treatment after concussion to better inform post-mTBI mental health care and to improve treatment outcomes.

Predictors of clinical and surgical characteristics of giant stones of the urinary bladder: a retrospective study

BackgroundGiant stones of the urinary bladder (GSBs) are rare and usually presented as case reports. We aimed to assess the clinical and surgical characteristics of GSBs and identify their predictors.MethodsA retrospective study of 74 patients with GSBs who presented between July, 2005 and June, 2020 was performed. Patients’ demographics, clinical presentations, and surgical peculiarities were studied.ResultsOlder age and male gender were risk factors for the occurrence of GSBs. The irritative lower urinary tract symptoms (iLUTS) were the main presenting symptoms (97.3%). Most patients were treated with cystolithotomy (90.1%). Univariate analyses showed that solitary (p < 0.001) and rough surface (P = 0.009) stones were significant factors for occurrence of iLUTS as the presenting symptoms. Also, the severity of symptoms (p = 0.021), rough surface (p = 0.010) and size (p < 0.001) of stones, and farmer occupation (p = 0.009) were significantly associated with adherence of the stone to the bladder mucosa at surgery. In multivariate analysis, the rough surface (p = 0.014) and solitary (p = 0.006) stones, and concomitant ureteral stones (p = 0.020) were independently associated with iLUTS as the main presentation. However, the stone size and severity of iLUTS were the independently associated factors for adherence of GSBs to the bladder mucosa.ConclusionsSolitary GSB, rough surface and the association with ureteral stones are independent risk factors for the occurrence of long-standing iLUTS. The stone size and severity of iLUTS were the independent predictors of adherence of GSBs to the bladder mucosa. Cystolithotomy is the main treatment, but it may be more difficult when there is bladder mucosa adherence.

Alcohol use disorder treatment delivered outside hepatology clinic.

Alcohol use disorder treatment delivered outside hepatology clinic.

Maintenance of intestinal epithelial barrier integrity by a combination of probiotics, herbal extract, and vitamins.

Irritable bowel syndrome (IBS) and Inflammatory bowel disease (IBD) are pathological conditions that severely hamper the quality of life of patients. Especially in pediatric and adolescent patients, the use of Complementary and alternative medicine is an appealing approach as an adjuvant for the management of symptoms, limiting the detrimental effect of the conventional therapy. In this work, we tested the effect of Enterokind Junior (EntJ), a mix of two probiotic strains Lactobacillus reuteri DSM 25175 and Lactobacillus acidophilus DSM 24936, Matricaria Chamomilla, and vitamins, in in vitro model of intestinal inflammation. Caco-2 cells were subjected to LPS treatment or THP-1 cells stimulated with LPS treatment, as paradigms of inflammatory conditions. The effect of the probiotic formulation was evaluated by measuring Caco-2 monolayer's Transepithelial Electrical resistance (TEER) and paracellular permeability alterations, tight junction proteins expression and localization by confocal microscopy, and release of pro-inflammatory cytokines (TNF-α and IL-8) by ELISA assay. Results demonstrated that upon impairment of intestinal parameters induced by inflammatory stimuli, the combination of probiotic was able to prevent TEER decrease and paracellular permeability alterations and to maintain the tight junction expression and localization. Moreover, the release of proinflammatory cytokines induced by inflammation was reduced by EntJ treatment. This work, in line with previous observations, supports a protective role of Lactobacillus reuteri DSM 25175, Lactobacillus acidophilus DSM 24936 and the other components in the maintenance of a healthy gut, holding up the use of this combination as an adjuvant for irritable bowel syndrome-related symptoms management.

Effects of repetitive head trauma on symptomatology of subsequent sport-related concussion.

Adolescent participation in athletics continues to grow, leading to an increasing incidence of sports-related concussion (SRC). The current literature suggests that a greater number of prior concussions positively correlates with a greater number of total symptoms, but the specific concussion-related symptoms are not as well defined. The current study investigated the effects of prior recurrent head injury on the symptom profiles of student-athletes after another suspected concussion. A multicenter database consisting of 25,815 Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) results was filtered for student-athletes aged 12-22 years old who competed in 21 different sports. Patients were separated into 2 cohorts: athletes reporting a single prior concussion (SRC1) and athletes reporting 2 or more prior concussions (SRC2+). Comparisons were assessed for differences in 22 symptoms and 4 symptom clusters at baseline, first postinjury test (PI1), and second postinjury test (PI2) by using univariate and multivariate analyses. No differences were seen between SRC1 (n = 2253) and SRC2+ (n = 976) at baseline. At PI1, the SRC2+ group (n = 286) had lower severity of headaches (p = 0.04) but increased nervousness (p = 0.042), irritability (p = 0.028), sadness (p = 0.028), visual problems (p = 0.04), and neuropsychiatric symptoms (p = 0.009) compared with SRC1 (n = 529). Multivariate analysis revealed decreased headache severity with increased prior concussion (β = -0.27,95% CI -0.45 to -0.09, p = 0.003). Multivariate analysis at PI2 demonstrated the SRC2+ cohort (n = 130) had increased cognitive (β = 1.22, 95% CI 0.27-2.18, p = 0.012), sleep (β = 0.63, 95% CI 0.17-1.08, p = 0.007), and neuropsychiatric (β = 0.67,95% CI 0.14-1.2,0.014) symptoms compared with SRC1 (n = 292). At longitudinal follow-up, patients with a history of recurrent concussions reported greater symptom burden in cognitive, sleep, and neuropsychiatric symptom clusters but not migraine symptoms. This is an important distinction because migraine symptoms are often more easily distinguishable to patients, parents, and physicians. Careful assessment of specific symptoms should be considered in patients with a history of recurrent head injury prior to return to play.

Guar fibers and simethicone: a winning synergy for the treatment of IBS. An observational comparative study of irritable bowel symptoms

BACKGROUND: Irritable bowel syndrome (IBS) affects a substantial quote of adult subjects. Alternate bowel movements and flatulence are the prevalent symptoms in IBS patients. A new medical device containing partially hydrolyzed gum guar (PHGG) and simethicone is presently available also in Italy. The present preliminary experience explored its usefulness in IBS patients.METHODS: After a negative colonoscopy, IBS patients were subdivided into two groups: Group A took a two-month cycle of the MD, whereas Group B did not take the medical device (MD). However, all patients had a standard management (diet and medications). The Visual Analogue Scale (VAS) measured the perception of symptom severity (abdominal pain, distention, flatulence, constipation, diarrhea, and incomplete bowel movement). Patients were evaluated at baseline and after 4 and 8 weeks.RESULTS: This preliminary experience included 50 patients (30 females and 20 males; mean age of 45.1 years). The medical device significantly reduced abdominal pain, distension, and flatulence in comparison with standard therapy alone (P<0.001, 0.042, and <0.01, respectively) after 8 weeks. Interestingly, abdominal distension was significantly improved just after 4 weeks (P=0.031). The treatment was well tolerated.CONCLUSIONS: The current preliminary experience showed that PHGG plus simethicone may represent an effective and safe add-on option in managing IBS patients. Therefore, this MD could be considered in the IBS management, mainly concerning the pathophysiological role exerted by intestinal barrier alterations and the microbiota-host interaction.

Knowledge, attitude, experience and management on premenstrual syndrome among secondary level adolescence girl students of Kirtipur Municipality, Kathmandu, Nepal

Background: Premenstrual syndrome (PMS) is a common menstrual disorder that affects the quality of life of women. The objective of this study is to identify the knowledge, attitude, experience and management on pre-menstrual syndrome among higher secondary level adolescence girls’ students of Kirtipur Municipality of Kathmandu district.&#x0D; Methods: A descriptive cross-sectional study was conducted among 322 adolescence girl students of higher secondary school of Kritipur Municipality using pre-tested self-administered questionnaire.&#x0D; Results: The mean age of the respondents was 17 years. It was found that 90.2% of the respondent had very poor knowledge on premenstrual syndrome and 9.2% of the respondent had fair /below average knowledge regarding PMS. The level of knowledge among the study participants was found statistically significant with education status of mother (p=0.002) and that of father (p=0.013). The prevalence of PMS among the female students of higher secondary level was found to be high (77%). Considerably high proportion of the participants reported having at least one somatic and one affective symptoms of premenstrual syndrome. The most frequent affective symptoms experienced by the respondents were mood swings, headache, irritability and somatic symptom was acnes in this study.&#x0D; Conclusions: Majority of the respondents had poor knowledge and extremely negative attitude towards PMS. High proportion of the participants reported having at least one somatic and one affective symptom of PMS. Comprehensive education on menstrual health and PMS can be suggested for the adolescence girl in school level.

Irritability in bipolar disorder and unipolar disorder measured daily using smartphone‐based data: An exploratory post hoc study

To investigate (i) the proportions of time with irritability and (ii) the association between irritability and affective symptoms and functioning, stress, and quality of life in patients with bipolar disorder (BD) and unipolar depressive disorder (UD). A total of 316 patients with BD and 58 patients with UD provided self-reported once-a-day data on irritability and other affective symptoms using smartphones for a total of 64,129 days with observations. Questionnaires on perceived stress and quality of life and clinical evaluations of functioning were collected multiple times during the study. During a depressive state, patients with UD spent a significantly higher proportion of time with presence of irritability (83.10%) as compared with patients with BD (70.27%) (p = 0.045). Irritability was associated with lower mood, activity level and sleep duration and with increased stress and anxiety level, in both patient groups (p-values<0.008). Increased irritability was associated with impaired functioning and increased perceived stress (p-values<0.024). In addition, in patients with UD, increased irritability was associated with decreased quality of life (p = 0.002). The results were not altered when adjusting for psychopharmacological treatments. Irritability is an important part of the symptomatology in affective disorders. Clinicians could have focus on symptoms of irritability in both patients with BD and UD during their course of illness. Future studies investigating treatment effects on irritability would be interesting.

Mid-term follow-up evaluation of a new arthroscopic Broström procedure for chronic lateral ankle instability

BackgroundChronic lateral ankle instability (CLAI) usually progresses from a previous lateral ankle sprain that was not treated properly. Several procedures have been introduced to address these patients, including open or arthroscopic techniques, the most common of which is the Broström procedure. Here, we describe a new outside-in arthroscopic Broström procedure and its results for treating patients with CLAI.MethodsThirty-nine patients (16 male and 23 female; mean age, 35 years [range, 16–60 years]) with CLAI were treated arthroscopically after failing non-operative management. All patients were symptomatic with a combination of recurrent ankle sprains, “giving way,” and avoidance of sports and presented with a positive anterior drawer test upon the physical examination. All patients underwent arthroscopic lateral ligament reconstruction using the new technique. Patient characteristics and pre- and postoperative visual analog scale (VAS), American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale system (AOFAS), and Karlsson scores were recorded.ResultsThe mean AOFAS score increased from 48 (mean 48, range 33–72) preoperatively to 91 (mean 91, range 75–98) at the final follow-up, Karlsson–Peterson and FAAM scores were also significantly improved. Two patients (5.13%) reported superficial peroneal nerve irritation symptoms postoperatively. Three patients (7.69%) complained of mild pain anteroinferior to the lateral ankle.ConclusionsThe arthroscopic outside-in Broström procedure with a single suture anchor was a safe, effective, and reproducible technique for CLAI. Ankle stability resumed with a high clinical success rate. The main complication was injury to the superficial peroneal nerve, which crossed the area of repair.

Risk factors-related first episode postpartum psychosis among Egyptian women: the role of psychosocial and the biological factors

BackgroundThe risks associated with postpartum psychosis (PP) are poorly recognized in Egyptian women. We aimed to study the role of sociodemographic, psychosocial, obstetric, and biological factors in the occurrence of PP within 4 weeks after delivery in a sample of Egyptian women. We included 60 women with PP and 30 postpartum women without psychosis. All participants underwent a full medical assessment and psychiatric assessment using the Holmes and Rahe Stress Scale, the Brief Psychiatric Rating Scale (BPRS), and hormonal assessment (including estrogen levels and thyroid function tests) were performed for each woman.ResultsThe mean age of pregnancy of women with PP was significantly younger than that of controls (19.2 ± 2.04 years versus 24.37 ± 4.92 years). PP was significantly more common among primipara (73.3%), women who underwent cesarean sections (58.3%) and had thyroid dysfunction. The rates of low birth weight, and premature delivery were significantly higher among women with PP than among those without PP. The mean time-lapse from parturition to the onset of PP symptoms was 6.11 ± 1.62 days. Sleep disturbance, and irritability symptoms were the earliest symptoms of PP in our study. Plasma estrogen levels were significantly correlated with the total BPRS scores in patients with PP (P = 0.001).ConclusionsYoung age, primiparity, low birth weight, cesarean delivery, a rapid drop in the estrogen level and thyroid dysfunction all could contribute to the occurrence of PP.

A study of post-traumatic stress disorder in schizophrenic patients 35 years after experiencing the Tangshan earthquake.

This study aimed to investigate the relationship between dissociative experiences, post-traumatic stress disorder (PTSD), and psychiatric symptoms exhibited byschizophrenic patients 35 years after the Tangshan earthquake. Seventy-one schizophrenic patients who had experienced the Tangshan earthquake were selected and evaluated by the Post-traumatic DissociativeExperience Questionnaire (PDEQ), thPTSD Checklist-Civilian Version (PCL-C), and the Positive and Negative Symptom Scale (PANSS). The score of Group B (re-experiencing symptoms) in PCL-C was significantly positively correlated with age and significantly negatively correlated with the course of schizophrenia. Both gender and marriage were significantly positively correlated with the score of PCL-C Group D (irritability symptoms caused by hyperarousal). The PDEQ score was negatively correlated with thecourse of schizophrenia and positively correlated with the presence of sleep difficulties. Significant differences were foundbetween the PCL-C scores of the positive and negative symptoms of the three core symptom groups; the positive rate of Group B was significantly higher than that of Group D, and the positive rate of Group C was significantly higher than that of Group D. The PCL-C total score was positively correlated with the negative symptom factor score of PANSS; Group C's symptoms were significantly negativelycorrelated with the positive factor score of PNASS; andGroup D's' symptoms were significantly negatively correlated with the PANSS total score and thepositive factor score. When consiering patients with schizophrenia post the Tangshan earthquake, age, gender, and marital status were all positively correlated with PTSD. The course of schizophrenia was negatively associated with PTSD and dissociative experiences. PTSD was positively correlated with the negative symptoms of schizophrenia and negatively correlated with the positive symptoms of schizophrenia. Thus, the conditions and symptoms of PTSD may interact with those of schizophrenia.

Neural correlates of irritability symptom relief in adolescents pre- and post-trauma-focused cognitive behavioral therapy: A pilot study on reward processing

Despite that Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is a first-line, evidence-based treatment for youths experiencing trauma-related symptoms, treatment responses vary and it remains unclear for whom and how this treatment works. In this context, we examined pre-treatment neural reward processing and pre- vs. post-treatment changes in neural reward processing, in relation to irritability – a transdiagnostic and dimensional feature present in multiple trauma-related syndromes, following TF-CBT. Adolescents (N = 22) with childhood trauma history completed a child-friendly monetary incentive delay task during fMRI acquisition, prior to and after the treatment, and irritability symptoms were assessed at five time points over the course of the treatment. Individual irritability slopes (i.e., irritability change rate) and intercepts (i.e., initial irritability level), generated by linear growth curve modeling, were integrated with fMRI data. Repeated ANCOVAs demonstrated that both pre-treatment neural response to reward and pre- vs. post-treatment changes in neural reward processing correlated with irritability symptom relief, such that opposite baseline neural reward processing profiles and differential changing patterns were observed in individuals showing irritability symptom relief vs. not. Together, our findings provide proof of concept that integrating brain information with clinical information has the potential to identify predictors and mechanisms of symptom relief.

A Computational Model Reveals Learning Dynamics During Interpretation Bias Training With Clinical Applications

BackgroundSome psychopathologies, including anxiety and irritability, are associated with biases when judging ambiguous social stimuli. Interventions targeting these biases, or interpretation bias training (IBT), are amenable to computational modeling to describe their associative learning mechanisms. Here, we translated ALCOVE (attention learning covering map), a model of category learning, to describe learning in youths with affective psychopathology when training on more positive judgments of ambiguous face emotions. MethodsA predominantly clinical sample comprised 71 youths (age range, 8–22 years) representing broad distributions of irritability and anxiety symptoms. Of these, 63 youths were included in the test sample by completing an IBT task with acceptable performance for computational modeling. We used a separate sample of 28 youths to translate ALCOVE for individual estimates of learning rate and generalization. In the test sample, we assessed associations between model learning estimates and irritability, anxiety, their shared variance (negative affectivity), and age. ResultsAge and affective symptoms were associated with category learning during IBT. Lower learning rates were associated with higher negative affectivity common in anxiety and irritability. Lower generalization, or improved discrimination between face emotions, was associated with increasing age. ConclusionsThis work demonstrates a functional consequence of age- and symptom-related learning during interpretation bias. Learning measured by ALCOVE also revealed learning types not accounted for in the prior literature on IBT. This work more broadly demonstrates the utility of measurement models for understanding trial-by-trial processes and identifying individual learning styles.

Suicidality risk in children and adolescents with externalizing disorders: symptoms profiles at high risk and the moderating role of dysregulated family relationships.

Children and adolescents with externalizing disorders are at risk for suicidal ideation or behavior. Factors that put them at risk could be symptoms related or facilitated by their environment. We evaluated the links of symptoms profiles with suicidality, and the effects of family relationship characteristics on these links. Latent profile analysis was used to subgroup participants referred for ADHD assessment (n = 1249, aged 6-17) based on their externalizing and internalizing symptoms. Self- and parent-reported child suicidal ideation (S-SI, P-SI), and parent-reported self-harm behavior (P-SHB) were compared across profiles. The moderating effects of parent-reported marital conflict and parenting practices were examined. A four-profile model showed optimal fit. Participants of the Low Symptoms profile followed by the Inattentive-Hyperactive/Impulsive profile showed lower P-SI compared to those of the Irritable-Defiant and the Conduct Problems profiles. Low Symptoms participants also reported lower S-SI compared to those of the Inattentive-Hyperactive/Impulsive and the Irritable-Defiant profiles. Participants of the Irritable-Defiant and the Conduct Problems profiles had higher P-SHB compared to the Low Symptoms and the Inattentive-Hyperactive/Impulsive participants. Dysregulated marital conflict practices were associated with greater increase in P-SI in all profiles compared to the Low Symptoms profile. Aggressive marital conflict practices were associated with increased P-SHB in the Conduct Problems profile compared to the Inattentive-Hyperactive/Impulsive profile. Children and adolescents with irritability and defiance symptoms with or without conduct problems show higher risk for suicidal ideation and behavior compared to those with ADHD symptoms alone. Dysregulated and aggressive marital conflict practices might pose additional suicidality risk in children and adolescents with disruptive behavior.

The relationship between irritability, depression and anxiety among Chinese college students during the COVID-19 pandemic: A network analysis

IntroductionIrritability, a common symptom included in the 5th Edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5), is thought to be associated with multiple emotional disorders. It is commonly seen among college students in isolation during the COVID-19 pandemic. However, its relation with anxiety and depression remains unclear. We aim to study the relation of irritability, anxiety and depression in Chinese college students during the COVID-19 pandemic by using network analysis to understand the co-occurrence of these three disorders.MethodsDuring the COVID-19 pandemic, we recruited 1516 college students from five general universities in China to complete the Irritability, Depression and Anxiety Scale (IDA-S) to analyze the symptom network of irritability, depression and anxiety. Specifically, we assessed the indices of strength centrality and bridge strength for each node in the network.ResultsSome strongest linkages were found among anxiety symptoms “nervous” and “panic” (weight = 0.36), depression symptoms “sad mood” and “amused” (weight = 0.32), inward irritability items “self-hurt” and “self-harm” (weight = 0.32) and outward items “rough” and “aggressive” (weight = 0.28). The anxiety symptom “panic” had the highest strength value, followed by the inward irritability symptom “annoyed”. The nodes “ease” and “sleep” had the lowest strength value. In addition, the anxiety symptom “relax” had the highest bridge strength value, followed by inward irritability symptom “annoyed”.ConclusionThis study explored the characteristics of a network of irritability, depression and anxiety symptoms among Chinese college students during the COVID-19 pandemic. We found that anxiety and irritability symptoms played an important role in the network. The findings provide evidence for prevention and intervention for college students' mental health problems during the COVID-19 pandemic.

Robust caregiver-youth discrepancies in irritability ratings on the affective reactivity index: An investigation of its origins

ObjectiveThe Affective Reactivity Index (ARI) is widely used to assess young people's irritability symptoms, but youth and caregivers often diverge in their assessments. Such informant discrepancy might be rooted in poor psychometric properties, the differential conceptualization of irritability across informants, or reflect sociodemographic and clinical characteristics. We use an out-of-sample replication approach and leverage longitudinal data, available for a subset of the participants, to test these hypotheses. MethodAcross two independent samples (NCohort-1 = 765, 8–21 years; NCohort-2 = 1910, 6–21 years), we investigate the reliability and measurement invariance of the ARI, examine sociodemographic and clinical predictors of discrepant reporting and probe the utility of a bifactor model for cross-informant integration. ResultsDespite good internal consistency and 6-week-retest-reliability of parent (Cohort-1: α = 0.92, ICC = 0.85; Cohort-2: α = 0.93) and youth forms (Cohort-1: α = 0.88, ICC = 0.78; Cohort-2: α = 0.82), we confirm substantial informant discrepancy in ARI ratings (3 points on a scale from 0 to 12), which is stable over six weeks (ICC = 0.53). Measurement invariance across informants was weak, indicating that parents and youth may interpret ARI items differently. Irritability severity and diagnostic status predicted informant-discrepancy, albeit in opposing directions: higher severity was linked to relative, higher irritability-ratings by youth (Cohort-1: β = −0.06, p < .001; Cohort-2: β = −0.06, p < .001), while diagnoses of Disruptive Mood Dysregulation Disorder (Cohort-1: β = 0.44, p < .001; Cohort-2: β = 0.84, p < .001) and Oppositional Defiant Disorder (Cohort-1: β = 0.41, p < .001; Cohort-2: β = 0.42, p < .001) predicted relative higher irritability-ratings by caregivers. In both datasets, a bifactor model parsing informant-specific from shared irritability-related variance fit the data well (CFI = 0.99, RMSEA = 0.05; N2: CFI = 0.99; RMSEA = 0.04). ConclusionParent and youth ARI reports and their discrepancy are reliable and reflect different interpretations of the scale items; hence they should not be averaged. This finding also suggests that irritability is not a unitary construct. Future work should investigate and model how different aspects of irritability might differ in their impact on the responses of specific informants.

Clinical portrait of an "ordinary" patient with benign prostatic hyperplasia and the efficacy of treating lower urinary tract symptoms

Introduction. Benign prostatic hyperplasia (BPH) is a common condition in aging men that is often associated with lower urinary tract symptoms (LUTS).Objective. To determine the clinical portrait of an "ordinary" patient with benign prostatic hyperplasia and develop an algorithm for improving the efficacy of treating lower urinary tract symptoms in benign prostatic hyperplasia.Materials &amp; methods. The study included 112 BPH-patients who received tamsulosin therapy or a combination of tamsulosin + solifenacin for three months. After three months of therapy, the patients were divided into two groups depending on the effectiveness of therapy: group 1 — a positive result (n = 77); group 2 — no positive effect (n = 35). Due to the lack of efficacy in patients of group 2, a multichannel urodynamics was performed, according to the results of which the patients were prescribed treatment with a subsequent assessment of the result after 3 months.Results. After 3 months of therapy in patients of group 1, a decrease in pollakiuria was noted. Regression of obstructive and irritative symptoms was also observed, and the urination-associated quality of life (QoL) improved. The maximum urine flow rate (Q max) remained unchanged mainly. By the sixth month, the frequency of urination continued to decrease (11.05 vs 9.32 episodes; p = 0.022), as well as the improvement of other parameters (IPSS, QoL, Q max and post-void residual urine volume (PVR) (80.87 vs 56.17 ml; p = 0.012). The indicators of patients of group 2 following three months of therapy remained without significant changes. Sixteen patients underwent transurethral prostate resection, 19 patients underwent therapy correction, which allowed reducing the number of episodes of daily pollakiuria. The total IPSS score decreased by 4.37 compared to baseline (IPSS (obstructive) — 13.79 vs 7.26 pts; p = 0.032). The QoL value was 2.84 pts, Q max — 14.90 mL/s, PVR — 10.58 mL.Conclusion. 19.8% of BPH-patients are resistant to drug therapy. The ineffectiveness of therapy may be due to the severe BOO. In the absence of the effect of the therapy within 3 months, it is recommended to perform multichannel urodynamics. Correction of therapy according to the multichannel urodynamics data improves its effectiveness by the sixth month of treatment. Indicators of IPSS, Q max and PVR after 3 months of therapy allow predicting the effectiveness of therapy, or suspect the need for surgical treatment.

The phenotype of Graves' orbitopathy is associated with thyrotropin receptor antibody levels.

Graves' orbitopathy (GO) is a specific inflammatory disorder of the orbit characterized by a highly heterogeneous clinical phenotype. The role of thyrotropin receptor antibodies (TSH-R-Ab) has been widely researched, however there is still no evidence that these antibodies have a direct pathogenic role in this pathology. The aim of this study was to examine their relation to the individual clinical features of GO. Ninety-one consecutive patients with GO were recruited. Total antibody concentration (TSH-R binding inhibitory immunoglobulins, TBII) and their functional activity (stimulating TSH-R-Ab, TSAb) were measured using binding immunoassay and cell-based bioassay, respectively. Both TSAb and TBII levels were significantly associated to the clinical parameters of GO activity. TSAb was a more sensitive serological marker compared to TBII pertaining to eyelid retraction and edema, proptosis, extra-orbital muscle disorders, diplopia, irritable eye symptoms, and photophobia. TSAb, but not TBII, was a significant predictive marker of conjunctival redness, chemosis, caruncle/plica inflammation, eye irritation, and orbital pain, (odds ratio: 3.096, p = 0.016; 5.833, p = 0.009; 6.443, p = 0.020; 3.167, p = 0.045; 2.893, p = 0.032; versus 2.187, p = 0.093; 2.775, p = 0.081; 3.824, p = 0.055; 0.952, p = 0.930; 2.226, p = 0.099, respectively). Neither TSAb nor TBII correlated with the level of proptosis (ρ = 0.259, p = 0.090, and ρ = 0.254, p = 0.104, respectively), however rising TSAb levels were strongly associated to the level of proptosis. TSH-R-Ab were significantly associated with GO's phenotype. Especially TSAb, as a sensitive and predictive serological biomarker, can improve diagnosis and management of GO.