Source: DGNews  |  Posted 9 years ago

By Roberta Friedman, PhD

SAN FRANCISCO, CA -- May 22, 2003 -- Practitioners can get a better handle on the irritability expressed by their female patients with a new scale for rating the severity of irritability in women with emotional disturbances, according to findings reported here on May 19th at the 156th Annual Meeting of the American Psychiatric Association.

Leslie Born, MsC, a PhD candidate at the University of Toronto, in Toronto, Ontario, Canada, presented data on the new tool showing inner consistency and inter-rater agreement. Born, who works at the St. Joseph's Healthcare Center in Hamilton, Ontario, Canada, said that irritability shows striking gender differences, and that, in fact, all of the existing scales to follow depression were developed by men.

Women will report that they are not depressed but irritable, said Born, "and that doesn't fit with the scales we have so far." The new test "was meant to fill a gap," she said. "This came out of clinical observations (that some) women didn't fit neatly into [Diagnostic and Statistical Manual] categories."

The testing of irritability that Born presented consists of self-rated core items that describe irritability -- annoyance, anger, tension, hostility, and sensitivity. The other part of the test is observer rating of the impact of irritability that Born calls "the burden of disease." This consists of statements elicited by questioning the patients, such as, "can't concentrate," "frustrated," "yelling at family," "moody," "more emotional," "physically tense," and "lowered self-esteem."

The test was developed by working with 121 women, and then validated on a sample of 36. Of these women, 28 were retested. Consistency had an r value of 0.701 (P=0.01). Interobserver consistency had a kappa value of 1.0 for "anger," "annoyance," "hostility," and "sensitivity," and a kappa of.857 for "tension."

Visual analog scales are employed, and the test can be taken in a few minutes, Born said.

The new measure "is meant to help us assess women with problems relating to the reproductive life cycle," said Born, who plans to expand research on the test to see if it picks up change as women are counseled and treated.

"It might help direct treatment choices," she added, noting that irritability responds within 3 to 4 days to selective serotonin reuptake inhibitors, but these drugs take much longer to aid depression. "You may not want to treat (irritability) like major depression, because maybe it's not."

The study was supported by Eli Lilly and Company and the Canadian Institute of Healthcare Research.

[Study title: Irritability in Women: A New Clinical Measure. Abstract NR134]