Irritability Does Not Make a Bipolar Diagnosis, Says Dr Gregory Mattingly

Psych Congress Steering Committee Member Gregory Mattingly, MD, explains why irritability does not make a bipolar disorder diagnosis—as irritability crosses all spectrums—and discusses what "vital statistics" should be known with every patient. Dr Mattingly answered these questions and more in a recent live Q&A session at the virtual Psych Congress Regionals.

Liked this podcast? Click here to listen to Dr Mattingly share tips on choosing between atypical antipsychotics and what place oxcarbazepine and carbamazepine have in the treatment of bipolar disorder.

To register for the next Psych Congress Regionals meeting in your time zone, visit the meeting website.

Gregory Mattingly, MD, is a physician and principal investigator in clinical trials for Midwest Research Group. He is also a founding partner of St Charles Psychiatric Associates. He earned his medical degree at Washington University. Dr Mattingly is a diplomat of the National Board of Medical Examiners. He is an associate clinical professor at Washington University where he teaches psychopharmacology courses for third-year medical students. Dr Mattingly has been a principal investigator in over 200 clinical trials. Dr Mattingly currently serves as the President-Elect for The American Professional Society of ADHD and Related Disorders and is a certified evaluator for the NFL regarding ADHD and head concussions. He also serves on the board of Headway House, a community support program for individuals with chronic mental illness. 

Read the transcript:

We have a question that's a great question, and this is a question that talks about transdiagnostically irritability. [A patient] comes in your office that [has] a mood disorder, they're irritable. What does that mean? Okay. Irritability crosses all spectrums. You can have irritability with post-traumatic stress disorder, you can have irritability with ADHD. You can have irritability with bad anxiety, bad insomnia, bad depression, bad bipolar. Irritability by itself does not make a diagnosis. It hits pretty much all of our psychiatric conditions. Now, we know the flavor of irritability in somebody with bipolar disorder, this driven quality, can be somewhat different for our patients. The volatile nature of irritability we sometimes see with bipolar patients who are stuck in a mixed episode.

But irritability by itself does not separate or differentiate between the psychiatric conditions. We know that irritability is a place that we want to intervene fairly quickly. We know that it can have devastating consequences within a marriage, within a job setting. It increased our patients to encounters with the law. So it's something that transdiagnostically we keep a close eye on. But that by itself does not make a diagnosis between depression versus bipolar disorder. There was a large study that was done here at Washington University, my university, that looked at what were the 5 best ways to separate a kid with bipolar disorder from kids that didn't. [The symptoms that had the best separating diagnostic criteria were:] decrease need for sleep, racing thoughts, unusual grandiosity, bizarre impulsivity, and then hypersexuality.

One last question. How do you use screening instruments? This is a place where I don't call them screening instruments anymore, I call them get your "vital statistics." What would you think of an internist that came in and didn't want to know your blood pressure? What would you think of an internist that didn't want to know If you had a fever? What would you think of an internist that didn't want to know what your heart rate was going? Same thing is true for us.

Our mental health vital statistics, our PHQ-9 to measure the severity of depression and to screen for suicide, MDQ to screen for bipolar, an ADHDRS to screen for cognitive issues and a GAD-7 to screen for anxiety. So those are our mental health vital statistics. It helps you know what flavor of depression. Is this a bipolar depression? Is this an anxious depression? Is this a depression with significant cognitive burden? Those are the vital statistics that we know with each and every patient, the doctors, the nurse practitioners, the therapists.

Let me thank everyone and we look forward to seeing you soon.