Irritable temperament and lifetime psychotic symptoms as predictors of anxiety symptoms in bipolar disorder

Nord J Psychiatry. 2018 Jan;72(1):63-71. doi: 10.1080/08039488.2017.1385851. Epub 2017 Oct 12.


Purpose: Affective temperaments, hopelessness, alexithymia, and anxiety/agitation symptoms may play a significant role in the psychopathological characteristics of bipolar disorder (BD). Here, we aimed to investigate the eventual association between the mentioned explanatory variables and anxiety/agitation symptoms in BD.

Materials and methods: We recruited at the Section of Psychiatry, Department of Neuroscience, University of Genoa (Italy), 92 BD inpatients having a mean age of 52 (±13.8) years. Participants were assessed using specific psychometric instruments. Anxiety/agitation symptoms have been evaluated using the 11-item of the Beck Depression Inventory II (BDI-II).

Results: Overall, 53.8% of participants presented with anxiety/agitation symptoms and 46.2% without. The two groups significantly differed about socio-economic status, lifetime psychotic symptoms, and residual depressive symptoms between episodes. Anxiety/agitation symptoms significantly correlated with irritable affective temperament (r = 0.407; p = .01), hopelessness (r = 0.541; p ≤ .001), difficulty identifying feelings (r = 0.440; p ≤ .001), difficulty describing feelings (r = 0.437; p ≤ .001), and externally oriented-thinking (r = 0.393; p ≤ .001). After multivariate analyses, irritable affective temperament (OR = 2.457, p ≤ .01) and less lifetime psychotic symptoms (OR = 0.007, p ≤ .05) remained the only significant variables associated with anxiety/agitation symptoms.

Conclusions: The generalization of the main findings is limited by the small sample size and cross-sectional study design. Nevertheless, our results suggest that the careful assessment of affective temperaments and psychotic symptoms may help to early identify BD patients suffering from anxiety/agitation symptoms and may allow to perform targeted interventions in the clinical practice.

Keywords: Bipolar disorder; alexithymia; anxiety/agitation symptoms; difficulty describing feelings; difficulty identifying feelings; externally oriented-thinking; hopelessness; irritable affective temperament; lifetime psychotic symptoms.

MeSH terms

  • Adult
  • Aged
  • Anxiety / diagnosis
  • Anxiety / epidemiology
  • Anxiety / psychology*
  • Bipolar Disorder / diagnosis
  • Bipolar Disorder / epidemiology
  • Bipolar Disorder / psychology*
  • Cross-Sectional Studies
  • Female
  • Forecasting
  • Humans
  • Irritable Mood*
  • Italy / epidemiology
  • Male
  • Middle Aged
  • Psychiatric Status Rating Scales
  • Psychotic Disorders / diagnosis
  • Psychotic Disorders / epidemiology
  • Psychotic Disorders / psychology*
  • Temperament*