The Journal of Clinical Psychiatry最新文献

{"title":"Ineligibility for and Refusal to Participate in Randomized Controlled Trials That Have Studied Impact on Suicide-Related Outcomes in the United States: A Meta-Analysis.","authors":"Ryoko Susukida,&nbsp;Masoumeh Amin-Esmaeili,&nbsp;Taylor C Ryan,&nbsp;Hadi Kharrazi,&nbsp;Renee F Wilson,&nbsp;Rashelle J Musci,&nbsp;Allen Zhang,&nbsp;Lawrence Wissow,&nbsp;Karen A Robinson,&nbsp;Holly C Wilcox","doi":"10.4088/JCP.20r13798","DOIUrl":"https://doi.org/10.4088/JCP.20r13798","url":null,"abstract":"<p><p><b><i>Objective:</i></b> Ineligibility for and refusal to participate in randomized controlled trials (RCTs) can potentially lead to unrepresentative study samples and limited generalizability of findings. We examined the rates of exclusion and refusal in RCTs that have studied impact on suicide-related outcomes in the US.</p><p><p><b><i>Data Sources:</i></b> PubMed, the Cochrane Library, the Campbell Collaboration Library of Systematic Reviews, CINAHL, PsycINFO, and Education Resources Information Center were searched from January 1990 to May 2020 using the terms (<i>suicide prevention</i>) AND (<i>clinical trial</i>).</p><p><p><b><i>Study Selection:</i></b> Of 8,403 studies retrieved, 36 RCTs assessing effectiveness on suicide-related outcomes in youth (≤ 25 years old) conducted in the US were included.</p><p><p><b><i>Data Extraction:</i></b> Study-level data were extracted by 2 independent investigators for a random-effects meta-analysis and meta-regression.</p><p><p><b><i>Results:</i></b> The study participants (N = 13,264) had a mean (SD) age of 14.87 (1.58) years and were 50% male, 23% African American, and 24% Hispanic. The exclusion rate was 36.4%, while the refusal rate was 25.5%. The exclusion rate was significantly higher in the studies excluding individuals not exceeding specified cutoff points of suicide screening tools (51.2%; adjusted linear coefficient [β] = 1.30, standard error [SE] = 0.15; <i>P</i> = .041) and individuals not meeting the age or school grade criterion (45.9%; β = 1.37, SE = 0.13; <i>P</i> = .005).</p><p><p><b><i>Conclusions:</i></b> The rates of exclusion and refusal in youth prevention interventions studying impact on suicide-related outcomes were not as high compared to the rates found in other mental and behavioral interventions. While there was strong racial/ethnic group representation in RCTs examining youth suicide-related outcomes, suicide severity and age limited eligibility.</p>","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2022-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39636531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective Memory Influences Social Functioning in People With First-Episode Schizophrenia: A Network Analysis and Longitudinal Study.","authors":"Simon S Y Lui,&nbsp;Rui-Ting Zhang,&nbsp;Wilson Y S Lau,&nbsp;Amy C Y Liu,&nbsp;William W H Chui,&nbsp;Ya Wang,&nbsp;Kirby C M Tsang,&nbsp;Hera K H Yeung,&nbsp;Eric F C Cheung,&nbsp;Raymond C K Chan","doi":"10.4088/JCP.21m14114","DOIUrl":"https://doi.org/10.4088/JCP.21m14114","url":null,"abstract":"<p><p><b><i>Background:</i></b> Prospective memory (PM) impairment is associated with impaired social functioning, but evidence is limited to chronic schizophrenia samples and cross-sectional design. The aim of this study was to utilize network analysis to address the complex interplay between PM, psychopathology, and functional outcome.</p><p><p><b><i>Methods:</i></b> This longitudinal study recruited 119 people with first-episode <i>DSM-IV</i> schizophrenia and followed up with them for 2 to 6 years. PM and working memory were assessed at baseline (in 2010-2015) using valid computerized tasks and the Letter-Number Span Test, respectively. Psychopathology and social functioning were assessed at endpoint (in 2016-2017) using the Positive and Negative Syndrome Scale (PANSS) and the Social and Occupational Functioning Assessment Scale (SOFAS), respectively. Network analysis examined the effect of baseline PM on SOFAS while accounting for the effects of psychopathology.</p><p><p><b><i>Results:</i></b> The resultant network showed that social functioning, PANSS positive symptoms, and PANSS general symptoms clustered together, whereas time-based and event-based PM and working memory formed another cluster. Time-based PM linked event-based PM and working memory with social functioning. Time-based PM (expected influence [EI] = 0.69), event-based PM (EI = 0.65), and working memory (EI = 0.83) demonstrated high values of expected influence, but social functioning (variance explained = 0.685) and PANSS negative (variance explained = 0.657) and general (variance explained = 0.583) subscales demonstrated high values of predictability.</p><p><p><b><i>Conclusions:</i></b> Time-based PM is the central node linking neurocognitive functions with social functioning. PM and working memory are \"target\" nodes for interventions bringing changes to the network, whereas social functioning and psychopathology are \"malleable\" nodes. PM and working memory are promising intervention targets for functional recovery in schizophrenia.</p>","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2022-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39906502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Dimensions Associated With Psychological Pain in Suicidal Patients: One-Year Follow-up Study.","authors":"Adrián Alacreu-Crespo,&nbsp;Sebastien Guillaume,&nbsp;Stephane Richard-Devantoy,&nbsp;Aurelie Cazals,&nbsp;Emilie Olié,&nbsp;Philippe Courtet","doi":"10.4088/JCP.21m14065","DOIUrl":"https://doi.org/10.4088/JCP.21m14065","url":null,"abstract":"<p><p><b><i>Objective:</i></b> Psychological pain is a transdiagnostic factor in mental health and a key clinical dimension to understand suicide in patients with mood disorders. However, less is known about the clinical characteristics that predict high psychological pain. The aim of this study was to fill this gap in a sample of patients with mood disorders.</p><p><p><b><i>Methods:</i></b> Inpatients admitted for a major depressive episode, according to <i>DSM-IV</i> criteria, from 2010 to 2017 were divided into 3 groups: 178 recent suicide attempters (within the last 7 days), 101 past suicide attempters (lifetime history of suicide attempt), and 93 nonattempters (no lifetime history of suicidal act). At inclusion, current psychopathology, medication, personality traits (impulsivity, anxiety, hopelessness), and childhood trauma were assessed. At inclusion and at 1-year follow-up, depressive symptomatology and current and maximal (within the 15 last days) psychological and physical pain were assessed.</p><p><p><b><i>Results:</i></b> At baseline, maximal psychological pain was higher in recent than in past suicide attempters (odds ratio [OR] = 1.18 [1.04-1.35]) and nonattempters (OR = 1.32 [1.16-1.50]). In the multivariate model, depression severity (OR = 1.11 [1.08-1.16]) and worst physical pain (OR = 2.53 [1.28-5.02]) predicted high psychological pain, whereas bipolar disorder (OR = 0.54 [0.29-0.98]) predicted low psychological pain. During the follow-up, the change in maximal psychological pain was predicted by changes in depressive symptomatology (β = 0.46, <i>P</i> < .001) and maximal physical pain (β = 0.42, <i>P</i> < .003). Finally, among depressive symptoms, guilt, lack of initiative, and loss of appetite better explained maximal psychological pain, both at inclusion and at 1 year (all <i>P</i> < .050).</p><p><p><b><i>Conclusions:</i></b> Psychological pain is associated with a recent suicidal act and depressive severity. Due to the strong link between psychological pain and physical pain, future studies should investigate whether psychotropic drugs with analgesic effects protect from psychological pain and therefore from suicide.</p>","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2022-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39906503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Three-Month Follow-up Study of Mental Health Outcomes After a National COVID-19 Lockdown: Comparing Patients With Mood or Anxiety Disorders Living in an Area With a Higher Versus Lower Infection Incidence.","authors":"Claudia Carmassi,&nbsp;Liliana Dell'Osso,&nbsp;Carlo Antonio Bertelloni,&nbsp;Virginia Pedrinelli,&nbsp;Valerio Dell'Oste,&nbsp;Annalisa Cordone,&nbsp;Mirella Ruggeri,&nbsp;Simone Schimmenti,&nbsp;Chiara Bonetto,&nbsp;Sarah Tosato","doi":"10.4088/JCP.21m14172","DOIUrl":"https://doi.org/10.4088/JCP.21m14172","url":null,"abstract":"<p><p><b><i>Objective:</i></b> The COVID-19 pandemic and the related containment measures can represent a traumatic experience, particularly for populations living in high incidence areas and individuals with mental disorders. The aim of this study was to prospectively examine posttraumatic stress disorder (PTSD), anxiety, and depressive symptoms since the end of the first COVID-19 pandemic wave and Italy's national lockdown in subjects with mood or anxiety disorders living in 2 regions with increasing pandemic incidence.</p><p><p><b><i>Methods:</i></b> 102 subjects with a <i>DSM-5</i> anxiety or mood disorder were enrolled from June to July 2020 and assessed at baseline (T0) and after 3 months (T1) with the Impact of Event Scale-Revised, Patient Health Questionnaire-9, Generalized Anxiety Disorder 7-Item, and Work and Social Adjustment Scale. At T1, subjects were also assessed by means of the Trauma and Loss Spectrum Self-Report for PTSD.</p><p><p><b><i>Results:</i></b> At T0, subjects from the high COVID-19 incidence area showed higher levels of traumatic symptoms than those from the low COVID-19 incidence area (P < .001), with a decrease at T1 with respect to T0 (<i>P</i> = .001). Full or partial <i>DSM-5</i> PTSD related to the COVID-19 pandemic emerged in 23 subjects (53.5%) from the high COVID-19 incidence area and in 9 (18.0%) from the low COVID-19 incidence area (<i>P</i> < .001).</p><p><p><b><i>Conclusions:</i></b> Subjects with mood or anxiety disorders presented relevant rates of PTSD, depressive, and anxiety symptoms in the aftermath of the lockdown, and in most cases these persisted after 3 months. The level of exposure to the pandemic emerged as a major risk factor for PTSD development. Further long-term studies are needed to follow up the course of traumatic burden.</p>","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2022-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39906501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the Relationship Between Depression Symptom Severity and Health Care Costs for Patients With Treatment-Resistant Depression.","authors":"Frances L Lynch,&nbsp;John F Dickerson,&nbsp;Maureen O'Keeffe-Rosetti,&nbsp;Wing Chow,&nbsp;Jacqueline Pesa","doi":"10.4088/JCP.21m13976","DOIUrl":"https://doi.org/10.4088/JCP.21m13976","url":null,"abstract":"<p><p><b><i>Objective:</i></b> To examine whether measures of depression symptom severity could improve understanding of health care costs for patients with major depressive disorder (MDD) or treatment-resistant depression (TRD) from the health plan perspective.</p><p><p><b><i>Methods:</i></b> In this retrospective cohort study within an integrated health system, cohorts consisted of 2 mutually exclusive groups: (1) adults with TRD based on a standard treatment algorithm and (2) adults with MDD, but no TRD, identified through <i>ICD-9/10-CM</i> codes. Depression severity was measured using the Patient Health Questionnaire-9 (PHQ-9). Patterns of health care resource utilization (HRU) and costs were compared between the TRD and MDD groups overall and within the groups at different symptom levels. A general linear model with a γ distribution and log link for cost outcomes, logistic regression for binary outcomes, and negative binomial regression for count outcomes were used.</p><p><p><b><i>Results:</i></b> Patients with TRD (n = 24,534) had greater comorbidity than those in the MDD group (n = 17,628). Mean age in the TRD group was 52.8 years versus 48.2 for MDD (<i>P</i> < .001). Both groups were predominantly female (TRD: 72.8% vs MDD: 66.9%; <i>P</i> < .001). Overall, the TRD group had greater costs than the MDD group, with 1.23 times (95% CI, 1.21-1.26; <i>P</i> < .001) greater total cost on average over 1 year following index date. Within both groups, those with severe symptoms had greater total mean (SD) costs (TRD: moderate: $12,429 [$23,900] vs severe: $13,344 [$22,895], <i>P</i> < .001; low: $12,220 [$31,864] vs severe: $13,344 [$22,895], <i>P</i> < .001; MDD: moderate: $8,899 [$20,755] vs severe: $10,098 [$22,853]; <i>P</i> < .001; low: $8,752 [$25,800] vs severe: $10,098 [$22,853], <i>P</i> < .001).</p><p><p><b><i>Conclusions:</i></b> MDD and TRD impose high costs for health systems, with increasing costs as PHQ-9 symptom severity rises. Better understanding of subgroups with different symptom levels could improve clinical care by helping target interventions.</p>","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39889087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recognizing Impaired Decisional Capacity in Vaccine Refusal: Reply to Kels and Kels.","authors":"Joseph F Goldberg,&nbsp;Jacob M Appel","doi":"10.4088/JCP.21lr14357a","DOIUrl":"https://doi.org/10.4088/JCP.21lr14357a","url":null,"abstract":"","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39889088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conflating Capacity and Compliance.","authors":"Charles G Kels,&nbsp;Lori H Kels","doi":"10.4088/JCP.21lr14357","DOIUrl":"https://doi.org/10.4088/JCP.21lr14357","url":null,"abstract":"","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39591969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treating Insulin Resistance With Metformin as a Strategy to Improve Clinical Outcomes in Treatment-Resistant Bipolar Depression (the TRIO-BD Study): A Randomized, Quadruple-Masked, Placebo-Controlled Clinical Trial.","authors":"Cynthia V Calkin,&nbsp;K N Roy Chengappa,&nbsp;Kathleen Cairns,&nbsp;Jacob Cookey,&nbsp;Jessica Gannon,&nbsp;Martin Alda,&nbsp;Claire O'Donovan,&nbsp;Claire Reardon,&nbsp;Marcos Sanches,&nbsp;Martina Růzicková","doi":"10.4088/JCP.21m14022","DOIUrl":"https://doi.org/10.4088/JCP.21m14022","url":null,"abstract":"<p><p><b><i>Objective:</i></b> Therapeutic options are limited for treatment-resistant bipolar depression (TRBD). Insulin resistance (IR) confers increased risk for TRBD. We investigated metformin, an insulin sensitizer, to reverse IR and improve clinical outcomes in TRBD.</p><p><p><b><i>Methods:</i></b> Using a random-assignment (1:1), intent-to-treat, 2-site, quadruple-masked, parallel-group (metformin to 2,000 mg/d or placebo) clinical trial design, patients with <i>DSM-5</i> bipolar disorder (BD) type I or II and IR received study medication for 26 weeks (February 2016 to October 2019). The primary outcome was the change in depression rating scores (Montgomery-Asberg Depression Rating Scale [MADRS]) at 14 weeks between those who no longer met IR criteria (converters) and those who still did (non-converters). Additional outcomes included scores on the Global Assessment of Functioning (GAF); the Clinical Global Impressions Scale, Bipolar Disorders version (CGI-BP); and the Hamilton Anxiety Rating Scale (HAM-A) and maintenance of improved outcomes up to 26 weeks.</p><p><p><b><i>Results:</i></b> Forty-five BD patients were randomized to metformin (n = 20) or placebo (n = 25), and at 14 weeks or later, 11 subjects no longer met IR criteria (n = 10 with metformin, n = 1 with placebo; <i>P</i> = .0009). These converters experienced significant improvements in MADRS (<i>P</i> values ranged from .031 to .008) and GAF (<i>P</i> values ranged from .045 to .008) scores compared to non-converters beginning at week 6, sustained to week 26. HAM-A (<i>P</i> = .022 at week 14 and .019 at week 26) and CGI-BP change scores (<i>P</i> = .046 at 26 weeks) significantly favored converters over non-converters. Effect sizes were large for the MADRS and GAF (Cohen <i>d</i> > 1 at 14 and 26 weeks) and large for the HAM-A and CGI-BP at 26 weeks. Transient gastrointestinal side effects occurred under both treatment conditions.</p><p><p><b><i>Conclusions:</i></b> Pending replication, this early study suggests that reversal of IR by metformin offers a path out of TRBD. Further characterization of metformin converters with TRBD will prove informative.</p><p><p><b><i>Trial Registration:</i></b> ClinicalTrials.gov identifier: NCT02519543.</p>","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39889089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methylphenidate and Other Pharmacologic Treatments for Apathy in Alzheimer's Disease.","authors":"Chittaranjan Andrade","doi":"10.4088/JCP.22f14398","DOIUrl":"https://doi.org/10.4088/JCP.22f14398","url":null,"abstract":"<p><p>Apathy is a common and important yet often ignored neuropsychiatric symptom of Alzheimer's disease (AD). Cholinesterase inhibitors and memantine, used to treat AD, appear ineffective against apathy. A meta-analysis of 4 randomized, placebo-controlled trials (RCTs) found that psychostimulants significantly attenuated apathy ratings in AD. However, the pooled sample size in this meta-analysis was just 156, and one of the trials was a 2-week crossover study with a large effect. A large RCT (n = 200) has now been published. This study found that methylphenidate (MPH; 20 mg/d) was superior to placebo in the attenuation of apathy scores in patients with possible or probable, mild to moderate AD; the advantage was evident by the end of the second month of treatment and remained evident to the end of 6 months. The effect size at 6 months was small (Cohen <i>d</i> = 0.37). In this RCT, disappointingly, MPH was not superior to placebo on secondary outcomes, including informant-rated apathy, dependence, activities of daily living, quality of life, and neurocognitive performance; caregiver burden was not formally studied. Speculatively, the psychosocial intervention provided to all participants in this RCT may have boosted response in the placebo group, thereby attenuating differences in outcomes between the MPH and placebo groups. A reasonable conclusion is that whereas MPH may attenuate the severity of apathy in patients with AD across as long as 6 months, the absence of improvements in measures of dependence, activities of daily living, and quality of life suggest that this effect of MPH on apathy may not be clinically significant. An unanswered question is whether the benefits of MPH may be clinically significant in real world practice settings in which the delivery of behavioral interventions is not feasible.</p>","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39591968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychometric Properties of the Emotional Outburst Inventory (EMO-I): Rating What Children Do When They Are Irritable.","authors":"Gabrielle A Carlson,&nbsp;Jamilah Silver,&nbsp;Daniel N Klein","doi":"10.4088/JCP.21m14015","DOIUrl":"https://doi.org/10.4088/JCP.21m14015","url":null,"abstract":"<p><p><b><i>Objective:</i></b> Existing measures of irritability rarely distinguish phasic and tonic forms, despite their different clinical implications. We developed the Emotional Outburst Inventory (EMO-I) as a brief screening tool for phasic irritability in youth in clinical settings. The EMO-I assesses outburst severity, frequency, and duration. This article reports on its psychometric properties.</p><p><p><b><i>Methods:</i></b> The sample included 2,552 youth (mean [SD] age = 12.1 [3.5] years) evaluated at a university outpatient clinic between February 2005 and June 2014. Parents of 1,772 youth (69.4%) endorsed some anger problem. We assessed convergent, construct, and incremental validity of the EMO-I using a variety of measures, including the Child Behavior Checklist (CBCL) dysregulation profile (DP) and the CBCL irritability subscale. We also examined associations with hospitalization, emergency department visits, atypical antipsychotic use, help-seeking for outbursts, and impairment.</p><p><p><b><i>Results:</i></b> The EMO-I severity had good internal consistency (Cronbach α = 0.83) and was significantly associated with other irritability constructs (median correlation, <i>r</i> = 0.66, all <i>P</i> < .01). Outburst severity was associated with impairment (β = .87, <i>P</i> < .01) and with hospitalization, emergency department referral, antipsychotic use, and help-seeking for outbursts (median odds ratio = 1.27, all <i>P</i> < .01). The EMO-I showed incremental validity over and above the CBCL-DP and CBCL irritability subscale (explaining an additional 2%-12% of variance) when examining associations with impairment, hospitalization, emergency department referral, antipsychotic use, and help-seeking for outbursts.</p><p><p><b><i>Conclusions:</i></b> The EMO-I showed good internal consistency and convergent, construct, and incremental validity. Outburst behavior severity had stronger associations with important clinical variables than did outburst frequency and duration.</p>","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2022-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39738012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}