{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T11:58:57Z","timestamp":1790769537039,"version":"4.1.0"},"reference-count":49,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Bipolar Disorders"],"published-print":{"date-parts":[[2026,11]]},"abstract":"ABSTRACT<\/jats:title>\n \n Objectives<\/jats:title>\n To examine the relationship between irritability and mixed states in bipolar disorder to determine how subjective irritability and mixed symptoms of mania and depression manifest in patients with bipolar disorder over a period of 18\u2009months.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This exploratory analysis examined longitudinal data from a randomised controlled trial of a psychological intervention for patients with bipolar disorder. Scores of subjective irritability and mood morbidity were analysed from data sampled over ten timepoints over the trial from 82 patients.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Significant associations were found between the presence of irritability and mixed symptoms (\n F<\/jats:italic>\n (1, 684)\u2009=\u200920.468,\n p<\/jats:italic>\n \u2009<\u20090.001). This relationship remained significant throughout the duration of the study and the administration of a psychological treatment which reduced both ratings of mood and irritability. Notably, when mixed symptoms are absent, irritability nevertheless remained for nearly half the time.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Irritability and mixed symptoms are phenomenologically linked. The persistence of this link, regardless of the existence of mixed symptoms, suggests that irritability permeates bipolar disorder and is core to its phenomenology. Future studies should interrogate the tethering of mixed symptoms and irritability in the context of bipolar disorder as this may lead to a deeper understanding of the core characteristics of the illness\u2014both clinically and in terms of its neurobiology.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/bdi.70185","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T11:19:49Z","timestamp":1790767189000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Irritability in the Mix: An Exploratory Study of the Role of Irritability in Characterising Mood Disorders"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8483-8497","authenticated-orcid":false,"given":"Erica","family":"Bell","sequence":"first","affiliation":[{"name":"Academic Department of Psychiatry, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia"},{"name":"CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6326-6100","authenticated-orcid":false,"given":"Maree","family":"Inder","sequence":"additional","affiliation":[{"name":"Department of Psychological Medicine University of Otago Christchurch New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4524-9091","authenticated-orcid":false,"given":"Gin S.","family":"Malhi","sequence":"additional","affiliation":[{"name":"Academic Department of Psychiatry, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia"},{"name":"CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District Sydney New South Wales Australia"},{"name":"Department of Psychiatry University of Oxford Oxford UK"},{"name":"Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy University of Oxford Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9607-819X","authenticated-orcid":false,"given":"Richard","family":"Bryant","sequence":"additional","affiliation":[{"name":"School of Psychology University of New South Wales Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9816-7356","authenticated-orcid":false,"given":"Philip","family":"Boyce","sequence":"additional","affiliation":[{"name":"Speciality of Psychiatry, Sydney Medical School, Faculty of Medicine and Health University of Sydney Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8695-3966","authenticated-orcid":false,"given":"Richard J.","family":"Porter","sequence":"additional","affiliation":[{"name":"Department of Psychological Medicine University of Otago Christchurch New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1016\/j.jpsychires.2024.11.074","article-title":"Prevalence, Correlates and Comorbidity of Irritability in Adults With Major Depressive Episode in the U.S. Population (2012\u20132013)","volume":"181","author":"Rizk M.","year":"2025","journal-title":"Journal of Psychiatric Research"},{"issue":"13","key":"e_1_2_8_3_1","doi-asserted-by":"crossref","first-page":"2052","DOI":"10.1038\/s41386-024-01959-3","article-title":"Prevalence and Correlates of Irritability Among U.S. Adults","volume":"49","author":"Perlis R. 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