Affective lability across psychosis spectrum disorders

Abstract

Background. Despite apparent clinical remission, individuals with psychotic disorders often experience significant impairments across functional domains. Thus, there is a need to search beyond management of core symptoms to optimize treatment outcomes. Affective dysregulation is considered a risk factor for poor clinical and functional outcomes in many mental disorders, but research investigating such features in psychosis, particularly in schizophrenia, is limited. We aimed to investigate the level of affective lability (AL) in participants with schizophrenia- and bipolar spectrum disorders (n = 222) compared to healthy controls (n = 140), as well as clinical correlates of AL in the diagnostic groups. Methods. The Affective Lability Scale (ALS-SF) was used to measure total score of AL and subscores covering the domains of anxiety/depression, depression/elation, and anger. An analysis of covariance was performed to compare the ALS-SF total score between groups, correcting for potential confounders, as well as standard multiple regression analyses for diagnosis-specific investigations of the relationship between AL and demographic and clinical features. Results. Both the schizophrenia- and bipolar spectrum group had significantly higher ALS-SF total score compared to controls (p < 0.001), and no significant differences between the patient groups were found. In the schizophrenia group, current psychotic and depressive symptoms were significantly and independently associated with AL (p = 0.012 and p = 0.024, respectively). Conclusions. The findings indicate that AL is elevated in psychotic disorders and that it transcends diagnostic boundaries. Further research into the causal relationship between psychotic and affective symptoms and AL, as well as its role as a potential therapeutic target in psychosis spectrum disorders, is warranted.

Characterization of affective lability across subgroups of psychosis spectrum disorders

“…The 18 items of the scale are rated on a four-point Likert scale ranging from 0 (“very uncharacteristic of me”) to 3 (“very characteristic of me”) and yields a total score of affective lability as well as scores for the three subdomains. There are no validated cut-off scores for evaluating the severity of affective lability, but in our previous study we found mean ALS-SF total and subscale scores in the range of 0.17–0.39 for healthy controls, 0.85–1.33 for individuals with BD, and 0.69–1.34 for individuals with SZ (Høegh et al 2020 ). This corresponds well with what has been found in at least one similar study (Marwaha et al 2018 ).…”

“…When it comes to the similarities between individuals with BD-I and SZ, this may not be surprising at least from a genetic point of view, given the established overlap between BD-I and SZ (Tamminga et al 2013 ; Tesli et al 2014 ). It is, however, important to keep in mind that both individuals with BD-I and SZ also present with higher affective lability rates than healthy controls (Høegh et al 2020 ).…”

“…The rationale for combining psychosis NOS and schizoaffective disorder into one “mixed” group was that these categories typically include patients with both psychotic- and affective symptoms that are diagnostically more heterogeneous than the other groups (Santelmann et al 2015 , 2016 ; Widing et al 2020 ). Of the present sample, n = 222 were used in our previous study investigating affective lability across the psychosis spectrum (Høegh et al 2020 ), and are now re-analyzed along with the newly added participants to shed light on putative differences in affective lability between the specific psychotic disorders.…”

“…In schizophrenia (SZ), there has previously been limited emphasis on the prevalence and correlates of affective lability, despite indications that it can be a prominent facet of psychotic experiences (Patel et al 2015 ; Marwaha et al 2014b ). Indeed, in our recently published study investigating affective lability across psychotic disorders, we found that affective lability was markedly elevated in individuals with SZ and BD compared to healthy controls, with equally high elevations in both groups (Høegh et al 2020 ). Also, affective lability was significantly and independently associated with higher levels of positive psychotic- and depressive symptoms in SZ, and with higher levels of AUD and depressive symptoms in BD.…”

“…Using the same sample as in our previous study (Høegh et al 2020 ) together with newly added participants, we are now able to further explore affective lability measured by The Affective Lability Scale Short Form (ALS-SF) across specific psychosis spectrum disorders. These include SZ, BD-I, BD-II in addition to a mixed “psychosis-affective” (MP) group including schizoaffective disorder and psychotic disorders not otherwise specified (psychosis NOS) with prominent mood symptoms.…”