Characterization of affective lability across subgroups of psychosis spectrum disorders

Abstract

Background Affective lability is elevated and associated with increased clinical burden in psychosis spectrum disorders. The extent to which the level, structure and dispersion of affective lability varies between the specific disorders included in the psychosis spectrum is however unclear. To have potential value as a treatment target, further characterization of affective lability in these populations is necessary. The main aim of our study was to investigate differences in the architecture of affective lability in different psychosis spectrum disorders, and if putative differences remained when we controlled for current symptom status. Methods Affective lability was measured with The Affective Lability Scale Short Form (ALS-SF) in participants with schizophrenia (SZ, n = 76), bipolar I disorder (BD-I, n = 105), bipolar II disorder (BD-II, n = 68) and a mixed psychosis-affective group (MP, n = 48). Multiple analyses of covariance were conducted to compare the ALS-SF total and subdimension scores of the diagnostic groups, correcting for current psychotic, affective and anxiety symptoms, substance use and sex. Double generalized linear models were performed to compare the dispersion of affective lability in the different groups. Results Overall group differences in affective lability remained significant after adjusting for covariates (p = .001). BD-II had higher affective lability compared to SZ and BD-I (p = .004), with no significant differences between SZ and BD-I. There were no significant differences in the contributions of ALS-SF dimensions to the total affective lability or in dispersion of affective lability between the groups. Conclusions This study provides the construct of affective lability in psychosis spectrum disorders with more granular details that may have implications for research and clinical care. It demonstrates that despite overlap in core symptom profiles, BD-I is more similar to SZ than it is to BD-II concerning affective lability and the BD groups should consequently be studied apart. Further, affective lability appears to be characterized by fluctuations between depressive- and other affective states across different psychosis spectrum disorders, indicating that affective lability may be related to internalizing problems in these disorders. Finally, although the level varies between groups, affective lability is evenly spread and not driven by extremes across psychosis spectrum disorders and should be assessed irrespective of diagnosis.

Affective lability and social functioning in severe mental disorders

“…In the bipolar spectrum group, on the other hand, affective lability remained significantly and independently associated with social functioning even when the other predictors were taken into account. Nonetheless, as our previous study showed that the level of affective lability is significantly different in BDI versus BDII disorders [ 22 ], this finding warrants further investigation in larger samples to tease out if the association between affective lability and social functioning is the same irrespective of bipolar subtype.…”

“…Albeit accounting for a modest part of the total variance, this association remained at a level of statistical significance even when we controlled for other well-established predictors of social functioning such as premorbid social functioning, duration of untreated illness, and level of current symptoms. We have previously found that affective lability in our sample was characterized by fluctuations between both anxiety-depression and depression-elation across diagnostic groups [ 22 ]. However, only fluctuations between anxiety- and depressive symptoms appear to be directly linked to social functioning.…”

“…There were no indications of problematic multicollinearity between the ALS-SF subdimensions (tolerance ≥ 0.35 and VIF ≤ 2.9 for all dimensions). Based on our previous findings of higher levels of affective lability in BDII versus BDI and schizophrenia [ 67 ] and lower levels of social functioning in schizophrenia and psychotic versus non-psychotic bipolar disorder, we anticipated a possible interaction effect between lifetime psychosis and affective lability on social functioning. However, visual inspections of a scatterplot of the relationship between SFS and ALS-SF split by the dichotomous psychosis lifetime variable (Fig.…”

“…Affective lability refers to the propensity to experience rapid, excessive and unpredictable changes in affective states and is associated with poor clinical and functional outcome in many psychiatric disorders [ 19 , 20 ]. In a sample partially overlapping with that of the current study, we have previously found that affective lability is elevated in schizophrenia- and bipolar spectrum disorders compared to healthy controls [ 21 ]; with the highest level in bipolar II disorder (BDII) and equally high levels in schizophrenia and bipolar I disorder (BDI) [ 22 ]. Hence, affective lability appears to be a common illness feature across these disorders, with potential consequences for clinical outcome.…”

Diagnostic Difficulties and Treatment Challenges of a Young Patient With Severe Acute Psychosis and Complete Recovery

“…Affective lability is also seen in psychotic spectrum disorders, though more familiar to clinicians in the setting of bipolar spectrum disorders. A recent study identified no significant differences in affective lability between bipolar I disorder vs. schizophrenia patients [ 55 ].…”