Høegh Margrethe Collier, Melle Ingrid, Aminoff Sofie R, Haatveit Beathe, Olsen Stine Holmstul, Huflåtten Idun B, Ueland Torill, Lagerberg Trine Vik
CoE NORMENT, Norwegian Centre for Mental Disorders Research, Division of Mental Health and Addiction, University of Oslo and Oslo University Hospital, Building 49, Ullevål sykehus, Nydalen, PO Box 4956, 0424, Oslo, Norway.
Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.
Int J Bipolar Disord. 2021 Nov 4;9(1):34. doi: 10.1186/s40345-021-00238-0.
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.
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.
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.
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.
情感不稳定在精神病性谱系障碍中较为常见，且与临床负担加重相关。然而，情感不稳定的程度、结构和离散度在精神病性谱系所包含的特定障碍之间如何变化尚不清楚。为了作为治疗靶点具有潜在价值，有必要对这些人群中的情感不稳定进行进一步的特征描述。我们研究的主要目的是调查不同精神病性谱系障碍中情感不稳定结构的差异，以及在控制当前症状状态时假定的差异是否仍然存在。
使用情感不稳定量表简表（ALS-SF）对精神分裂症（SZ，n = 76）、双相I型障碍（BD-I，n = 105）、双相II型障碍（BD-II，n = 68）和精神病性情感混合组（MP，n = 48）的参与者进行情感不稳定测量。进行了多次协方差分析，以比较诊断组的ALS-SF总分和子维度得分，并对当前的精神病性、情感和焦虑症状、物质使用和性别进行校正。采用双广义线性模型比较不同组中情感不稳定的离散度。
在调整协变量后，情感不稳定的总体组间差异仍然显著（p = 0.001）。与SZ和BD-I相比，BD-II的情感不稳定程度更高（p = 0.004），SZ和BD-I之间无显著差异。ALS-SF维度对总情感不稳定的贡献或组间情感不稳定的离散度无显著差异。
本研究为精神病性谱系障碍中的情感不稳定结构提供了更详细的细节，这可能对研究和临床护理有影响。研究表明，尽管核心症状谱存在重叠，但在情感不稳定方面，BD-I与SZ的相似性高于与BD-II的相似性，因此应将BD组分开研究。此外，情感不稳定似乎表现为不同精神病性谱系障碍中抑郁状态与其他情感状态之间的波动，这表明情感不稳定可能与这些障碍中的内化问题有关。最后，尽管不同组之间水平有所不同，但情感不稳定在精神病性谱系障碍中分布均匀，并非由极端情况驱动，无论诊断如何都应进行评估。
