Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Mar;40(2):269-77.
doi: 10.1093/schbul/sbt149. Epub 2013 Oct 25.

Mood instability and psychosis: analyses of British national survey data

Steven Marwaha  1 , Matthew R Broome, Paul E Bebbington, Elizabeth Kuipers, Daniel Freeman
Affiliations

Mood instability and psychosis: analyses of British national survey data

Steven Marwaha et al. Schizophr Bull. 2014 Mar.

Abstract

Background: We used British national survey data to test specific hypotheses that mood instability (1) is associated with psychosis and individual psychotic phenomena, (2) predicts the later emergence of auditory hallucinations and paranoid ideation, and (3) mediates the link between child sexual abuse and psychosis.

Methods: We analyzed data from the 2000 and 2007 UK national surveys of psychiatric morbidity (N = 8580 and 7403, respectively). The 2000 survey included an 18-month follow-up of a subsample (N = 2406). Mood instability was assessed from the Structured Clinical Interview for DSM-IV Axis II (SCID-II) questionnaire. Our dependent variables comprised auditory hallucinations, paranoid ideation, the presence of psychosis overall, and a 15-item paranoia scale.

Results: Mood instability was strongly associated in cross-sectional analyses with psychosis (2000: OR: 7.5; 95% CI: I 4.1-13.8; 2007: OR: 21.4; CI: 9.7-41.2), paranoid ideation (2000: OR: 4.7; CI: 4.1-5.4; 2007: OR: 5.7; CI: 4.9-6.7), auditory hallucinations (2000: OR: 3.4; CI: 2.6-4.4; 2007: OR 3.5; CI: 2.7-4.7), and paranoia total score (2000: Coefficient: 3.6; CI: 3.3-3.9), remaining so after adjustment for current mood state. Baseline mood instability significantly predicted 18-month inceptions of paranoid ideation (OR: 2.3; CI: 1.6-3.3) and of auditory hallucinations (OR: 2.6; CI: 1.5-4.4). Finally, it mediated a third of the total association of child sexual abuse with psychosis and persecutory ideation and a quarter of that with auditory hallucinations.

Conclusions: Mood instability is a prominent feature of psychotic experience and may have a role in its genesis. Targeting mood instability could lead to innovative treatments for psychosis.

Keywords: auditory hallucination; child sexual abuse; epidemiology; paranoia; psychopathology.

PubMed Disclaimer

Figures

Fig. 1.
Fig. 1.
The cross-sectional associations of mood instability and psychosis with paranoia score.
See this image and copyright information in PMC

Comment in

  • Whither the psychosis-neurosis borderline.
    Kelleher I, Cannon M. Kelleher I, et al. Schizophr Bull. 2014 Mar;40(2):266-8. doi: 10.1093/schbul/sbt230. Epub 2014 Jan 16. Schizophr Bull. 2014. PMID: 24436054 Free PMC article. No abstract available.

References

    1. Birchwood M. Pathways to emotional dysfunction in first-episode psychosis. Br J Psychiatry. 2003;182:373–375 - PubMed
    1. Freeman D, Garety PA. Connecting neurosis and psychosis: the direct influence of emotion on delusions and hallucinations. Behav Res Ther. 2003;41:923–947 - PubMed
    1. van Os J. A salience dysregulation syndrome. Br J Psychiatry. 2009;194:101–103 - PubMed
    1. Fisher HL, Appiah-Kusi E, Grant C. Anxiety and negative self-schemas mediate the association between childhood maltreatment and paranoia. Psychiatry Res. 2012;196:323–324 - PMC - PubMed
    1. Fowler D, Hodgekins J, Garety P, et al. Negative cognition, depressed mood, and paranoia: a longitudinal pathway analysis using structural equation modeling. Schizophr Bull. 2012;38:1063–1073 - PMC - PubMed

Publication types