Journal
SCHIZOPHRENIA BULLETIN
Volume 40, Issue 2, Pages 269-277Publisher
OXFORD UNIV PRESS
DOI: 10.1093/schbul/sbt149
Keywords
epidemiology; psychopathology; paranoia; auditory hallucination; child sexual abuse
Categories
Funding
- English Department of Health
- Scottish Executive
- National Assembly for Wales
- NHS Information Centre for Health and Social Care
- MRC [G0902308] Funding Source: UKRI
- Medical Research Council [G0902308] Funding Source: researchfish
- National Institute for Health Research [NF-SI-0611-10103] Funding Source: researchfish
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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 4.113.8; 2007: OR: 21.4; CI: 9.741.2), paranoid ideation (2000: OR: 4.7; CI: 4.15.4; 2007: OR: 5.7; CI: 4.96.7), auditory hallucinations (2000: OR: 3.4; CI: 2.64.4; 2007: OR 3.5; CI: 2.74.7), and paranoia total score (2000: Coefficient: 3.6; CI: 3.33.9), remaining so after adjustment for current mood state. Baseline mood instability significantly predicted 18-month inceptions of paranoid ideation (OR: 2.3; CI: 1.63.3) and of auditory hallucinations (OR: 2.6; CI: 1.54.4). 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.
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