Characterization of affective lability across subgroups of psychosis spectrum disorders

Margrethe Collier Høegh,Trine Vik Lagerberg,Torill Ueland,Beathe Haatveit,Sofie R Aminoff,Ingrid Melle,Stine Holmstul Olsen,Idun B Huflåtten

doi:10.1186/s40345-021-00238-0

Margrethe Collier Høegh, Trine Vik Lagerberg + Show 6 more

Open Access

https://doi.org/10.1186/s40345-021-00238-0

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Abstract

BackgroundAffective 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.MethodsAffective 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.ResultsOverall 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.ConclusionsThis 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.

Highlights

Affective lability is elevated and associated with increased clinical burden in psychosis spectrum disorders
We aim to investigate whether putative differences in affective lability between the diagnostic groups are primarily mediated by differences in their current symptomatology
Post-hoc group comparisons with Bonferroni showed that the difference in AL between bipolar disorder (BD)-II versus SZ and BD-I remained statistically significant for the ALS total (p = 0.004 for both SZ and BD-I), anxiety-depression (SZ p = 0.038, BD-I p = 0.001) and depressionelation dimensions (SZ p = 0.031, BD-I p = 0.006)

Summary

Introduction

Affective lability is elevated and associated with increased clinical burden in psychosis spectrum disorders. Affective lability has been found to be both a trait- and a state-dependent factor in individuals with bipolar I (BD-I) and bipolar II (BD-II) disorders. It is present in periods of euthymia (Henry et al 2008), early in the course of illness (Aminoff et al 2012), in all polarities of the illness episodes (Henry et al 2003; Gershon and Eidelman 2015; Faurholt-Jepsen et al 2015; Verdolini et al 2019), as well as in non-affected relatives (Hafeman et al 2016; Birmaher et al 2013). Due to its associations with adverse clinical correlates such as alcohol use disorders (AUD) (Lagerberg et al 2017), suicidality (Aas et al 2017; Ducasse et al 2017), anxiety disorders (Aas et al 2017), cardiometabolic risk (Dargel et al 2018) and inflammation (Dargel et al 2017), there is mounting evidence that affective lability may be a relevant therapeutic target in BD

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