title: Mood instability and psychosis: analyses of British national survey data.
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.
authors.affiliation: *To whom correspondence should be addressed; Mental Health Sciences Unit, University College London, 67-73 Riding House St. London W1W 7EJ, UK; tel: +44-20-7679-9465, fax: +44-20-7679-9426, e-mail: p.bebbington@ucl.ac.uk.
authors.forename: Steven
authors.initials: S
authors.lastname: Marwaha
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Broome
authors.forename: Paul E
authors.initials: PE
authors.lastname: Bebbington
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Kuipers
authors.forename: Daniel
authors.initials: D
authors.lastname: Freeman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002650:Child Abuse, Sexual / Q000706:statistics & numerical data; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006212:Hallucinations / Q000453:epidemiology; D006306:Health Surveys / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000453:epidemiology*; D010259:Paranoid Disorders / Q000453:epidemiology; D011618:Psychotic Disorders / Q000453:epidemiology*; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
keywords: auditory hallucination; child sexual abuse; epidemiology; paranoia; psychopathology