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Mood instability common in many mental disorders, linked to poorer outcomes

Analysis of a large national cohort showed mood instability was common across many mental disorders and led to higher rates of hospitalization and antipsychotic treatment.

Based on this analysis, study researcher Rashmi Patel, PhD, of King’s College London, and colleagues recommend clinicians screen for mood instability among all patients with mental disorders, in an effort to improve outcomes and identify patients in need who otherwise may go unrecognized.

Rashmi Patel

“Although it has been principally considered as a core feature of borderline personality disorder, mood instability has also been described in bipolar disorder, depression and more recently psychotic disorders,” Patel and colleagues wrote in BMJ Open. “Across a range of mental disorders, mood instability has been associated with poor functioning, unhappiness and low self-esteem, increases use of health care services and suicidality.”

Researchers assessed mood instability, number of days in a psychiatric hospital, hospital admission, antipsychotic prescriptions and non-antipsychotic mood stabilizer prescriptions using medical record data for 27,704 patients aged 16 to 65 years diagnosed with schizophrenia, bipolar affective disorder, psychotic depression, personality disorder, unipolar depression without psychosis or any other affective disorder between 2006 and 2013. Patients were followed for up to 5 years after initial diagnosis.

Mood instability was recorded within 1 month of clinical presentation among 12.1% of the study cohort. Younger patients, aged 16 to 25 years, and females were more likely to experience mood instability.

Patients who experienced mood instability were more likely to be admitted to a hospital and spent a higher number of days in a hospital. These associations remained after adjusting for age, gender, ethnicity, marital status and diagnosis (P < .001 for both).

Mood instability was associated with an increased risk for antipsychotic prescription and non-antipsychotic mood stabilizer prescription, after adjustment for demographic factors (P < .001 for both).

“Taken together, our findings suggest that mood instability is associated with poorer clinical outcomes and increased use of antipsychotic and non-antipsychotic mood stabilizer therapy, regardless of the mental disorder with which an individual initially presents,” Patel and colleagues wrote. “Our study suggests that clinicians should consider screening for the presence of mood instability on a routine basis and that it should be given more attention, irrespective of an individual’s underlying psychiatric diagnosis.” – by Amanda Oldt

Disclosure: Patel reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.