Prevalence and Incidence of Clinical Outcomes in Patients Presenting to Secondary Mental Health Care with Mood Instability and Sleep Disturbance

Overview

Journal Eur Psychiatry

Publisher Cambridge University Press

Specialty Psychiatry

Date 2020 Apr 28

PMID 32336304

Citations 6

Authors

Keltie McDonald

Tanya Smith

Matthew Broadbent

Rashmi Patel

John R Geddes

Kate E A Saunders

Affiliations

Soon will be listed here.

Abstract

Background: Mood instability and sleep disturbance are common symptoms in people with mental illness. Both features are clinically important and associated with poorer illness trajectories. We compared clinical outcomes in people presenting to secondary mental health care with mood instability and/or sleep disturbance with outcomes in people without either mood instability or sleep disturbance.

Methods: Data were from electronic health records of 31,391 patients ages 16-65 years presenting to secondary mental health services between 2008 and 2016. Mood instability and sleep disturbance were identified using natural language processing. Prevalence of mood instability and sleep disturbance were estimated at baseline. Incidence rate ratios were estimates for clinical outcomes including psychiatric diagnoses, prescribed medication, and hospitalization within 2-years of presentation in persons with mood instability and/or sleep disturbance compared to individuals without either symptom.

Results: Mood instability was present in 9.58%, and sleep disturbance in 26.26% of patients within 1-month of presenting to secondary mental health services. Compared with individuals without either symptom, those with mood instability and sleep disturbance showed significantly increased incidence of prescription of any psychotropic medication (incidence rate ratios [IRR] = 7.04, 95% confidence intervals [CI] 6.53-7.59), and hospitalization (IRR = 5.32, 95% CI 5.32, 4.67-6.07) within 2-years of presentation. Incidence rates of most clinical outcomes were considerably increased among persons with both mood instability and sleep disturbance, relative to persons with only one symptom.

Conclusions: Mood instability and sleep disturbance are present in a wide range of mental disorders, beyond those in which they are conventionally considered to be symptoms. They are associated with poor outcomes, particularly when they occur together. The poor prognosis associated with mood instability and sleep disorder may be, in part, because they are often treated as secondary symptoms. Mood instability and sleep disturbance need better recognition as clinical targets for treatment in their own right.

Citing Articles

Mood instability and risk of gastrointestinal diseases - a univariable and multivariable mendelian randomization study.

Liu R, Song Q, Liu L, Yang Y, Zhu W Ann Gen Psychiatry. 2024; 23(1):50.

PMID: 39702383 PMC: 11660901. DOI: 10.1186/s12991-024-00537-7.

A survey on clinical natural language processing in the United Kingdom from 2007 to 2022.

Wu H, Wang M, Wu J, Francis F, Chang Y, Shavick A NPJ Digit Med. 2022; 5(1):186.

PMID: 36544046 PMC: 9770568. DOI: 10.1038/s41746-022-00730-6.

Aggressive challenging behavior in adults with intellectual disability: An electronic register-based cohort study of clinical outcome and service use.

Smith J, Baksh R, Hassiotis A, Sheehan R, Ke C, Wong T Eur Psychiatry. 2022; 65(1):e74.

PMID: 36321353 PMC: 9706303. DOI: 10.1192/j.eurpsy.2022.2336.

Natural language processing in clinical neuroscience and psychiatry: A review.

Crema C, Attardi G, Sartiano D, Redolfi A Front Psychiatry. 2022; 13:946387.

PMID: 36186874 PMC: 9515453. DOI: 10.3389/fpsyt.2022.946387.

NeuroBlu, an electronic health record (EHR) trusted research environment (TRE) to support mental healthcare analytics with real-world data.

Patel R, Wee S, Ramaswamy R, Thadani S, Tandi J, Garg R BMJ Open. 2022; 12(4):e057227.

PMID: 35459671 PMC: 9036423. DOI: 10.1136/bmjopen-2021-057227.

References

Wilson S, Anderson K, Baldwin D, Dijk D, Espie A, Espie C . British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders: An update. J Psychopharmacol. 2019; 33(8):923-947. DOI: 10.1177/0269881119855343. View

Sheaves B, Freeman D, Isham L, McInerney J, Nickless A, Yu L . Stabilising sleep for patients admitted at acute crisis to a psychiatric hospital (OWLS): an assessor-blind pilot randomised controlled trial. Psychol Med. 2017; 48(10):1694-1704. PMC: 6088775. DOI: 10.1017/S0033291717003191. View

McDonald K, Saunders K, Geddes J . Sleep problems and suicide associated with mood instability in the Adult Psychiatric Morbidity Survey, 2007. Aust N Z J Psychiatry. 2017; 51(8):822-828. PMC: 5947783. DOI: 10.1177/0004867416687398. View

Marwaha S, Broome M, Bebbington P, Kuipers E, Freeman D . Mood instability and psychosis: analyses of British national survey data. Schizophr Bull. 2013; 40(2):269-77. PMC: 3932088. DOI: 10.1093/schbul/sbt149. View

Harvey A . A transdiagnostic approach to treating sleep disturbance in psychiatric disorders. Cogn Behav Ther. 2009; 38 Suppl 1:35-42. DOI: 10.1080/16506070903033825. View

Roth T, Jaeger S, Jin R, Kalsekar A, Stang P, Kessler R . Sleep problems, comorbid mental disorders, and role functioning in the national comorbidity survey replication. Biol Psychiatry. 2006; 60(12):1364-71. PMC: 1894656. DOI: 10.1016/j.biopsych.2006.05.039. View

Marwaha S, Parsons N, Flanagan S, Broome M . The prevalence and clinical associations of mood instability in adults living in England: results from the Adult Psychiatric Morbidity Survey 2007. Psychiatry Res. 2012; 205(3):262-8. DOI: 10.1016/j.psychres.2012.09.036. View

Broome M, Saunders K, Harrison P, Marwaha S . Mood instability: significance, definition and measurement. Br J Psychiatry. 2015; 207(4):283-5. PMC: 4589661. DOI: 10.1192/bjp.bp.114.158543. View

DeMartinis N, Winokur A . Effects of psychiatric medications on sleep and sleep disorders. CNS Neurol Disord Drug Targets. 2007; 6(1):17-29. DOI: 10.2174/187152707779940835. View

10.

Wing J, Beevor A, CURTIS R, Park S, Hadden S, Burns A . Health of the Nation Outcome Scales (HoNOS). Research and development. Br J Psychiatry. 1998; 172:11-8. DOI: 10.1192/bjp.172.1.11. View

11.

Wulff K, Gatti S, Wettstein J, Foster R . Sleep and circadian rhythm disruption in psychiatric and neurodegenerative disease. Nat Rev Neurosci. 2010; 11(8):589-99. DOI: 10.1038/nrn2868. View

12.

Trull T, Solhan M, Tragesser S, Jahng S, Wood P, Piasecki T . Affective instability: measuring a core feature of borderline personality disorder with ecological momentary assessment. J Abnorm Psychol. 2008; 117(3):647-61. DOI: 10.1037/a0012532. View

13.

Yatham L, Kennedy S, Parikh S, Schaffer A, Bond D, Frey B . Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disord. 2018; 20(2):97-170. PMC: 5947163. DOI: 10.1111/bdi.12609. View

14.

Bopp J, Miklowitz D, Goodwin G, Stevens W, Rendell J, Geddes J . The longitudinal course of bipolar disorder as revealed through weekly text messaging: a feasibility study. Bipolar Disord. 2010; 12(3):327-34. PMC: 2921773. DOI: 10.1111/j.1399-5618.2010.00807.x. View

15.

Ohayon M . Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev. 2003; 6(2):97-111. DOI: 10.1053/smrv.2002.0186. View

16.

Perera G, Broadbent M, Callard F, Chang C, Downs J, Dutta R . Cohort profile of the South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLaM BRC) Case Register: current status and recent enhancement of an Electronic Mental Health Record-derived data resource. BMJ Open. 2016; 6(3):e008721. PMC: 4785292. DOI: 10.1136/bmjopen-2015-008721. View

17.

Hombali A, Seow E, Yuan Q, Chang S, Satghare P, Kumar S . Prevalence and correlates of sleep disorder symptoms in psychiatric disorders. Psychiatry Res. 2018; 279:116-122. DOI: 10.1016/j.psychres.2018.07.009. View

18.

Harvey A, Murray G, Chandler R, Soehner A . Sleep disturbance as transdiagnostic: consideration of neurobiological mechanisms. Clin Psychol Rev. 2010; 31(2):225-35. PMC: 2954256. DOI: 10.1016/j.cpr.2010.04.003. View

19.

Henry C, Mitropoulou V, New A, Koenigsberg H, Silverman J, Siever L . Affective instability and impulsivity in borderline personality and bipolar II disorders: similarities and differences. J Psychiatr Res. 2001; 35(6):307-12. DOI: 10.1016/s0022-3956(01)00038-3. View

20.

Patel R, Lloyd T, Jackson R, Ball M, Shetty H, Broadbent M . Mood instability is a common feature of mental health disorders and is associated with poor clinical outcomes. BMJ Open. 2015; 5(5):e007504. PMC: 4452754. DOI: 10.1136/bmjopen-2014-007504. View