{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T17:17:44Z","timestamp":1788455864192,"version":"build-2803163510"},"reference-count":62,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,11,4]],"date-time":"2021-11-04T00:00:00Z","timestamp":1635984000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,11,4]],"date-time":"2021-11-04T00:00:00Z","timestamp":1635984000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"research council of norway","award":["#181831"],"award-info":[{"award-number":["#181831"]}]},{"name":"research council of norway","award":["147787\/320"],"award-info":[{"award-number":["147787\/320"]}]},{"name":"research council of norway","award":["342#67153\/V50"],"award-info":[{"award-number":["342#67153\/V50"]}]},{"name":"research council of norway","award":["#288542"],"award-info":[{"award-number":["#288542"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int J Bipolar Disord"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Affective 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.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Affective lability was measured with The Affective Lability Scale Short Form (ALS-SF) in participants with schizophrenia (SZ, n\u2009=\u200976), bipolar I disorder (BD-I, n\u2009=\u2009105), bipolar II disorder (BD-II, n\u2009=\u200968) and a mixed psychosis-affective group (MP,\u00a0n\u2009=\u200948). 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.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Overall group differences in affective lability remained significant after adjusting for covariates (p\u2009=\u2009.001). BD-II had higher affective lability compared to SZ and BD-I (p\u2009=\u2009.004), 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.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>This 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.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s40345-021-00238-0","type":"journal-article","created":{"date-parts":[[2021,11,4]],"date-time":"2021-11-04T03:03:21Z","timestamp":1635995001000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Characterization of affective lability across subgroups of psychosis spectrum disorders"],"prefix":"10.1186","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6574-0382","authenticated-orcid":false,"given":"Margrethe Collier","family":"H\u00f8egh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingrid","family":"Melle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofie R.","family":"Aminoff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beathe","family":"Haatveit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stine Holmstul","family":"Olsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Idun B.","family":"Hufl\u00e5tten","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Torill","family":"Ueland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trine Vik","family":"Lagerberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,11,4]]},"reference":[{"issue":"1\u20132","key":"238_CR1","doi-asserted-by":"publisher","first-page":"252","DOI":"10.1016\/j.psychres.2014.03.046","volume":"218","author":"M Aas","year":"2014","unstructured":"Aas M, Aminoff SR, Vik Lagerberg T, Etain B, Agartz I, Andreassen OA, et al. Affective lability in patients with bipolar disorders is associated with high levels of childhood trauma. Psychiatry Res. 2014;218(1\u20132):252\u20135.","journal-title":"Psychiatry Res"},{"key":"238_CR2","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1016\/j.jad.2014.10.028","volume":"172","author":"M Aas","year":"2015","unstructured":"Aas M, Pedersen G, Henry C, Bjella T, Bellivier F, Leboyer M, et al. Psychometric properties of the affective lability scale (54 and 18-item version) in patients with bipolar disorder, first-degree relatives, and healthy controls. J Affect Disord. 2015;172:375\u201380.","journal-title":"J Affect Disord"},{"issue":"5","key":"238_CR3","doi-asserted-by":"publisher","first-page":"902","DOI":"10.1017\/S0033291716003081","volume":"47","author":"M Aas","year":"2017","unstructured":"Aas M, Henry C, Bellivier F, Lajnef M, Gard S, Kahn JP, et al. Affective lability mediates the association between childhood trauma and suicide attempts, mixed episodes and co-morbid anxiety disorders in bipolar disorders. Psychol Med. 2017;47(5):902\u201312.","journal-title":"Psychol Med"},{"issue":"4","key":"238_CR4","doi-asserted-by":"publisher","first-page":"811","DOI":"10.1093\/schbul\/sbp148","volume":"37","author":"AM Achim","year":"2011","unstructured":"Achim AM, Maziade M, Raymond E, Olivier D, Merette C, Roy MA. How prevalent are anxiety disorders in schizophrenia? A meta-analysis and critical review on a significant association. Schizophr Bull. 2011;37(4):811\u201321.","journal-title":"Schizophr Bull"},{"issue":"1","key":"238_CR5","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1016\/j.psychres.2011.12.044","volume":"198","author":"SR Aminoff","year":"2012","unstructured":"Aminoff SR, Jensen J, Lagerberg TV, Hellvin T, Sundet K, Andreassen OA, et al. An association between affective lability and executive functioning in bipolar disorder. Psychiatry Res. 2012;198(1):58\u201361.","journal-title":"Psychiatry Res"},{"issue":"1","key":"238_CR6","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1186\/s40345-019-0169-5","volume":"7","author":"F Bennett","year":"2019","unstructured":"Bennett F, Hodgetts S, Close A, Frye M, Grunze H, Keck P, et al. Predictors of psychosocial outcome of bipolar disorder: data from the Stanley Foundation Bipolar Network. Int J Bipolar Disord. 2019;7(1):28.","journal-title":"Int J Bipolar Disord"},{"issue":"1","key":"238_CR7","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1159\/000081413","volume":"11","author":"AH Berman","year":"2005","unstructured":"Berman AH, Bergman H, Palmstierna T, Schlyter F. Evaluation of the drug use disorders identification test (DUDIT) in criminal justice and detoxification settings and in a Swedish population sample. Eur Addict Res. 2005;11(1):22\u201331.","journal-title":"Eur Addict Res"},{"issue":"3","key":"238_CR8","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1111\/bdi.12060","volume":"15","author":"B Birmaher","year":"2013","unstructured":"Birmaher B, Goldstein BI, Axelson DA, Monk K, Hickey MB, Fan J, et al. Mood lability among offspring of parents with bipolar disorder and community controls. Bipolar Disord. 2013;15(3):253\u201363.","journal-title":"Bipolar Disord"},{"key":"238_CR9","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1016\/j.neubiorev.2015.01.021","volume":"51","author":"MR Broome","year":"2015","unstructured":"Broome MR, He Z, Iftikhar M, Eyden J, Marwaha S. Neurobiological and behavioural studies of affective instability in clinical populations: a systematic review. Neurosci Biobehav Rev. 2015a;51:243\u201354.","journal-title":"Neurosci Biobehav Rev"},{"issue":"4","key":"238_CR10","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1192\/bjp.bp.114.158543","volume":"207","author":"MR Broome","year":"2015","unstructured":"Broome MR, Saunders KE, Harrison PJ, Marwaha S. Mood instability: significance, definition and measurement. Br J Psychiatry. 2015b;207(4):283\u20135.","journal-title":"Br J Psychiatry"},{"issue":"6","key":"238_CR11","doi-asserted-by":"publisher","first-page":"428","DOI":"10.1097\/01.pra.0000456591.20622.9e","volume":"20","author":"MJ Brus","year":"2014","unstructured":"Brus MJ, Solanto MV, Goldberg JF. Adult ADHD vs. bipolar disorder in the DSM-5 era: a challenging differentiation for clinicians. J Psychiatr Pract. 2014;20(6):428\u201337.","journal-title":"J Psychiatr Pract"},{"issue":"2","key":"238_CR12","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1192\/bjp.bp.109.073429","volume":"196","author":"N Craddock","year":"2010","unstructured":"Craddock N, Owen MJ. The Kraepelinian dichotomy\u2014going, going\u2026but still not gone. Br J Psychiatry. 2010;196(2):92\u20135.","journal-title":"Br J Psychiatry"},{"issue":"8","key":"238_CR13","doi-asserted-by":"publisher","first-page":"788","DOI":"10.1177\/0004867417691850","volume":"51","author":"AA Dargel","year":"2017","unstructured":"Dargel AA, Godin O, Etain B, Hirakata V, Azorin JM, M\u2019Bailara K, et al. Emotional reactivity, functioning, and C-reactive protein alterations in remitted bipolar patients: clinical relevance of a dimensional approach. Aust N Z J Psychiatry. 2017;51(8):788\u201398.","journal-title":"Aust N Z J Psychiatry"},{"key":"238_CR14","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1111\/acps.12901","volume":"138","author":"AA Dargel","year":"2018","unstructured":"Dargel AA, Roussel F, Volant S, Etain B, Grant R, Azorin JM, et al. Emotional hyper-reactivity and cardiometabolic risk in remitted bipolar patients: a machine learning approach. Acta Psychiatr Scand. 2018;138:348.","journal-title":"Acta Psychiatr Scand"},{"issue":"5","key":"238_CR15","doi-asserted-by":"publisher","first-page":"460","DOI":"10.1111\/acps.12710","volume":"135","author":"D Ducasse","year":"2017","unstructured":"Ducasse D, Jaussent I, Guillaume S, Azorin JM, Bellivier F, Belzeaux R, et al. Affect lability predicts occurrence of suicidal ideation in bipolar patients: a two-year prospective study. Acta Psychiatr Scand. 2017;135(5):460\u20139.","journal-title":"Acta Psychiatr Scand"},{"key":"238_CR16","doi-asserted-by":"publisher","first-page":"342","DOI":"10.1016\/j.jad.2015.06.026","volume":"186","author":"M Faurholt-Jepsen","year":"2015","unstructured":"Faurholt-Jepsen M, Ritz C, Frost M, Mikkelsen RL, Margrethe Christensen E, Bardram J, et al. Mood instability in bipolar disorder type I versus type II-continuous daily electronic self-monitoring of illness activity using smartphones. J Affect Disord. 2015;186:342\u20139.","journal-title":"J Affect Disord"},{"issue":"1","key":"238_CR17","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1186\/s40345-019-0141-4","volume":"7","author":"M Faurholt-Jepsen","year":"2019","unstructured":"Faurholt-Jepsen M, Frost M, Busk J, Christensen EM, Bardram JE, Vinberg M, et al. Differences in mood instability in patients with bipolar disorder type I and II: a smartphone-based study. Int J Bipolar Disord. 2019;7(1):5.","journal-title":"Int J Bipolar Disord"},{"issue":"3","key":"238_CR18","doi-asserted-by":"publisher","first-page":"426","DOI":"10.1007\/s10608-016-9772-2","volume":"40","author":"KC Fernandez","year":"2016","unstructured":"Fernandez KC, Jazaieri H, Gross JJ. Emotion regulation: a transdiagnostic perspective on a new RDoC domain. Cognit Ther Res. 2016;40(3):426\u201340.","journal-title":"Cognit Ther Res"},{"key":"238_CR19","doi-asserted-by":"crossref","unstructured":"First MB, Spitzer RL, Gibbon M, Williams JBW. Structured clinical interview for DSM-IV axis I disorders: patient edition (SCID-P), version 2; 1995.","DOI":"10.1037\/t07827-000"},{"key":"238_CR20","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1016\/j.jbtep.2014.07.005","volume":"46","author":"A Gershon","year":"2015","unstructured":"Gershon A, Eidelman P. Inter-episode affective intensity and instability: predictors of depression and functional impairment in bipolar disorder. J Behav Ther Exp Psychiatry. 2015;46:14\u20138.","journal-title":"J Behav Ther Exp Psychiatry"},{"issue":"2","key":"238_CR21","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1017\/S0033291717001775","volume":"48","author":"S Guloksuz","year":"2018","unstructured":"Guloksuz S, van Os J. The slow death of the concept of schizophrenia and the painful birth of the psychosis spectrum. Psychol Med. 2018;48(2):229\u201344.","journal-title":"Psychol Med"},{"issue":"7","key":"238_CR22","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1176\/appi.ajp.2015.15040414","volume":"173","author":"DM Hafeman","year":"2016","unstructured":"Hafeman DM, Merranko J, Axelson D, Goldstein BI, Goldstein T, Monk K, et al. Toward the definition of a bipolar prodrome: dimensional predictors of bipolar spectrum disorders in at-risk youths. Am J Psychiatry. 2016;173(7):695\u2013704.","journal-title":"Am J Psychiatry"},{"issue":"6","key":"238_CR23","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1016\/S0022-3956(01)00038-3","volume":"35","author":"C Henry","year":"2001","unstructured":"Henry C, Mitropoulou V, New AS, Koenigsberg HW, Silverman J, Siever LJ. Affective instability and impulsivity in borderline personality and bipolar II disorders: similarities and differences. J Psychiatr Res. 2001;35(6):307\u201312.","journal-title":"J Psychiatr Res"},{"issue":"3","key":"238_CR24","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1016\/S0924-9338(03)00041-5","volume":"18","author":"C Henry","year":"2003","unstructured":"Henry C, Swendsen J, Van den Bulke D, Sorbara F, Demotes-Mainard J, Leboyer M. Emotional hyper-reactivity as a fundamental mood characteristic of manic and mixed states. Eur Psychiatry. 2003;18(3):124\u20138.","journal-title":"Eur Psychiatry"},{"issue":"1\u20132","key":"238_CR25","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.psychres.2005.11.016","volume":"159","author":"C Henry","year":"2008","unstructured":"Henry C, Van den Bulke D, Bellivier F, Roy I, Swendsen J, M\u2019Bailara K, et al. Affective lability and affect intensity as core dimensions of bipolar disorders during euthymic period. Psychiatry Res. 2008;159(1\u20132):1\u20136.","journal-title":"Psychiatry Res"},{"issue":"1","key":"238_CR26","doi-asserted-by":"publisher","first-page":"e53","DOI":"10.1192\/j.eurpsy.2020.44","volume":"63","author":"MC H\u00f8egh","year":"2020","unstructured":"H\u00f8egh MC, Melle I, Aminoff SR, Laskemoen JF, B\u00fcchmann CB, Ueland T, et al. Affective lability across psychosis spectrum disorders. Eur Psychiatry. 2020;63(1):e53.","journal-title":"Eur Psychiatry"},{"issue":"7","key":"238_CR27","doi-asserted-by":"publisher","first-page":"748","DOI":"10.1176\/appi.ajp.2010.09091379","volume":"167","author":"T Insel","year":"2010","unstructured":"Insel T, Cuthbert B, Garvey M, Heinssen R, Pine DS, Quinn K, et al. Research domain criteria (RDoC): toward a new classification framework for research on mental disorders. Am J Psychiatry. 2010;167(7):748\u201351.","journal-title":"Am J Psychiatry"},{"key":"238_CR28","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1016\/j.jad.2014.12.055","volume":"175","author":"D Janiri","year":"2015","unstructured":"Janiri D, Sani G, Danese E, Simonetti A, Ambrosi E, Angeletti G, et al. Childhood traumatic experiences of patients with bipolar disorder type I and type II. J Affect Disord. 2015;175:92\u20137.","journal-title":"J Affect Disord"},{"issue":"4","key":"238_CR29","doi-asserted-by":"publisher","first-page":"392","DOI":"10.1111\/bdi.12867","volume":"22","author":"A Karanti","year":"2020","unstructured":"Karanti A, Kardell M, Joas E, Runeson B, Palsson E, Landen M. Characteristics of bipolar I and II disorder: a study of 8766 individuals. Bipolar Disord. 2020;22(4):392\u2013400.","journal-title":"Bipolar Disord"},{"key":"238_CR30","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.eurpsy.2016.04.007","volume":"37","author":"B Karpov","year":"2016","unstructured":"Karpov B, Joffe G, Aaltonen K, Suvisaari J, Baryshnikov I, Naatanen P, et al. Anxiety symptoms in a major mood and schizophrenia spectrum disorders. Eur Psychiatry. 2016;37:1\u20137.","journal-title":"Eur Psychiatry"},{"issue":"2","key":"238_CR31","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1093\/schbul\/13.2.261","volume":"13","author":"SR Kay","year":"1987","unstructured":"Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull. 1987;13(2):261\u201376.","journal-title":"Schizophr Bull"},{"issue":"5","key":"238_CR32","doi-asserted-by":"publisher","first-page":"784","DOI":"10.1176\/appi.ajp.159.5.784","volume":"159","author":"HW Koenigsberg","year":"2002","unstructured":"Koenigsberg HW, Harvey PD, Mitropoulou V, Schmeidler J, New AS, Goodman M, et al. Characterizing affective instability in borderline personality disorder. Am J Psychiatry. 2002;159(5):784\u20138.","journal-title":"Am J Psychiatry"},{"key":"238_CR33","doi-asserted-by":"publisher","first-page":"316","DOI":"10.1016\/j.jad.2016.09.062","volume":"208","author":"TV Lagerberg","year":"2017","unstructured":"Lagerberg TV, Aminoff SR, Aas M, Bjella T, Henry C, Leboyer M, et al. Alcohol use disorders are associated with increased affective lability in bipolar disorder. J Affect Disord. 2017;208:316\u201324.","journal-title":"J Affect Disord"},{"issue":"3","key":"238_CR34","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1016\/j.paid.2010.03.030","volume":"49","author":"AE Look","year":"2010","unstructured":"Look AE, Flory JD, Harvey PD, Siever LJ. Psychometric properties of a short form of the affective lability scale (ALS-18). Pers Individ Dif. 2010;49(3):187\u201391.","journal-title":"Pers Individ Dif"},{"issue":"9","key":"238_CR35","doi-asserted-by":"publisher","first-page":"811","DOI":"10.1038\/sj.mp.4001701","volume":"10","author":"GM MacQueen","year":"2005","unstructured":"MacQueen GM, Hajek T, Alda M. The phenotypes of bipolar disorder: relevance for genetic investigations. Mol Psychiatry. 2005;10(9):811\u201326.","journal-title":"Mol Psychiatry"},{"issue":"9","key":"238_CR36","doi-asserted-by":"publisher","first-page":"1431","DOI":"10.1007\/s00127-013-0653-7","volume":"48","author":"S Marwaha","year":"2013","unstructured":"Marwaha S, Parsons N, Broome M. Mood instability, mental illness and suicidal ideas: results from a household survey. Soc Psychiatry Psychiatr Epidemiol. 2013a;48(9):1431\u20137.","journal-title":"Soc Psychiatry Psychiatr Epidemiol"},{"issue":"3","key":"238_CR37","doi-asserted-by":"publisher","first-page":"262","DOI":"10.1016\/j.psychres.2012.09.036","volume":"205","author":"S Marwaha","year":"2013","unstructured":"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. 2013b;205(3):262\u20138.","journal-title":"Psychiatry Res"},{"issue":"9","key":"238_CR38","doi-asserted-by":"publisher","first-page":"1793","DOI":"10.1017\/S0033291713002407","volume":"44","author":"S Marwaha","year":"2014","unstructured":"Marwaha S, He Z, Broome M, Singh SP, Scott J, Eyden J, et al. How is affective instability defined and measured? A systematic review. Psychol Med. 2014a;44(9):1793\u2013808.","journal-title":"Psychol Med"},{"issue":"2","key":"238_CR39","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1093\/schbul\/sbt149","volume":"40","author":"S Marwaha","year":"2014","unstructured":"Marwaha S, Broome MR, Bebbington PE, Kuipers E, Freeman D. Mood instability and psychosis: analyses of British national survey data. Schizophr Bull. 2014b;40(2):269\u201377.","journal-title":"Schizophr Bull"},{"key":"238_CR40","doi-asserted-by":"publisher","first-page":"764","DOI":"10.1016\/j.jad.2015.11.024","volume":"190","author":"S Marwaha","year":"2016","unstructured":"Marwaha S, Gordon-Smith K, Broome M, Briley PM, Perry A, Forty L, et al. Affective instability, childhood trauma and major affective disorders. J Affect Disord. 2016;190:764\u201371.","journal-title":"J Affect Disord"},{"key":"238_CR41","doi-asserted-by":"publisher","first-page":"492","DOI":"10.1016\/j.jad.2018.08.046","volume":"241","author":"S Marwaha","year":"2018","unstructured":"Marwaha S, Price C, Scott J, Weich S, Cairns A, Dale J, et al. Affective instability in those with and without mental disorders: a case control study. J Affect Disord. 2018;241:492\u20138.","journal-title":"J Affect Disord"},{"issue":"1","key":"238_CR42","doi-asserted-by":"publisher","first-page":"e59","DOI":"10.1192\/j.eurpsy.2020.39","volume":"63","author":"K McDonald","year":"2020","unstructured":"McDonald K, Smith T, Broadbent M, Patel R, Geddes JR, Saunders KEA. Prevalence and incidence of clinical outcomes in patients presenting to secondary mental health care with mood instability and sleep disturbance. Eur Psychiatry. 2020;63(1):e59.","journal-title":"Eur Psychiatry"},{"key":"238_CR43","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1016\/j.jad.2018.04.021","volume":"236","author":"LA O'Donnell","year":"2018","unstructured":"O\u2019Donnell LA, Ellis AJ, Van de Loo MM, Stange JP, Axelson DA, Kowatch RA, et al. Mood instability as a predictor of clinical and functional outcomes in adolescents with bipolar I and bipolar II disorder. J Affect Disord. 2018;236:199\u2013206.","journal-title":"J Affect Disord"},{"issue":"6","key":"238_CR44","doi-asserted-by":"publisher","first-page":"1279","DOI":"10.1016\/j.paid.2003.12.013","volume":"37","author":"MNI Oliver","year":"2004","unstructured":"Oliver MNI, Simons JS. The affective lability scales: development of a short-form measure. Pers Indiv Differ. 2004;37(6):1279\u201388.","journal-title":"Pers Indiv Differ"},{"issue":"6","key":"238_CR45","doi-asserted-by":"publisher","first-page":"454","DOI":"10.1192\/bjp.bp.115.179655","volume":"209","author":"JE Palmier-Claus","year":"2016","unstructured":"Palmier-Claus JE, Berry K, Bucci S, Mansell W, Varese F. Relationship between childhood adversity and bipolar affective disorder: systematic review and meta-analysis. Br J Psychiatry. 2016;209(6):454\u20139.","journal-title":"Br J Psychiatry"},{"issue":"7","key":"238_CR46","doi-asserted-by":"publisher","first-page":"372","DOI":"10.1007\/s11920-013-0372-5","volume":"15","author":"C Pataki","year":"2013","unstructured":"Pataki C, Carlson GA. The comorbidity of ADHD and bipolar disorder: any less confusion? Curr Psychiatry Rep. 2013;15(7):372.","journal-title":"Curr Psychiatry Rep"},{"issue":"5","key":"238_CR47","doi-asserted-by":"publisher","first-page":"e007504","DOI":"10.1136\/bmjopen-2014-007504","volume":"5","author":"R Patel","year":"2015","unstructured":"Patel R, Lloyd T, Jackson R, Ball M, Shetty H, Broadbent M, et al. Mood instability is a common feature of mental health disorders and is associated with poor clinical outcomes. BMJ Open. 2015;5(5):e007504.","journal-title":"BMJ Open"},{"issue":"8","key":"238_CR48","doi-asserted-by":"publisher","first-page":"710","DOI":"10.1016\/S2215-0366(15)00112-1","volume":"2","author":"B Pavlova","year":"2015","unstructured":"Pavlova B, Perlis RH, Alda M, Uher R. Lifetime prevalence of anxiety disorders in people with bipolar disorder: a systematic review and meta-analysis. Lancet Psychiatry. 2015;2(8):710\u20137.","journal-title":"Lancet Psychiatry"},{"issue":"1","key":"238_CR49","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1146\/annurev-clinpsy-032814-112915","volume":"11","author":"GD Pearlson","year":"2015","unstructured":"Pearlson GD. Etiologic, phenomenologic, and endophenotypic overlap of schizophrenia and bipolar disorder. Annu Rev Clin Psychol. 2015;11(1):251\u201381.","journal-title":"Annu Rev Clin Psychol"},{"issue":"2","key":"238_CR50","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1111\/j.1600-0447.2007.01135.x","volume":"117","author":"PA Ringen","year":"2008","unstructured":"Ringen PA, Melle I, Birkenaes AB, Engh JA, Faerden A, J\u00f3nsd\u00f3ttir H, et al. Illicit drug use in patients with psychotic disorders compared with that in the general population: a cross-sectional study. Acta Psychiatr Scand. 2008;117(2):133\u20138.","journal-title":"Acta Psychiatr Scand"},{"issue":"7","key":"238_CR51","doi-asserted-by":"publisher","first-page":"753","DOI":"10.1111\/bdi.12340","volume":"17","author":"H Santelmann","year":"2015","unstructured":"Santelmann H, Franklin J, Busshoff J, Baethge C. Test-retest reliability of schizoaffective disorder compared with schizophrenia, bipolar disorder, and unipolar depression\u2014a systematic review and meta-analysis. Bipolar Disord. 2015;17(7):753\u201368.","journal-title":"Bipolar Disord"},{"issue":"2\u20133","key":"238_CR52","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1016\/j.schres.2016.07.012","volume":"176","author":"H Santelmann","year":"2016","unstructured":"Santelmann H, Franklin J, Busshoff J, Baethge C. Interrater reliability of schizoaffective disorder compared with schizophrenia, bipolar disorder, and unipolar depression\u2014a systematic review and meta-analysis. Schizophr Res. 2016;176(2\u20133):357\u201363.","journal-title":"Schizophr Res"},{"issue":"6","key":"238_CR53","doi-asserted-by":"publisher","first-page":"791","DOI":"10.1111\/j.1360-0443.1993.tb02093.x","volume":"88","author":"JB Saunders","year":"1993","unstructured":"Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M. Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction. 1993;88(6):791\u2013804.","journal-title":"Addiction"},{"key":"238_CR54","doi-asserted-by":"publisher","first-page":"368","DOI":"10.1111\/bdi.12978","volume":"23","author":"KEA Saunders","year":"2020","unstructured":"Saunders KEA, Jones T, Perry A, Di Florio A, Craddock N, Jones I, et al. The influence of borderline personality traits on clinical outcomes in bipolar disorder. Bipolar Disord. 2020;23:368.","journal-title":"Bipolar Disord"},{"issue":"11","key":"238_CR55","doi-asserted-by":"publisher","first-page":"1263","DOI":"10.1176\/appi.ajp.2013.12101339","volume":"170","author":"CA Tamminga","year":"2013","unstructured":"Tamminga CA, Ivleva EI, Keshavan MS, Pearlson GD, Clementz BA, Witte B, et al. Clinical phenotypes of psychosis in the bipolar-schizophrenia network on intermediate phenotypes (B-SNIP). Am J Psychiatry. 2013;170(11):1263\u201374.","journal-title":"Am J Psychiatry"},{"issue":"4","key":"238_CR56","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1111\/acps.12307","volume":"130","author":"M Tesli","year":"2014","unstructured":"Tesli M, Espeseth T, Bettella F, Mattingsdal M, Aas M, Melle I, et al. Polygenic risk score and the psychosis continuum model. Acta Psychiatr Scand. 2014;130(4):311\u20137.","journal-title":"Acta Psychiatr Scand"},{"issue":"9690","key":"238_CR57","doi-asserted-by":"publisher","first-page":"635","DOI":"10.1016\/S0140-6736(09)60995-8","volume":"374","author":"J Van Os","year":"2009","unstructured":"Van Os J, Kapur S. Schizophrenia. The Lance. 2009;374(9690):635\u201345.","journal-title":"The Lance"},{"issue":"2","key":"238_CR58","doi-asserted-by":"publisher","first-page":"17m12082","DOI":"10.4088\/JCP.17m12082","volume":"80","author":"N Verdolini","year":"2019","unstructured":"Verdolini N, Menculini G, Perugi G, Murru A, Samalin L, Angst J, Azorin JM, Bowden C, Mosolov S, Young AH, Barbuti M, Popovic D, Vieta E, Pacchiarotti I, for the BRIDGE-II-MIX Study Group. Sultans of swing: a reappraisal of the intertwined association between affective lability and mood reactivity in a post hoc analysis of the BRIDGE-II-MIX study. J Clin Psychiatry. 2019;80(2):17m12082.","journal-title":"J Clin Psychiatry"},{"key":"238_CR59","doi-asserted-by":"crossref","unstructured":"Widing L, Simonsen C, Flaaten CB, Haatveit B, Vik RK, Wold KF, \u00c5sb\u00f8 G, Ueland T, Melle I. Symptom profiles in psychotic disorder not otherwise specified. Front Psychiatry. 2020.","DOI":"10.3389\/fpsyt.2020.580444"},{"issue":"4","key":"238_CR60","first-page":"209","volume":"254","author":"D Winkler","year":"2004","unstructured":"Winkler D, Pjrek E, Heiden A, Wiesegger G, Klein N, Konstantinidis A, et al. Gender differences in the psychopathology of depressed inpatients. Eur Arch Psychiatry Clin Neurosci. 2004;254(4):209\u201314.","journal-title":"Eur Arch Psychiatry Clin Neurosci"},{"key":"238_CR61","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1192\/bjp.133.5.429","volume":"133","author":"RC Young","year":"1978","unstructured":"Young RC, Biggs JT, Ziegler VE, Meyer DA. A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry. 1978;133:429\u201335.","journal-title":"Br J Psychiatry"},{"key":"238_CR62","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1007\/s00787-019-01355-z","volume":"29","author":"A Zwicker","year":"2019","unstructured":"Zwicker A, Drobinin V, MacKenzie LE, Howes Vallis E, Patterson VC, Cumby J, et al. Affective lability in offspring of parents with major depressive disorder, bipolar disorder and schizophrenia. Eur Child Adolesc Psychiatry. 2019;29:445\u201351.","journal-title":"Eur Child Adolesc Psychiatry"}],"container-title":["International Journal of Bipolar Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40345-021-00238-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s40345-021-00238-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40345-021-00238-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,11,4]],"date-time":"2021-11-04T03:04:33Z","timestamp":1635995073000},"score":1,"resource":{"primary":{"URL":"https:\/\/journalbipolardisorders.springeropen.com\/articles\/10.1186\/s40345-021-00238-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,4]]},"references-count":62,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["238"],"URL":"https:\/\/doi.org\/10.1186\/s40345-021-00238-0","relation":{},"ISSN":["2194-7511"],"issn-type":[{"value":"2194-7511","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,4]]},"assertion":[{"value":"23 June 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 September 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 November 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The TOP study is conducted in line with the Helsinki declaration of 1975 (as revised in 2008 and 2013) and has been approved by the Regional Committee for Medical Research Ethics and the Norwegian Data Inspectorate. All participants must be able to provide informed consent before entering the study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors report no conflicts of interest.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"34"}}