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.

中文翻译：

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出现情绪不稳定和睡眠障碍的二级精神卫生保健患者临床结果的患病率和发病率

背景。情绪不稳定和睡眠障碍是精神疾病患者的常见症状。这两个特征在临床上都很重要，并且与较差的疾病轨迹相关。我们将接受二级心理健康护理的有情绪不稳定和/或睡眠障碍的人的临床结果与没有情绪不稳定或睡眠障碍的人的结果进行了比较。方法。数据来自 2008 年至 2016 年期间接受二级心理健康服务的 31,391 名 16-65 岁患者的电子健康记录。使用自然语言处理识别情绪不稳定和睡眠障碍。在基线估计情绪不稳定和睡眠障碍的流行率。发病率比率是对临床结果的估计，包括精神病诊断、处方药、与没有任何症状的人相比，有情绪不稳定和/或睡眠障碍的人在出现后 2 年内住院。结果。9.58% 的患者出现情绪不稳定，26.26% 的患者在接受二级心理健康服务后 1 个月内出现睡眠障碍。与没有任何一种症状的个体相比，有情绪不稳定和睡眠障碍的人开出任何精神药物处方（发病率比 [IRR] = 7.04，95% 置信区间 [CI] 6.53-7.59）和住院（IRR）的发生率显着增加= 5.32, 95% CI 5.32, 4.67–6.07) 在 2 年内出现。与只有一种症状的人相比，情绪不稳定和睡眠障碍的人的大多数临床结果的发生率显着增加。结论。情绪不稳定和睡眠障碍存在于范围广泛的精神障碍中，超出了传统上认为是症状的那些。它们与不良结果有关，特别是当它们同时发生时。与情绪不稳定和睡眠障碍相关的不良预后可能部分是因为它们通常被视为继发症状。情绪不稳定和睡眠障碍需要更好地识别为临床治疗目标。因为它们通常被视为次要症状。情绪不稳定和睡眠障碍需要更好地识别为临床治疗目标。因为它们通常被视为次要症状。情绪不稳定和睡眠障碍需要更好地识别为临床治疗目标。