Abstract
BACKGROUND: Auditory hallucinations and delusions occur across neuropsychiatric conditions. As psychosis in bipolar disorder (BD) is often mood congruent, spikes in sad moods could precede occurrences of psychosis. The temporal association of episodic psychosis and negative affect (NA) is not understood in schizophrenia (SZ). We identified occurrences of episodic psychosis and temporally related them to NA with ecological momentary assessment (EMA). METHODS: Participants with SZ (N = 126) or BD (N = 114) were surveyed 3 times per day, 7 days a week, for 30 days. Surveys assessed location, social context, activities, mood states, and psychotic symptoms. Psychosis was queried on a present/absent basis and included auditory hallucinations, paranoia, and three other delusions. We examined the intensity (on a 1-7 scale) of NA (average of Sadness and Anxiety) concurrently, prior to, and after momentary psychosis. HLM was used to examine temporal convergence. RESULTS: SZ reported paranoia on 52% of surveys and voices on 42%, while participants with BD reported paranoia on 18% of surveys and no other symptoms on 10% or more. NA ratings were correlated with all 5 psychotic experiences in participants with SZ (all p < .009) and with paranoia in BD (p < .001). Concurrent NA was more strongly associated with symptoms in both groups compared to prior or later intensity. Anxiety was significantly more strongly correlated than sadness with psychosis in both groups. IMPLICATIONS: Anxiety was associated with concurrent psychotic symptoms in BD and SZ. There were no differential antecedent or consequent associations, and momentary sadness was less strongly associated with episodic psychosis than anxiety.