Association between symptom dimensions and categorical diagnoses of psychosis: a cross-sectional and longitudinal investigation.
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Authors
Russo, Manuela
Levine, Stephen Z
Demjaha, Arsime
Di Forti, Marta
Bonaccorso, Stefania
Fearon, Paul
Dazzan, Paola
Pariante, Carmine M
David, Anthony S
Morgan, Craig
Issue Date
2013-05-09
Type
Journal Article
Research Support, Non-U.S. Gov't
Research Support, Non-U.S. Gov't
Language
en
Keywords
DSM-5 , diagnostic classification , longitudinal study , psychosis , symptom dimensions
Alternative Title
Abstract
Cross-sectional studies of the signs and symptoms of psychosis yield dimensional phenotypes. However, the validity and clinical utility of such dimensions remain debated. This study investigated the structure of psychotic symptomatology, the stability of the structure over time, and the concordance between symptom dimensions and categorical diagnoses.
Sample consisted of 500 first-episode psychotic patients. A cross-sectional study (N = 500) investigated the organizational structure of symptom dimensions at the onset of psychosis and its concordance with categorical diagnoses; next, a nested longitudinal study (N = 100) examined the stability of the symptom dimensions structure after 5-10 years of follow-up.
Factor analyses identified 6 first-order factors (mania, negative, disorganization, depression, hallucinations, and delusions) and 2 high-order factors (affective and nonaffective psychoses). Cumulative variance accounted for by the first and high-order factors was 63%: 31% by the first-order factors and 32% by the high-order factors. The factorial structure of psychotic symptoms during first episode remained stable after 5-10 years of follow-up. The overall concordance between 4 categorical diagnostic groups (schizophrenia, mania with psychosis, psychotic depression and schizoaffective disorder) and dimensional symptom ranged from 62.2% to 73.1% (when the schizoaffective group was excluded).
Symptoms of psychosis assume a multidimensional hierarchical structure. This hierarchical model was stable over time and showed good concordance with categorical diagnoses. The combined use of dimensional and categorical approach to psychotic disorders would be of clinical and research utility.
Sample consisted of 500 first-episode psychotic patients. A cross-sectional study (N = 500) investigated the organizational structure of symptom dimensions at the onset of psychosis and its concordance with categorical diagnoses; next, a nested longitudinal study (N = 100) examined the stability of the symptom dimensions structure after 5-10 years of follow-up.
Factor analyses identified 6 first-order factors (mania, negative, disorganization, depression, hallucinations, and delusions) and 2 high-order factors (affective and nonaffective psychoses). Cumulative variance accounted for by the first and high-order factors was 63%: 31% by the first-order factors and 32% by the high-order factors. The factorial structure of psychotic symptoms during first episode remained stable after 5-10 years of follow-up. The overall concordance between 4 categorical diagnostic groups (schizophrenia, mania with psychosis, psychotic depression and schizoaffective disorder) and dimensional symptom ranged from 62.2% to 73.1% (when the schizoaffective group was excluded).
Symptoms of psychosis assume a multidimensional hierarchical structure. This hierarchical model was stable over time and showed good concordance with categorical diagnoses. The combined use of dimensional and categorical approach to psychotic disorders would be of clinical and research utility.
Description
Citation
Russo, M., Levine, S. Z., Demjaha, A., Di Forti, M., Bonaccorso, S., Fearon, P., Dazzan, P., Pariante, C. M., David, A. S., Morgan, C., Murray, R. M., & Reichenberg, A. (2014). Association between symptom dimensions and categorical diagnoses of psychosis: a cross-sectional and longitudinal investigation. Schizophrenia bulletin, 40(1), 111–119. https://doi.org/10.1093/schbul/sbt055
Publisher
License
Journal
Schizophrenia bulletin
Volume
40
Issue
1
PubMed ID
ISSN
1745-1701