Combining dimensional and categorical representation of psychosis: the way forward for DSM-V and ICD-11?

Psychological Medicine - Tập 39 Số 12 - Trang 1943-1955 - 2009
Arsime Demjaha1, Kevin Morgan2, Craig Morgan3, Sabine Landau4, Kimberlie Dean1, Abraham Reichenberg1, P. Sham5, Patricia Andrews-Fearon1, Gerard Hutchinson6, Peter B. Jones7, Robin Murray1, Paola Dazzan1
1Division of Psychological Medicine, Institute of Psychiatry, King's College, London, UK
2Department of Psychology, Westminster University, London, UK
3Centre for Public Mental Health, Health Service and Population Research Department, Institute of Psychiatry, King's College, London, UK
4Department of Biostatistics, Institute of Psychiatry, King's College London, UK
5Department of Psychiatry and State Key Laboratory for Cognitive and Brain Sciences, LKS Faculty of Medicine, the University of Hong Kong
6University of the West Indies,
7University of Cambridge

Tóm tắt

BackgroundThere is good evidence that psychotic symptoms segregate into symptom dimensions. However, it is still unclear how these dimensions are associated with risk indicators and other clinical variables, and whether they have advantages over categorical diagnosis in clinical practice. We investigated symptom dimensions in a first-onset psychosis sample and examined their associations with risk indicators and clinical variables. We then examined the relationship of categorical diagnoses to the same variables.MethodWe recruited 536 patients as part of a population-based, incidence study of psychosis. Psychopathology was assessed using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). A principal axis factor analysis was performed on symptom scores. The relationship of dimension scores with risk indicators and with clinical variables was then examined employing regression analyses. Finally, regression models were compared to assess the contribution of dimensionsversusdiagnosis in explaining these variables.ResultsFactor analysis gave rise to a five-factor solution of manic, reality distortion, negative, depressive and disorganization symptom dimensions. The scores of identified dimensions were differentially associated with specific variables. The manic dimension had the highest number of significant associations; strong correlations were observed with shorter duration of untreated psychosis, acute mode of onset and compulsory admission. Adding dimensional scores to diagnostic categories significantly increased the amount of variability explained in predicting these variables; the reverse was also true but to a lesser extent.ConclusionsCategorical and dimensional representations of psychosis are complementary. Using both appears to be a promising strategy in conceptualising psychotic illnesses.

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Psychological Medicine

Tập 39 Số 12

1943-1955

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