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

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    Authors
    Demjaha, A
    Morgan, K
    Morgan, C
    Landau, S
    Dean, K
    Reichenberg, A
    Sham, P
    Fearon, P
    Hutchinson, G
    Jones, P B
    Murray, R M
    Dazzan, P
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    Affiliation
    Division of Psychological Medicine, Institute of Psychiatry, King's College, London, UK. a.demjaha@iop.kcl.ac.uk
    Issue Date
    2009-12
    MeSH
    Adolescent
    Adult
    Comorbidity
    Cross-Sectional Studies
    Diagnostic and Statistical Manual of Mental Disorders
    Factor Analysis, Statistical
    Female
    Humans
    Incidence
    Intelligence
    International Classification of Diseases
    Male
    Marijuana Abuse
    Middle Aged
    Patient Admission
    Psychiatric Status Rating Scales
    Psychometrics
    Psychopathology
    Psychotic Disorders
    Risk Factors
    Social Behavior
    Young Adult
    Show allShow less
    
    Metadata
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    Citation
    Combining dimensional and categorical representation of psychosis: the way forward for DSM-V and ICD-11? 2009, 39 (12):1943-55 Psychol Med
    Journal
    Psychological medicine
    URI
    http://hdl.handle.net/10147/128747
    DOI
    10.1017/S0033291709990651
    PubMed ID
    19627645
    Additional Links
    DOI: 10.1017/S0033291709990651
    Abstract
    There 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.
    We 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 dimensions versus diagnosis in explaining these variables.
    Factor 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.
    Categorical and dimensional representations of psychosis are complementary. Using both appears to be a promising strategy in conceptualising psychotic illnesses.
    Language
    en
    ISSN
    1469-8978
    ae974a485f413a2113503eed53cd6c53
    10.1017/S0033291709990651
    Scopus Count
    Collections
    St. Patrick's University Hospital

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