Combining dimensional and categorical representation of psychosis: the way forward for DSM-V and ICD-11?
Authors
Demjaha, AMorgan, K
Morgan, C
Landau, S
Dean, K
Reichenberg, A
Sham, P
Fearon, P
Hutchinson, G
Jones, P B
Murray, R M
Dazzan, P
Affiliation
Division of Psychological Medicine, Institute of Psychiatry, King's College, London, UK. a.demjaha@iop.kcl.ac.ukIssue Date
2009-12MeSH
AdolescentAdult
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
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Combining dimensional and categorical representation of psychosis: the way forward for DSM-V and ICD-11? 2009, 39 (12):1943-55 Psychol MedJournal
Psychological medicineDOI
10.1017/S0033291709990651PubMed ID
19627645Additional Links
DOI: 10.1017/S0033291709990651Abstract
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
enISSN
1469-8978ae974a485f413a2113503eed53cd6c53
10.1017/S0033291709990651
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