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

Published online by Cambridge University Press:  23 July 2009

A. Demjaha ,
K. Morgan ,
C. Morgan ,
S. Landau ,
K. Dean ,
A. Reichenberg ,
P. Sham ,
P. Fearon ,
G. Hutchinson  and
P. B. Jones
...Show all authors
A. Demjaha*
Affiliation:
Division of Psychological Medicine, Institute of Psychiatry, King's College, London, UK
K. Morgan
Affiliation:
Department of Psychology, Westminster University, London, UK
C. Morgan
Affiliation:
Centre for Public Mental Health, Health Service and Population Research Department, Institute of Psychiatry, King's College, London, UK
S. Landau
Affiliation:
Department of Biostatistics, Institute of Psychiatry, King's College, London, UK
K. Dean
Affiliation:
Division of Psychological Medicine, Institute of Psychiatry, King's College, London, UK
A. Reichenberg
Affiliation:
Division of Psychological Medicine, Institute of Psychiatry, King's College, London, UK
P. Sham
Affiliation:
Department of Psychiatry and State Key Laboratory for Cognitive and Brain Sciences, LKS Faculty of Medicine, the University of Hong Kong
P. Fearon
Affiliation:
Division of Psychological Medicine, Institute of Psychiatry, King's College, London, UK
G. Hutchinson
Affiliation:
Psychiatry Unit, University of the West Indies, Trinidad
P. B. Jones
Affiliation:
Department of Psychiatry, University of Cambridge, Cambridge, UK
R. M. Murray
Affiliation:
Division of Psychological Medicine, Institute of Psychiatry, King's College, London, UK
P. Dazzan
Affiliation:
Division of Psychological Medicine, Institute of Psychiatry, King's College, London, UK
*
*Address for correspondence: A. Demjaha, Institute of Psychiatry, Box PO63, De Crespigny Park, London SE5 8AF, UK. (Email: [email protected])
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Abstract

Background

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.

Method

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.

Results

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.

Conclusions

Categorical and dimensional representations of psychosis are complementary. Using both appears to be a promising strategy in conceptualising psychotic illnesses.

Keywords

Diagnostic categoriesdimensionsfactor analysisfirst-episode psychosisrisk indicators
Type
Original Articles
Information
Psychological Medicine , Volume 39 , Issue 12 , December 2009 , pp. 1943 - 1955
Copyright
Copyright © Cambridge University Press 2009

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