Dimensions and classes of psychosis in a population cohort: a four-class, four-dimension model of schizophrenia and affective psychoses

Background. Classification of psychosis lacks a biological basis and current diagnostic categories may obscure underlying continuities. Data reduction methods of symptom profiles within a population-based cohort of people with a wide range of affective and non-affective psychoses may permit an empir...

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Published inPsychological medicine Vol. 35; no. 4; pp. 499 - 510
Main Authors MURRAY, V., McKEE, I., MILLER, P. M., YOUNG, D., MUIR, W. J., PELOSI, A. J., BLACKWOOD, D. H. R.
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LanguageEnglish
Published Cambridge, UK Cambridge University Press 01.04.2005
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Abstract Background. Classification of psychosis lacks a biological basis and current diagnostic categories may obscure underlying continuities. Data reduction methods of symptom profiles within a population-based cohort of people with a wide range of affective and non-affective psychoses may permit an empirical classification of psychosis. Method. OPCRIT (operational criteria) analysis was performed on 387 adults aged 18–65 years in an attempted ascertainment of all patients with psychosis from a geographical area with a stable population. The data were analysed firstly using principal components analysis with varimax rotation to identify factors, and secondly to establish latent classes. Information relating to key variables known to be of relevance in schizophrenia was coded blind to the establishment of the classes and dimensions. Results. Striking correspondence was obtained between the two methods. The four dimensions emerging were labelled ‘depression’, ‘reality distortion’, ‘mania’ and ‘disorganization’. Latent classes identified were ‘depression’, ‘bipolar’, ‘reality distortion/depression’ and ‘disorganization’. The latent classes corresponded well with DSM-III-R diagnoses, but also revealed groupings usually obscured by diagnostic boundaries. The latent classes differed on gender ratio, fertility, age of onset and self-harming behaviour, but not on substance misuse or season of birth. Conclusions. Both dimensional and categorical approaches are useful in tapping the latent constructs underlying psychosis. Broad agreement with other similar studies suggests such findings could represent discrete pathological conditions. The four classes described appear meaningful, and suggest that the term non-affective psychosis should be reserved for the disorganization class, which represents only a subgroup of those with schizophrenia.
AbstractList BACKGROUNDClassification of psychosis lacks a biological basis and current diagnostic categories may obscure underlying continuities. Data reduction methods of symptom profiles within a population-based cohort of people with a wide range of affective and non-affective psychoses may permit an empirical classification of psychosis. METHODOPCRIT (operational criteria) analysis was performed on 387 adults aged 18-65 years in an attempted ascertainment of all patients with psychosis from a geographical area with a stable population. The data were analysed firstly using principal components analysis with varimax rotation to identify factors, and secondly to establish latent classes. Information relating to key variables known to be of relevance in schizophrenia was coded blind to the establishment of the classes and dimensions. RESULTSStriking correspondence was obtained between the two methods. The four dimensions emerging were labelled 'depression', 'reality distortion', 'mania' and 'disorganization'. Latent classes identified were 'depression', 'bipolar', 'reality distortion/depression' and 'disorganization'. The latent classes corresponded well with DSM-III-R diagnoses, but also revealed groupings usually obscured by diagnostic boundaries. The latent classes differed on gender ratio, fertility, age of onset and self-harming behaviour, but not on substance misuse or season of birth. CONCLUSIONSBoth dimensional and categorical approaches are useful in tapping the latent constructs underlying psychosis. Broad agreement with other similar studies suggests such findings could represent discrete pathological conditions. The four classes described appear meaningful, and suggest that the term non-affective psychosis should be reserved for the disorganization class, which represents only a subgroup of those with schizophrenia.
Background. Classification of psychosis lacks a biological basis and current diagnostic categories may obscure underlying continuities. Data reduction methods of symptom profiles within a population-based cohort of people with a wide range of affective and non-affective psychoses may permit an empirical classification of psychosis. Method. OPCRIT (operational criteria) analysis was performed on 387 adults aged 18–65 years in an attempted ascertainment of all patients with psychosis from a geographical area with a stable population. The data were analysed firstly using principal components analysis with varimax rotation to identify factors, and secondly to establish latent classes. Information relating to key variables known to be of relevance in schizophrenia was coded blind to the establishment of the classes and dimensions. Results. Striking correspondence was obtained between the two methods. The four dimensions emerging were labelled ‘depression’, ‘reality distortion’, ‘mania’ and ‘disorganization’. Latent classes identified were ‘depression’, ‘bipolar’, ‘reality distortion/depression’ and ‘disorganization’. The latent classes corresponded well with DSM-III-R diagnoses, but also revealed groupings usually obscured by diagnostic boundaries. The latent classes differed on gender ratio, fertility, age of onset and self-harming behaviour, but not on substance misuse or season of birth. Conclusions. Both dimensional and categorical approaches are useful in tapping the latent constructs underlying psychosis. Broad agreement with other similar studies suggests such findings could represent discrete pathological conditions. The four classes described appear meaningful, and suggest that the term non-affective psychosis should be reserved for the disorganization class, which represents only a subgroup of those with schizophrenia.
Background. Classification of psychosis lacks a biological basis and current diagnostic categories may obscure underlying continuities. Data reduction methods of symptom profiles within a population-based cohort of people with a wide range of affective and non-affective psychoses may permit an empirical classification of psychosis. Method. OPCRIT (operational criteria) analysis was performed on 387 adults aged 18–65 years in an attempted ascertainment of all patients with psychosis from a geographical area with a stable population. The data were analysed firstly using principal components analysis with varimax rotation to identify factors, and secondly to establish latent classes. Information relating to key variables known to be of relevance in schizophrenia was coded blind to the establishment of the classes and dimensions. Results. Striking correspondence was obtained between the two methods. The four dimensions emerging were labelled ‘depression’, ‘reality distortion’, ‘mania’ and ‘disorganization’. Latent classes identified were ‘depression’, ‘bipolar’, ‘reality distortion/depression’ and ‘disorganization’. The latent classes corresponded well with DSM-III-R diagnoses, but also revealed groupings usually obscured by diagnostic boundaries. The latent classes differed on gender ratio, fertility, age of onset and self-harming behaviour, but not on substance misuse or season of birth. Conclusions. Both dimensional and categorical approaches are useful in tapping the latent constructs underlying psychosis. Broad agreement with other similar studies suggests such findings could represent discrete pathological conditions. The four classes described appear meaningful, and suggest that the term non-affective psychosis should be reserved for the disorganization class, which represents only a subgroup of those with schizophrenia.
Background. Classification of psychosis lacks a biological basis and current diagnostic categories may obscure underlying continuities. Data reduction methods of symptom profiles within a population-based cohort of people with a wide range of affective and non-affective psychoses may permit an empirical classification of psychosis. Method. OPCRIT (operational criteria) analysis was performed on 387 adults aged 18-65 years in an attempted ascertainment of all patients with psychosis from a geographical area with a stable population. The data were analysed firstly using principal components analysis with varimax rotation to identify factors, and secondly to establish latent classes. Information relating to key variables known to be of relevance in schizophrenia was coded blind to the establishment of the classes and dimensions. Results. Striking correspondence was obtained between the two methods. The four dimensions emerging were labelled "depression", "reality distortion", "mania" and "disorganization". Latent classes identified were "depression", "bipolar", "reality distortion/depression" and "disorganization". The latent classes corresponded well with DSM-III-R diagnoses, but also revealed groupings usually obscured by diagnostic boundaries. The latent classes differed on gender ratio, fertility, age of onset and self-harming behaviour, but not on substance misuse or season of birth. Conclusions. Both dimensional and categorical approaches are useful in tapping the latent constructs underlying psychosis. Broad agreement with other similar studies suggests such findings could represent discrete pathological conditions. The four classes described appear meaningful, and suggest that the term non-affective psychosis should be reserved for the disorganization class, which represents only a subgroup of those with schizophrenia. (Original abstract)
Classification of psychosis lacks a biological basis and current diagnostic categories may obscure underlying continuities. Data reduction methods of symptom profiles within a population-based cohort of people with a wide range of affective and non-affective psychoses may permit an empirical classification of psychosis. OPCRIT (operational criteria) analysis was performed on 387 adults aged 18-65 years in an attempted ascertainment of all patients with psychosis from a geographical area with a stable population. The data were analysed firstly using principal components analysis with varimax rotation to identify factors, and secondly to establish latent classes. Information relating to key variables known to be of relevance in schizophrenia was coded blind to the establishment of the classes and dimensions. Striking correspondence was obtained between the two methods. The four dimensions emerging were labelled 'depression', 'reality distortion', 'mania' and 'disorganization'. Latent classes identified were 'depression', 'bipolar', 'reality distortion/depression' and 'disorganization'. The latent classes corresponded well with DSM-III-R diagnoses, but also revealed groupings usually obscured by diagnostic boundaries. The latent classes differed on gender ratio, fertility, age of onset and self-harming behaviour, but not on substance misuse or season of birth. Both dimensional and categorical approaches are useful in tapping the latent constructs underlying psychosis. Broad agreement with other similar studies suggests such findings could represent discrete pathological conditions. The four classes described appear meaningful, and suggest that the term non-affective psychosis should be reserved for the disorganization class, which represents only a subgroup of those with schizophrenia.
Background. Classification of psychosis lacks a biological basis and current diagnostic categories may obscure underlying continuities. Data reduction methods of symptom profiles within a population-based cohort of people with a wide range of affective and non-affective psychoses may permit an empirical classification of psychosis. Method. OPCRIT (operational criteria) analysis was performed on 387 adults aged 18-65 years in an attempted ascertainment of all patients with psychosis from a geographical area with a stable population. The data were analysed firstly using principal components analysis with varimax rotation to identify factors, and secondly to establish latent classes. Information relating to key variables known to be of relevance in schizophrenia was coded blind to the establishment of the classes and dimensions. Results. Striking correspondence was obtained between the two methods. The four dimensions emerging were labelled "depression", "reality distortion", "mania" and "disorganization". Latent classes identified were "depression", "bipolar", "reality distortion/depression" and "disorganization". The latent classes corresponded well with DSM-III-R diagnoses, but also revealed groupings usually obscured by diagnostic boundaries. The latent classes differed on gender ratio, fertility, age of onset and self-harming behaviour, but not on substance misuse or season of birth. Conclusions. Both dimensional and categorical approaches are useful in tapping the latent constructs underlying psychosis. Broad agreement with other similar studies suggests such findings could represent discrete pathological conditions. The four classes described appear meaningful, and suggest that the term non-affective psychosis should be reserved for the disorganization class, which represents only a subgroup of those with schizophrenia. [PUBLICATION ABSTRACT]
Author McKEE, I.
MUIR, W. J.
BLACKWOOD, D. H. R.
MILLER, P. M.
YOUNG, D.
MURRAY, V.
PELOSI, A. J.
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Issue 4
Keywords Social environment
Human
Mood disorder
Evaluation
Factor analysis
Prevalence
Methodology
Mental health
Schizophrenia
Nosology
Latent variable model
Affective psychosis
Epidemiology
Retrospective
Psychosis
Symptomatology
Criterion
Classification
Diagnosis
Comparative study
Public health
Language English
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PublicationCentury 2000
PublicationDate 2005-04-01
PublicationDateYYYYMMDD 2005-04-01
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PublicationTitle Psychological medicine
PublicationTitleAlternate Psychol. Med
PublicationYear 2005
Publisher Cambridge University Press
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Snippet Background. Classification of psychosis lacks a biological basis and current diagnostic categories may obscure underlying continuities. Data reduction methods...
Classification of psychosis lacks a biological basis and current diagnostic categories may obscure underlying continuities. Data reduction methods of symptom...
Background. Classification of psychosis lacks a biological basis and current diagnostic categories may obscure underlying continuities. Data reduction methods...
BACKGROUNDClassification of psychosis lacks a biological basis and current diagnostic categories may obscure underlying continuities. Data reduction methods of...
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SubjectTerms Adolescent
Adult and adolescent clinical studies
Affective psychoses
Aged
Biological and medical sciences
Classification
Cohort analysis
Diagnosis, Differential
Female
Health Surveys
Humans
Latent structures
Male
Medical diagnosis
Medical sciences
Mental disorders
Middle Aged
Needs Assessment - statistics & numerical data
Nosology. Terminology. Diagnostic criteria
Operational criteria
Other psychotic disorders
Principal Component Analysis
Psychiatric Status Rating Scales - statistics & numerical data
Psychiatry
Psychology. Psychoanalysis. Psychiatry
Psychometrics - statistics & numerical data
Psychopathology. Psychiatry
Psychoses
Psychosis
Psychotic Disorders - classification
Psychotic Disorders - diagnosis
Psychotic Disorders - epidemiology
Psychotic Disorders - psychology
Reproducibility of Results
Schizophrenia
Schizophrenia - classification
Schizophrenia - diagnosis
Schizophrenia - epidemiology
Schizophrenic Psychology
Scotland
Techniques and methods
Title Dimensions and classes of psychosis in a population cohort: a four-class, four-dimension model of schizophrenia and affective psychoses
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Volume 35
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