Dimensions and the psychosis phenotype

Allardyce, Judith; Suppes, Trisha; Os, Jim van

doi:10.1002/mpr.214

Cited by 101 publications

(81 citation statements)

References 71 publications

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“…In addition, the results demonstrate a continuous distribution of (hypo)manic symptoms and distress, thus supporting the hypothesis that a dimensional representation may usefully describe the (hypo)manic phenotype (Allardyce et al 2007). Only a small fraction of adolescents and young adults experiencing these phenomena were receiving psychiatric care and the co-occurrence of (hypo)manic episodes with depression was low compared to most of the literature.…”

Section: Resultsmentioning

confidence: 73%

Evidence that bipolar disorder is the poor outcome fraction of a common developmental phenotype: an 8-year cohort study in young people

Tijssen

Wittchen

et al. 2009

Psychol. Med.

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Background. Reported rates of bipolar syndromes are highly variable between studies because of age differences, differences in diagnostic criteria, or restriction of sampling to clinical contacts.Method. In 1395 adolescents aged 14-17 years, DSM-IV (hypo)manic episodes (manic and hypomanic episodes combined), use of mental health care, and five ordinal subcategories representing the underlying continuous score of (hypo)manic symptoms (' mania symptom scale ') were measured at baseline and approximately 1.5, 4 and 10 years later using the Munich-Composite International Diagnostic Interview (DIA-X/M-CIDI).Results. Incidence rates (IRs) of both (hypo)manic episodes and (hypo)manic symptoms (at least one DSM-IV core symptom) were far higher (714/105 person-years and 1720/10 5 person-years respectively) than traditional estimates. In addition, the risk of developing (hypo)manic episodes was very low after the age of 21 years [hazard ratio (HR) 0.031, 95 % confidence interval (CI) 0.0050-0.19], independent of childhood disorders such as attention deficit hyperactivity disorder (ADHD). Most individuals with hypomanic and manic episodes were never in care (87 % and 62 % respectively) and not presenting co-morbid depressive episodes (69 % and 60 % respectively). The probability of mental health care increased linearly with the number of symptoms on the mania symptom scale. The incidence of the bipolar categories, in particular at the level of clinical morbidity, was strongly associated with previous childhood disorders and male sex.Conclusions. This study showed, for the first time, that experiencing (hypo)manic symptoms is a common adolescent phenomenon that infrequently predicts mental health care use. The findings suggest that the onset of bipolar disorder can be elucidated by studying the pathway from non-pathological behavioural expression to dysfunction and need for care.

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Section: Resultsmentioning

confidence: 73%

Evidence that bipolar disorder is the poor outcome fraction of a common developmental phenotype: an 8-year cohort study in young people

Tijssen

Wittchen

et al. 2009

Psychol. Med.

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“…Considerable overlap in symptom expression is one of the most important arguments that categorical models may not adequately describe psychopathology as it exists in nature (Kendell & Jablensky, 2003). A dimensional model, delineating psychopathology not as a binary phenomenon, but along a continuous scale of severity, may complement the traditional categorical approach (Allardyce et al 2007;Kendler et al 2011).…”

Section: Discussionmentioning

confidence: 99%

Subclinical psychotic experiences and bipolar spectrum features in depression: association with outcome of psychotherapy

Wigman

Abidi

et al. 2013

Psychol. Med.

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Background. Subthreshold psychotic and bipolar experiences are common in major depressive disorder (MDD). However, it is unknown if effectiveness of psychotherapy is altered in depressed patients who display such features compared with those without. The current paper aimed to investigate the impact of the co-presence of subclinical psychotic experiences and subclinical bipolar symptoms on the effectiveness of psychological treatment, alone or in combination with pharmacotherapy.Method. In a naturalistic study, patients with MDD (n = 116) received psychological treatment (cognitive behavioural therapy or interpersonal psychotherapy) alone or in combination with pharmacotherapy. Depression and functioning were assessed six times over 2 years. Lifetime psychotic experiences and bipolar symptoms were assessed at the second time point.Results. Subclinical psychotic experiences predicted more depression over time (β = 0.20, p < 0.002), non-remission [odds ratio (OR) 7.51, p < 0.016] and relapse (OR 3.85, p < 0.034). Subthreshold bipolar symptoms predicted relapse (OR 1.16, p < 0.037).Conclusions. In general, subclinical psychotic experiences have a negative impact on the course and outcome of psychotherapy in MDD. Effects of subclinical bipolar experiences were less prominent.

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“…F3) disorders [10,27], other studies found support for a separation of schizoaffective disorders from schizophrenia with regard to clinical picture and outcome [20,28]. A dimensional approach seems to be superior in terms of predictive validity [2], but of course the categorical status of current classification systems, the usefulness and simplicity of categorical decisions [40], and a tendency of human beings to think in categories [13] should not be neglected either. The conclusion is obvious: A combination of the categorical and the dimensional perspective would seem to be the most promising approach.…”

Section: Introductionmentioning

confidence: 99%

“…[22,23,35], and the field of psychotic disorders in particular, e.g. [2,11,39]. Many fruitful methodological approaches have been applied and discussed in this regard in order to identify either categories or dimensions, such as cluster analysis, e.g.…”

Section: Introductionmentioning

confidence: 99%

Combining the categorical and the dimensional perspective in a diagnostic map of psychotic disorders

Läge

Egli

Riedel

et al. 2010

Eur Arch Psychiatry Clin Neurosci

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We introduce a diagnostic map that was calculated by robust non-metric multidimensional scaling based on AMDP symptom profiles of patients with schizophrenic and affective disorders to demonstrate a possibility to combine the categorical and the dimensional perspective at the same time. In the diagnostic map, a manic, a depressive, and a non-affective cluster clearly emerged. At the same time, the mania dimension (r = 0.82), the depression dimension (r = 0.68), and the apathy dimension (r = 0.74) showed high multiple regression values in the map. We found substantial overlaps of the diagnostic groups with regard to the affective spectrum but irrespective of the ICD-10 classification. Within this sample, we found the association and quality of mood symptoms to be a structuring principle in a diagnostic map. We demonstrate that this approach represents a promising way of combining the categorical and the dimensional perspective. As a practical implementation of these findings, a multidimensional diagnostic map could serve as an automated diagnostic tool based on psychopathological symptom profiles.

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Dimensions and the psychosis phenotype

Cited by 101 publications

References 71 publications

Evidence that bipolar disorder is the poor outcome fraction of a common developmental phenotype: an 8-year cohort study in young people

Evidence that bipolar disorder is the poor outcome fraction of a common developmental phenotype: an 8-year cohort study in young people

Subclinical psychotic experiences and bipolar spectrum features in depression: association with outcome of psychotherapy

Combining the categorical and the dimensional perspective in a diagnostic map of psychotic disorders

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