Psychopathological Course Typology in Schizophrenia Spectrum Disorders: A Heuristic Approach in a Sample of 100 Patients

Abstract

Background: Despite several previous attempts at subtyping schizophrenia, a typology that reflects neurobiological knowledge and reliably predicts course and outcome is lacking. We applied the system-specific concept of the Bern Psychopathology Scale (BPS) to generate a course typology based on three domains: language, affectivity, and motor behaviour. Sampling and Methods: A cohort of 100 patients with schizophrenia or schizoaffective disorders according to DSM-IV criteria underwent psychopathological assessment, and all their available medical records were retrospectively analysed on the basis of the BPS. Results: Overall, 39% of the patients showed dominant abnormalities in only one domain, 37% in two domains, and 24% in all three domains. The motor domain was affected in the majority of patients (76%), followed by affectivity (63%) and language (46%). Eighty-six percent of patients showed a bipolar course pattern in at least one domain. Conclusions: In a retrospective analysis of 100 patient records we described system-specific course patterns of schizophrenia by using a neurobiologically informed psychopathological assessment. The results showed a surprisingly high proportion of bipolar courses and a pattern of pure and mixed subtypes, which speaks for an overlap of domains with regards to psychopathological symptoms. A limitation of this heuristic and retrospective approach is that it was largely based on clinical judgement. Prospective studies with more rigorous threshold definitions are needed to clarify the neurobiological and clinical implications of the proposed reorganization of psychotic disorders.

Psychosis Is Mutable over Time: A Longitudinal Psychopathology Study

“…The BPS [6] is a tool that follows such an approach. It is complementary to the positive-negative approach [15] and related to global functioning [19] as well as severe clinical events [20] and has been used to retrospectively describe the course of schizophrenia [16]. Previously, a prospective application of the BPS in a cohort of patients with schizophrenia had been lacking, and to our knowledge, this is the first study to apply such an approach.…”

“…Both the PANSS and BPS were designed as instruments for cross-sectional assessment, but our group has used the BPS to categorise longitudinal data retrospectively [16]. In this retrospective study, we found that 86% of patients showed a bipolar course pattern (i.e., they showed switches from inhibition to disinhibition or vice versa) in at least 1 of the 3 domains.…”

“…In this retrospective study, we found that 86% of patients showed a bipolar course pattern (i.e., they showed switches from inhibition to disinhibition or vice versa) in at least 1 of the 3 domains. Thirty-nine percent of cases showed psychopathology mainly in 1 domain and were thus rated as “pure types”; the rest showed psychopathology in more than 1 domain [16]. …”

SyNoPsis: Response to the Commentators

“…However, it allows recurrent assessments at deliberate intervals for follow-up observations. First retrospective studies have recently been published [7], and the issue of the course of psychosis dimensions will be addressed in detail in future projects.Regarding negative symptoms, we pursued a novel approach, mapping "negative" behavior onto inhibitory states of the respective brain functions. Following our objective to revise the semiology of psychosis based on the best of our knowledge about the related brain functions, this group of symptoms was disentangled respecting the boundaries of higher brain functions.…”

“…However, it allows recurrent assessments at deliberate intervals for follow-up observations. First retrospective studies have recently been published [7], and the issue of the course of psychosis dimensions will be addressed in detail in future projects.…”