Transdiagnostic Dimensions of Psychiatric Comorbidity in Individuals at Clinical High Risk for Psychosis: A Preliminary Study Informed by HiTOP

Abstract

Background: Although psychiatric comorbidity is the norm among individuals at clinical high risk for psychotic disorders (CHR), research has yet to examine transdiagnostic dimensional models of comorbidity in this critical population.Methods: This study analyzed quantitative measures of eleven psychiatric syndromes in a group at CHR (n = 71) and a matched healthy comparison group (n = 73) to determine these syndromes' dimensional structure and relationships to cognition, functioning, and risk of conversion to psychotic disorders.Results: Relative to the comparison group, the CHR group was elevated on all eleven psychiatric syndromes. Exploratory factor analysis found three psychopathology dimensions: internalizing, negative symptoms, and positive symptoms. Depression cross-loaded onto the internalizing and negative symptom dimensions. Hypomania loaded positively on positive symptoms but negatively on negative symptoms. The negative symptom factor was associated with poorer cognition and functioning and a higher risk of conversion to psychosis.Conclusions: These dimensions align with internalizing, detachment, and thought disorder, three of the five spectra in higher-order models such as the Hierarchical Taxonomy of Psychopathology (HiTOP). In the CHR state, detachment appears to be particularly insidious and predictive of psychosis. Further research is required to distinguish depression and hypomania from attenuated psychotic symptoms in this population.

A network analysis of anxiety, depressive, and psychotic symptoms and functioning in children and adolescents at clinical high risk for psychosis

“…Indeed, a recent study estimating age-specific (i.e., ages 9–17 years vs. ages 18–45 years) prediction models of psychosis ( 107 ) showed that the conversion outcome was best predicted by negative symptoms in CHR-P adolescents, but positive symptoms in CHR-P adults ( 107 ). The lack of associations of positive symptoms with other nodes it is partially in line with a recent study informed ( 108 ) by the Hierarchical Taxonomy of Psychopathology [HiTOP ( 109 , 110 )]. In this study ( 108 ), an explanatory factor analysis in a CHR-P group was employed, showing three different psychopathology dimensions: internalizing, primarily negative symptoms, and primarily positive symptoms.…”

“…The lack of associations of positive symptoms with other nodes it is partially in line with a recent study informed ( 108 ) by the Hierarchical Taxonomy of Psychopathology [HiTOP ( 109 , 110 )]. In this study ( 108 ), an explanatory factor analysis in a CHR-P group was employed, showing three different psychopathology dimensions: internalizing, primarily negative symptoms, and primarily positive symptoms. If, on the one hand, the three archipelagos of symptoms of our network and the three dimensions of such research present several similarities, on the other, there are some differences.…”

“…Conversely, we did not find a relevant connection between depressive and negative symptoms. The authors ( 108 ) emphasized the need for further research on the “dividing lines” between depressive and negative symptoms. Moreover, the authors found small to medium factor intercorrelations, whereas we did not find relevant associations among symptom sub-groups.…”

The Latent Structure of Negative Symptoms in the General Population in Adolescence and Emerging Adulthood

“… 81 , 82 , 88 However, an alternative approach is to view negative symptoms within a broader, hierarchical framework of psychopathology such as the Hierarchical Taxonomy of Psychopathology (HiTOP) system, 89 , 90 to harness the co-occurrence of these (and other) symptoms and traits in order to delineate etiology at multiple levels. 6 , 89 , 91 Together with a research framework such as the NIMH Research Domain Criteria (RDoC) 92 that seeks to understand transdiagnostic psychological processes, 93 this is likely to be an important complement to the extant negative symptoms CFA literature in the pursuit of understanding the etiology of general and specific factors influencing both distinct and transdiagnostic symptoms.…”

The maladaptive domains according to the alternative model of personality disorders (AMPD) criterion B in patients with affective disorders and temperamental triads related to these domains: two unique profiles

“…The Hierarchical Taxonomy of Psychopathology (HiTOP) introduces many diagnostic categories of psychopathology in traditional classification systems as subsets of five major maladaptive domains called higher-order spectra [8,9]. However, this factor analysis model still faces challenges for some diagnostic categories such as somatoform and bipolar spectrum disorders [8,[10][11][12].…”