Dimensions and the psychosis phenotype

Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, Maastricht, The Netherlands.
International Journal of Methods in Psychiatric Research (Impact Factor: 3.76). 06/2007; 16 Suppl 1(S1):S34-40. DOI: 10.1002/mpr.214
Source: PubMed


In this paper, we discuss the conceptual background for including a dimensional component to the DSM V diagnoses for psychoses. We review the evidence for a continuous distribution of psychosis like symptoms in the general population and summarise the research validating the clinical usefulness of psychopathological dimensions. We conclude that diagnostic models using both categorical and dimensional representations of psychosis have better predictive validity than either model independently. Dimensions do not appear to be diagnosis specific so a flexible scoring of dimensions across all psychotic and major affective disorders may be potentially more informative than a system where categorical diagnoses are kept artificially dimension-specific.

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    • "Most MDD patients present with several symptoms beyond the formal diagnostic constructs of the 4 th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) or 10 th revision of the International Statistical Classification of Diseases and Related Health Problems. Clinical and subclinical psychotic experiences [6e8] and bipolar spectrum features [9] [10] are commonly manifested in the context of MDD. From a clinical course perspective, a reciprocal relationship between depression and psychosis has been identified [11] [12]. "
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    ABSTRACT: Although major depressive disorder (MDD) has a variety of symptoms beyond the af-fective dimensions, the factor structure and contents of comprehensive psychiatric symptoms of this disorder have rarely been explored using the 18-item Brief Psychiatric Rating Scale (BPRS). We aimed to identify the factor structure of the 18-item BPRS in Korean MDD patients. A total of 258 MDD patients were recruited from a multicenter sample of the Clinical Research Center for Depression of South Korea study. Psychometric scales were used to assess overall psychiatric symptoms (BPRS), depression (Hamilton Depression Rating Scale), anxiety (Hamil-ton Anxiety Rating Scale), global severity (Clinical Global Impression of Severity Scale), suicidal ideation (Scale for Suicide Ideation), functioning (Social and Occupational Functioning Assessment Scale), and quality of life (World Health Organization Quality of Life Assessmentabbreviated version). Common factor analysis with oblique rotation was used to yield factor structure. A four-factor structure was designed and interpreted by the symptom dimensions to reflect mood disturbance, positive symptoms/apathy, bipolarity, and thought distortion/ mannerism. These individual factors were also significantly correlated with clinical variables. The findings of this study support the view that the BPRS may be a promising measuring tool for the initial assessment of MDD patients. In addition, the four-factor structure of the BPRS may be useful in understanding the mood and psychotic characteristics of these patients.
    Full-text · Article · Jan 2015 · The Kaohsiung journal of medical sciences
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    • "bipolar disorder with psychosis). This notion could have relevance to the characteristic distorted perceptions of narcissistic individuals, since it appears that the delusional symptoms of psychoses exist on a continuum in the general population (Allardyce et al., 2007). Using self-report measures in a narcissistic population is known to have limitations due to the individual's characteristic distorted perceptions of self and others, as well as their tendency to self-aggrandize. "

    Full-text · Article · Jul 2014 · Psychiatry Research
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    • "It seems dubious that a dimensional model will ever completely replace categories. For that reason, even proponents of the dimensional approach advocate a graded categorical approach (Allardyce et al. 2007, Mellsop et al. 2007, Vieta and Phillips 2007). In this approach, classical categories are preserved, but in addition, the severity of the pathology is integrated into the diagnosis using rating scales. "
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    ABSTRACT: The neo-Kraepelinian paradigm has been the dominant paradigm in psychiatry since the introduction of DSM-III in 1980. Though successful in achieving reliability and in some other respects, it also has limitations. Lately, it has been argued that a paradigm shift is needed in psychiatric diagnosis. The aim of this paper is to review evidence of the limitations of DSM and to determine whether our classification system is in a phase of crisis in the Kuhnian sense. The most important criticisms raised since the early eighties include: the psychodynamic objection, the descriptive approach criticism, the criticism of poor diagnostic validity, and Öztürk's critique. The author concludes that these old objections are not a real threat. In particular, problems stemming from the descriptive approach and low diagnostic validity are not attributable to DSM but are due to under-achievements in psychiatry. On the other hand, the new problems seem more serious and may be considered signs of crisis. These include high rates of false positives, high levels of pseudo-comorbidity, and other deficiencies attributed to the categorical approach. However, because of the advantages of this approach and the lack of a serious candidate available to replace it, a paradigm shift seems highly unlikely. The real source of the problem is not the categorical model but the low validity of some of our categories. If our etiopathological understanding of all the categories were to reach that of medical disorders, no paradigm shift would seem necessary.
    Full-text · Article · Jun 2012 · Turk psikiyatri dergisi = Turkish journal of psychiatry
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