Transdiagnostic dimensions of psychosis in the Bipolar‐Schizophrenia Network on Intermediate Phenotypes (B‐SNIP)

• Published in: World psychiatry Vol. 18; no. 1; pp. 67 - 76
• Main Authors: Reininghaus, Ulrich, Böhnke, Jan R., Chavez‐Baldini, UnYoung, Gibbons, Robert, Ivleva, Elena, Clementz, Brett A., Pearlson, Godfrey D., Keshavan, Matcheri S., Sweeney, John A., Tamminga, Carol A.
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01-02-2019; Wiley Subscription Services, Inc
• Subjects: biotypes; Bipolar disorder; bipolar disorder with psychosis; general symptom dimensions; Item response theory; Psychosis; Research Report; Research Reports; schizoaffective disorder; Schizophrenia; specific symptom dimensions; transdiagnostic phenotypes; Validity; Psychosis; bipolar disorder with psychosis; general symptom dimensions; biotypes; schizophrenia; specific symptom dimensions; schizoaffective disorder; transdiagnostic phenotypes
• ISSN: 1723-8617; 2051-5545
• DOI: 10.1002/wps.20607

The validity of the classification of non‐affective and affective psychoses as distinct entities has been disputed, but, despite calls for alternative approaches to defining psychosis syndromes, there is a dearth of empirical efforts to identify transdiagnostic phenotypes of psychosis. We aimed to investigate the validity and utility of general and specific symptom dimensions of psychosis cutting across schizophrenia, schizoaffective disorder and bipolar I disorder with psychosis. Multidimensional item‐response modeling was conducted on symptom ratings of the Positive and Negative Syndrome Scale, Young Mania Rating Scale, and Montgomery‐Åsberg Depression Rating Scale in the multicentre Bipolar‐Schizophrenia Network on Intermediate Phenotypes (B‐SNIP) consortium, which included 933 patients with a diagnosis of schizophrenia (N=397), schizoaffective disorder (N=224), or bipolar I disorder with psychosis (N=312). A bifactor model with one general symptom dimension, two distinct dimensions of non‐affective and affective psychosis, and five specific symptom dimensions of positive, negative, disorganized, manic and depressive symptoms provided the best model fit. There was further evidence on the utility of symptom dimensions for predicting B‐SNIP psychosis biotypes with greater accuracy than categorical DSM diagnoses. General, positive, negative and disorganized symptom dimension scores were higher in African American vs. Caucasian patients. Symptom dimensions accurately classified patients into categorical DSM diagnoses. This study provides evidence on the validity and utility of transdiagnostic symptom dimensions of psychosis that transcend traditional diagnostic boundaries of psychotic disorders. Findings further show promising avenues for research at the interface of dimensional psychopathological phenotypes and basic neurobiological dimensions of psychopathology.