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Distribution of symptom dimensions across Kraepelinian divisions

Division of Psychological Medicine, Institute of Psychiatry, King’s College London, UK and Department of Psychiatry, University of Athens, Greece

HARVEY WICKHAM, MD, MRCPsych, FRSS

Division of Psychological Medicine, Institute of Psychiatry, King’s College London, UK

COLM McDONALD, MD, MRCPsych, PhD

Division of Psychological Medicine, Institute of Psychiatry, King’s College London, UK and Department of Psychiatry, National University of Ireland, Galway, Ireland

MURIEL WALSHE, BA

Division of Psychological Medicine, Institute of Psychiatry, King’s College London, UK

THORDUR SIGMUNDSSON, MD, MRCPsych

Department of Psychiatry, Landspitalinn, The University Hospital, Reykjavik, Iceland

ELVIRA BRAMON, MD, PhD

Division of Psychological Medicine, Institute of Psychiatry, King’s College London, UK

ANTON GRECH, MD, MSc, MRCPsych

Mount Carmel Hospital, Attard, Malta

TIMOTHEA TOULOPOULOU, BA, MSc, PhD

Division of Psychological Medicine, Institute of Psychiatry, King’s College London, UK

ROBIN MURRAY, MD, DSc

Division of Psychological Medicine, Institute of Psychiatry, King’s College London, UK

PAK C. SHAM, MD, MRCPsych, PhD

Division of Psychological Medicine, Institute of Psychiatry, King’s College London, UK and Department of Psychiatry, University of Hong Kong

Correspondence: Dr Dimitris G. Dikeos, Institute of Psychiatry, SGDP Building, De Crespigny Park, Denmark Hill, London SE5 8AF, UK. Tel: +44(0)20 7848 0854; email d.dikeos{at}iop.kcl.ac.uk

Declaration of interest None. Funding detailed in Acknowledgements.

Background Dimensional structures are established for many psychiatric diagnoses, but dimensions have not been compared between diagnostic groups.

Aims To examine the structure of dimensionsin psychosis, to analyse their correlations with disease characteristics and to assess the relative contribution of dimensions v. diagnosis in explaining these characteristics.

Method Factor analysis of the OPCRIT items of 191 Maudsley Family Study patients with schizophrenia, mood disorders with psychosis, schizoaffective disorder, and other psychotic illnesses, followed by regression of disease characteristics from factor scores and diagnosis.

Results Five factors were identified (mania, reality distortion, depression, disorganisation, negative); all were more variable in schizophrenia than in affective psychosis. Mania was the best discriminator between schizophrenia and affective psychosis; the negative factor was strongly correlated with poor premorbid functioning, insidious onset and worse course. Dimensions explained more of the disease characteristics than did diagnosis, but the explanatory power of the latter was also high.

Conclusions Kraepelinian diagnostic categories suffice for understanding illness characteristics, but the use of dimensions adds substantial information.

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