Testing extra-linearity across a psychosis continuum
Abstract Background It is unclear whether psychotic experiences (PEs) gradually merge into states of clinical psychosis along a continuum which correspond to a dimensional classification or whether latent classes appear above a certain severity threshold which correspond better to diagnostic categor...
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BMC
2021
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oai:doaj.org-article:409778288a904d878d74b9cb841b09792021-11-21T12:05:10ZTesting extra-linearity across a psychosis continuum10.1186/s12888-021-03498-31471-244Xhttps://doaj.org/article/409778288a904d878d74b9cb841b09792021-11-01T00:00:00Zhttps://doi.org/10.1186/s12888-021-03498-3https://doaj.org/toc/1471-244XAbstract Background It is unclear whether psychotic experiences (PEs) gradually merge into states of clinical psychosis along a continuum which correspond to a dimensional classification or whether latent classes appear above a certain severity threshold which correspond better to diagnostic categories of psychosis. Methods Annual cross-sectional surveys, 2014–19, among Chinese undergraduates (N = 47,004) measured PEs, depression and etiological risk factors using standardized self-report instruments. We created a psychosis continuum with five levels and tested linear and extra-linear contrasts in associated etiological risk factors, before and after adjustment for depression. We carried out latent class analysis. Results Categorical expression of psychosis, including hallucinations and delusions, nuclear symptoms, and nuclear symptoms and depression were found at severe level 5. Etiological risk factors which impacted linearly across the continuum were more common for depression. Child maltreatment impacted extra-linearly on both psychosis and depression. Family history of psychosis impacted linearly on psychosis; male sex and urban birth impacted extra-linearly and were specific for psychosis. Four latent classes were found, but only at level 5. These corresponded to nuclear schizophrenia symptoms, nuclear schizophrenia and depressive symptoms, severe depression, and an unclassified category with moderate prevalence of PEs. Conclusion Quantitative and qualitative changes in the underlying structure of psychosis were observed at the most severe level along a psychosis continuum, where four latent classes emerged. These corresponded to existing categorical classifications but require confirmation with clinical interview. PEs are non-specific and our findings suggest some are on a continuum with depression, whilst others are on a continuum with non-affective psychosis. Differing patterns of impact from etiological risk factors across the spectrum of psychopathology determine outcome at the most severe level of these continua.Jeremy W. CoidYamin ZhangJinkun ZengXiaojing LiQiuyue LvWanjie TangQiang WangWei DengWanjun GuoLiansheng ZhaoXiaohong MaYajing MengMingli LiHuiyao WangTing ChenMin YangTao LiBMCarticlePsychotic experiencesPsychosis continuumExtra-linearityEtiologyPsychosis subtypesPsychiatryRC435-571ENBMC Psychiatry, Vol 21, Iss 1, Pp 1-15 (2021) |
| institution |
DOAJ |
| collection |
DOAJ |
| language |
EN |
| topic |
Psychotic experiences Psychosis continuum Extra-linearity Etiology Psychosis subtypes Psychiatry RC435-571 |
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Psychotic experiences Psychosis continuum Extra-linearity Etiology Psychosis subtypes Psychiatry RC435-571 Jeremy W. Coid Yamin Zhang Jinkun Zeng Xiaojing Li Qiuyue Lv Wanjie Tang Qiang Wang Wei Deng Wanjun Guo Liansheng Zhao Xiaohong Ma Yajing Meng Mingli Li Huiyao Wang Ting Chen Min Yang Tao Li Testing extra-linearity across a psychosis continuum |
| description |
Abstract Background It is unclear whether psychotic experiences (PEs) gradually merge into states of clinical psychosis along a continuum which correspond to a dimensional classification or whether latent classes appear above a certain severity threshold which correspond better to diagnostic categories of psychosis. Methods Annual cross-sectional surveys, 2014–19, among Chinese undergraduates (N = 47,004) measured PEs, depression and etiological risk factors using standardized self-report instruments. We created a psychosis continuum with five levels and tested linear and extra-linear contrasts in associated etiological risk factors, before and after adjustment for depression. We carried out latent class analysis. Results Categorical expression of psychosis, including hallucinations and delusions, nuclear symptoms, and nuclear symptoms and depression were found at severe level 5. Etiological risk factors which impacted linearly across the continuum were more common for depression. Child maltreatment impacted extra-linearly on both psychosis and depression. Family history of psychosis impacted linearly on psychosis; male sex and urban birth impacted extra-linearly and were specific for psychosis. Four latent classes were found, but only at level 5. These corresponded to nuclear schizophrenia symptoms, nuclear schizophrenia and depressive symptoms, severe depression, and an unclassified category with moderate prevalence of PEs. Conclusion Quantitative and qualitative changes in the underlying structure of psychosis were observed at the most severe level along a psychosis continuum, where four latent classes emerged. These corresponded to existing categorical classifications but require confirmation with clinical interview. PEs are non-specific and our findings suggest some are on a continuum with depression, whilst others are on a continuum with non-affective psychosis. Differing patterns of impact from etiological risk factors across the spectrum of psychopathology determine outcome at the most severe level of these continua. |
| format |
article |
| author |
Jeremy W. Coid Yamin Zhang Jinkun Zeng Xiaojing Li Qiuyue Lv Wanjie Tang Qiang Wang Wei Deng Wanjun Guo Liansheng Zhao Xiaohong Ma Yajing Meng Mingli Li Huiyao Wang Ting Chen Min Yang Tao Li |
| author_facet |
Jeremy W. Coid Yamin Zhang Jinkun Zeng Xiaojing Li Qiuyue Lv Wanjie Tang Qiang Wang Wei Deng Wanjun Guo Liansheng Zhao Xiaohong Ma Yajing Meng Mingli Li Huiyao Wang Ting Chen Min Yang Tao Li |
| author_sort |
Jeremy W. Coid |
| title |
Testing extra-linearity across a psychosis continuum |
| title_short |
Testing extra-linearity across a psychosis continuum |
| title_full |
Testing extra-linearity across a psychosis continuum |
| title_fullStr |
Testing extra-linearity across a psychosis continuum |
| title_full_unstemmed |
Testing extra-linearity across a psychosis continuum |
| title_sort |
testing extra-linearity across a psychosis continuum |
| publisher |
BMC |
| publishDate |
2021 |
| url |
https://doaj.org/article/409778288a904d878d74b9cb841b0979 |
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