Categorical vs dimensional classifications of psychotic disorders.
OBJECTIVE
Both categorical and dimensional methods appear relevant to classifying psychotic disorders; however, there is no clear consensus on the most appropriate categories and dimensions or on the best approach for constructing nosologic criteria that integrate these 2 methods. This review examines the evidence on specific dimensions and categories that would best characterize psychoses.


METHODS
Entries in the MEDLINE database between 1980 and 2011 were searched for studies of the dimensional and/or categorical structure of psychosis. Studies were included if samples represented a spectrum of psychotic disorders and dimensions/categories were empirically derived using principal components analysis, factor analysis, or latent class analysis.


RESULTS
Most dimensional studies observed 4 or 5 dimensions within psychosis, with positive, negative, disorganization, and affective symptom domains most frequently reported. Substance abuse, anxiety, early onset/developmental, insight, cognition, hostility, and behavioral/social disturbance dimensions appeared in some studies. Categorical studies suggested 3 to 7 major classes within psychosis, including a class similar to Kraepelin's dementia praecox and one or more classes with significant mood components. Only 2 studies compared the relative fit of empirically derived dimensions and categories within the same data set, and each had significant limitations.


CONCLUSIONS
There is relatively consistent evidence on appropriate categories and dimensions for characterizing psychoses. However, the lack of studies directly comparing or combining these approaches provides insufficient evidence for definitive conclusions about their relative merits and integration. The authors provide specific recommendations for designing future studies to identify valid dimensions and/or categories of the psychoses and investigate hybrid approaches to model the structure of the underlying illnesses.
Psychotic Disorders Division, McLean Hospital, 1125 Mill St., Belmont, MA 02478, USA.
Melissa
M
Potuzak
Caitlin
C
Ravichandran
Kathryn E
KE
Lewandowski
Dost
D
Ongür
Bruce M
BM
Cohen
D015897:Comorbidity; D039721:Diagnostic and Statistical Manual of Mental Disorders; D006801:Humans; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011594:Psychometrics / Q000706:statistics & numerical data; D011618:Psychotic Disorders / Q000145:classification* / Q000175:diagnosis* / Q000523:psychology; D015203:Reproducibility of Results; D012559:Schizophrenia / Q000145:classification* / Q000175:diagnosis; D012565:Schizophrenic Psychology