Evidence that a psychopathology interactome has diagnostic value, predicting clinical needs: an experience sampling study.
BACKGROUND
For the purpose of diagnosis, psychopathology can be represented as categories of mental disorder, symptom dimensions or symptom networks. Also, psychopathology can be assessed at different levels of temporal resolution (monthly episodes, daily fluctuating symptoms, momentary fluctuating mental states). We tested the diagnostic value, in terms of prediction of treatment needs, of the combination of symptom networks and momentary assessment level.


METHODS
Fifty-seven patients with a psychotic disorder participated in an ESM study, capturing psychotic experiences, emotions and circumstances at 10 semi-random moments in the flow of daily life over a period of 6 days. Symptoms were assessed by interview with the Positive and Negative Syndrome Scale (PANSS); treatment needs were assessed using the Camberwell Assessment of Need (CAN).


RESULTS
Psychotic symptoms assessed with the PANSS (Clinical Psychotic Symptoms) were strongly associated with psychotic experiences assessed with ESM (Momentary Psychotic Experiences). However, the degree to which Momentary Psychotic Experiences manifested as Clinical Psychotic Symptoms was determined by level of momentary negative affect (higher levels increasing probability of Momentary Psychotic Experiences manifesting as Clinical Psychotic Symptoms), momentary positive affect (higher levels decreasing probability of Clinical Psychotic Symptoms), greater persistence of Momentary Psychotic Experiences (persistence predicting increased probability of Clinical Psychotic Symptoms) and momentary environmental stress associated with events and activities (higher levels increasing probability of Clinical Psychotic Symptoms). Similarly, the degree to which momentary visual or auditory hallucinations manifested as Clinical Psychotic Symptoms was strongly contingent on the level of accompanying momentary paranoid delusional ideation. Momentary Psychotic Experiences were associated with CAN unmet treatment needs, over and above PANSS measures of psychopathology, similarly moderated by momentary interactions with emotions and context.


CONCLUSIONS
The results suggest that psychopathology, represented as an interactome at the momentary level of temporal resolution, is informative in diagnosing clinical needs, over and above traditional symptom measures.
Dept of Psychiatry and Psychology, Centre of Contextual Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands ; King's College London, King's Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, United Kingdom.
Jim
J
van Os
Dept of Psychiatry and Psychology, Centre of Contextual Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands.
Tineke
T
Lataster
Dept of Psychiatry and Psychology, Centre of Contextual Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands.
Philippe
P
Delespaul
Dept of Psychiatry and Psychology, Centre of Contextual Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands.
Marieke
M
Wichers
Dept of Psychiatry and Psychology, Centre of Contextual Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands.
Inez
I
Myin-Germeys
D000328:Adult; D005260:Female; D006212:Hallucinations / Q000473:pathology / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010259:Paranoid Disorders / Q000473:pathology / Q000523:psychology*; D011599:Psychopathology; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D012494:Sampling Studies; D013315:Stress, Psychological / Q000523:psychology; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult