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Psychopathology factors in first-episode affective and non-affective psychotic disorders.
J Psychiatr Res. 2007 Nov; 41(9):724-36.JP

Abstract

BACKGROUND

Since the onset, prevalence, and course of specific psychopathological features rarely have been analyzed simultaneously from the start of dissimilar psychotic illnesses, we compared symptom-clusters in first-episode DSM-IV affective and non-affective psychotic disorders.

METHODS

Subjects (N=377) from the McLean-Harvard First Episode Project hospitalized for first-lifetime primary psychotic illnesses were followed prospectively for 2 years to verify stable DSM-IV diagnoses. We ascertained initial symptoms from baseline SCID and clinical assessments, applying AMDP and Bonn psychopathology schemes systematically to describe a broad range of features. Final consensus diagnoses were based on intake and follow-up SCID assessments, family interviews, and medical records. Factor-analytic methods defined first-episode symptom-clusters (Factors), and multiple-regression modeling related identified factors to initial DSM-IV diagnoses and to later categories (affective, non-affective, or schizoaffective disorders).

RESULTS

Psychopathological features were accommodated by four factors: I represented mania with psychosis; II a mixed depressive-agitated state; III an excited-hallucinatory-delusional state; IV a disorganized-catatonic-autistic state. Each factor was associated with characteristic prodromal symptoms. Factors I and III associated with DSM-IV mania, II with major depression or bipolar mixed-state, III negatively with delusional disorder, IV with major depression and negatively with mania. Factors I and II predicted later affective diagnoses; absence of Factor I features predicted non-affective diagnoses, and no Factor predicted later schizoaffective diagnoses.

CONCLUSION

The findings contribute to descriptive categorizations of psychopathology from onset of dissimilar psychotic illnesses. This approach was effective in identifying and subtyping affective psychotic disorders early in their clinical evolution, but non-affective and schizoaffective conditions appear to be more complex and unstable.

Authors+Show Affiliations

Department of Psychiatry and Neuroscience Program, Harvard Medical School, Boston, MA, USA. psalvatore@mclean.harvard.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16762370

Citation

Salvatore, P, et al. "Psychopathology Factors in First-episode Affective and Non-affective Psychotic Disorders." Journal of Psychiatric Research, vol. 41, no. 9, 2007, pp. 724-36.
Salvatore P, Khalsa HM, Hennen J, et al. Psychopathology factors in first-episode affective and non-affective psychotic disorders. J Psychiatr Res. 2007;41(9):724-36.
Salvatore, P., Khalsa, H. M., Hennen, J., Tohen, M., Yurgelun-Todd, D., Casolari, F., Depanfilis, C., Maggini, C., & Baldessarini, R. J. (2007). Psychopathology factors in first-episode affective and non-affective psychotic disorders. Journal of Psychiatric Research, 41(9), 724-36.
Salvatore P, et al. Psychopathology Factors in First-episode Affective and Non-affective Psychotic Disorders. J Psychiatr Res. 2007;41(9):724-36. PubMed PMID: 16762370.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Psychopathology factors in first-episode affective and non-affective psychotic disorders. AU - Salvatore,P, AU - Khalsa,H M K, AU - Hennen,J, AU - Tohen,M, AU - Yurgelun-Todd,D, AU - Casolari,F, AU - Depanfilis,C, AU - Maggini,C, AU - Baldessarini,R J, Y1 - 2006/06/09/ PY - 2005/11/14/received PY - 2006/04/08/revised PY - 2006/04/18/accepted PY - 2006/6/10/pubmed PY - 2007/8/4/medline PY - 2006/6/10/entrez SP - 724 EP - 36 JF - Journal of psychiatric research JO - J Psychiatr Res VL - 41 IS - 9 N2 - BACKGROUND: Since the onset, prevalence, and course of specific psychopathological features rarely have been analyzed simultaneously from the start of dissimilar psychotic illnesses, we compared symptom-clusters in first-episode DSM-IV affective and non-affective psychotic disorders. METHODS: Subjects (N=377) from the McLean-Harvard First Episode Project hospitalized for first-lifetime primary psychotic illnesses were followed prospectively for 2 years to verify stable DSM-IV diagnoses. We ascertained initial symptoms from baseline SCID and clinical assessments, applying AMDP and Bonn psychopathology schemes systematically to describe a broad range of features. Final consensus diagnoses were based on intake and follow-up SCID assessments, family interviews, and medical records. Factor-analytic methods defined first-episode symptom-clusters (Factors), and multiple-regression modeling related identified factors to initial DSM-IV diagnoses and to later categories (affective, non-affective, or schizoaffective disorders). RESULTS: Psychopathological features were accommodated by four factors: I represented mania with psychosis; II a mixed depressive-agitated state; III an excited-hallucinatory-delusional state; IV a disorganized-catatonic-autistic state. Each factor was associated with characteristic prodromal symptoms. Factors I and III associated with DSM-IV mania, II with major depression or bipolar mixed-state, III negatively with delusional disorder, IV with major depression and negatively with mania. Factors I and II predicted later affective diagnoses; absence of Factor I features predicted non-affective diagnoses, and no Factor predicted later schizoaffective diagnoses. CONCLUSION: The findings contribute to descriptive categorizations of psychopathology from onset of dissimilar psychotic illnesses. This approach was effective in identifying and subtyping affective psychotic disorders early in their clinical evolution, but non-affective and schizoaffective conditions appear to be more complex and unstable. SN - 0022-3956 UR - https://www.unboundmedicine.com/medline/citation/16762370/Psychopathology_factors_in_first_episode_affective_and_non_affective_psychotic_disorders_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-3956(06)00073-2 DB - PRIME DP - Unbound Medicine ER -