The psychosis continuum and categorical versus dimensional diagnostic approaches

  title={The psychosis continuum and categorical versus dimensional diagnostic approaches},
  author={Michelle L. Esterberg and Michael T. Compton},
  journal={Current Psychiatry Reports},
This overview briefly presents recent thinking on the dimensional approach to understanding psychotic experiences. First, evidence is provided for a continuum of psychosis ranging from self-reported infrequent psychotic symptoms in the general population, to schizotypal traits, to schizotypal personality disorder, and finally to full-blown psychosis resulting in a diagnosable primary psychotic disorder. Variation within each of these types of psychotic experience is discussed. Then, a… 

Schyzotipy: from Personality Organization to Transition to Schizophrenia.

The traditional medical model of schizophrenia assumes a categorical view of the syndrome, butSchizotipy comprise a set of inherited traits reflected in personality organization, which presents as qualitatively similar to schizophrenia.

From the Categorical to the Dimensional Approach in Psychopathology: The Case of Auditory Hallucinations

The aim of this paper is to show that the dimensional approach, explaining symptoms by other symptoms, may help to reach a much more complex vision of the metacognitive, relational, and social dynamics that underlie psychotic symptoms.

Etiologic, phenomenologic, and endophenotypic overlap of schizophrenia and bipolar disorder.

  • G. Pearlson
  • Psychology, Medicine
    Annual review of clinical psychology
  • 2015
This review examines the history of psychiatric nosology, with particular reference to the nineteenth-century origins of the concepts of manic-depressive illness and schizophrenia as distinct

Cognitive mechanisms of auditory verbal hallucinations in psychotic and non-psychotic groups

Onset of schizophrenia diagnoses in a large clinical cohort

The diagnostic patterns preceding and following the onset of schizophrenia diagnoses in outpatient clinics are described to give partial support to a dimensional view of schizophrenia and emphasize the need for longitudinal assessment.

The cognitive antecedents of psychosis-like (anomalous) experiences: variance within a stratified quota sample of the general population

In the general population, psychosis-like experiences have been extensively studied under the psychometric rubric of schizotypy (psychosis-proneness). As such, Phase 1 of this thesis aimed to assess

Distress severity in perceptual anomalies moderates the relationship between prefrontal brain structure and psychosis proneness in nonclinical individuals

In this study, brain structural variation was related to PLE level, but not distress severity, suggesting specificity, and positive relationships between PLE and prefrontal volumes may indicate protective features, which supports the insufficiency of PLE for the prediction of CHR.

Positive Interventions in Schizophrenia and Psychotic Disorders

This chapter pulls together the conceptual framework, the current evidence base, and clinical applications of PPT for psychotic conditions with clinical examples of real-world scenarios to show how these interventions can be used by the entire treatment team within their regular workflow so that they can be sustainable.

The Limits between Schizophrenia and Bipolar Disorder: What Do Magnetic Resonance Findings Tell Us?

The findings show that gray and white matter structural changes and functional dysconnectivity predominate in the frontal and limbic areas and the frontotemporal circuitry of the brain areas involved in the integration of executive, cognitive and affective functions, commonly affected in both disorders.



The continuity of psychotic experiences in the general population.

Psychotic symptoms in non-clinical populations and the continuum of psychosis

Self-reported psychosis-like symptoms and the continuum of psychosis

Quantitative differences were apparent in the great majority of items on delusional ideation and hallucinatory experiences, in that normals scored lowest, psychosis patients scored highest and GHQ cases scored in between.

Classifying psychotic disorders: issues regarding categorial vs. dimensional approaches and time frame to assess symptoms

It is concluded that classification of psychotic disorders is highly dependent upon the time frame considered to assess symptoms and that dimensional classifications do have higher predictive power than categorical ones.

A dimensional and categorical architecture for the classification of psychotic disorders.

  • V. PeraltaM. Cuesta
  • Psychology
    World psychiatry : official journal of the World Psychiatric Association
  • 2007
There is an urgent need to change the current approach to categorical classifications of psychotic disorders, and this change needs to be a radical one.

Diagnostic approaches to schizotypal personality disorder: a historical perspective.

A historical perspective on the DSM-III concept of schizotypal personality disorder is provided to provide a historical perspective about the nature of the relationship of SPD to schizophrenia on the one hand and to other personality disorders on the other.

Explaining Transitions Over the Hypothesized Psychosis Continuum

Transitions over the psychosis continuum are, at least in part, driven by the emotional, cognitive and behavioural responses to the initial psychotic or psychosis-like experiences.

A comparison of the utility of dimensional and categorical representations of psychosis

A dimensional approach towards classification of psychotic illness offers important clinical advantages and is likely to provide clinically useful information on need for care.

Biological, life course, and cross-cultural studies all point toward the value of dimensional and developmental ratings in the classification of psychosis.

Whether more progress would be achieved in DSM-V by abandoning the familiar categorical system and instead moving to a dimensional system which rates both developmental impairment and symptom factor scores is discussed.