Predicting Long-Term Outcomes in First-Admission Psychosis: Does the Hierarchical Taxonomy of Psychopathology Aid DSM in Prognostication?
Predicting Long-Term Outcomes in First-Admission Psychosis: Does the Hierarchical Taxonomy of Psychopathology Aid DSM in Prognostication?
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DOI：
10.1093/schbul/sbab043
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发表时间：
2021-04-23
影响因子：
6.6
通讯作者：
Kotov, Roman
中科院分区：
文献类型：
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作者：
Martin, Elizabeth A.;Jonas, Katherine G.;Kotov, Roman
HiTOP（Hierarchical Taxonomy of Psychopathology）是一种心理症状和功能的经验性维度模型。它的目标是增加使用和解决传统诊断的局限性，如任意阈值的严重性，疾病内的异质性，和低可靠性。HiTOP在解决这些问题方面取得了进展，但其预测有效性尚不确定。本研究旨在测试当HiTOP维度方法与传统（即DSM）诊断一起考虑时，对精神病性障碍长期结局的预测得到改善。我们分析了来自萨福克郡精神卫生项目（N = 316）的数据，这是一项对首次入院精神病队列进行了20年随访的流行病学研究。我们比较了5个诊断组（精神分裂症/情感障碍、双相情感障碍伴精神病、重性抑郁障碍伴精神病、物质诱发精神病和其他精神病）和5个来自HiTOP思维障碍谱的维度（现实扭曲、混乱、无法表达、无意志和功能障碍）。这两种疾病分类法预测了大多数结果的显著差异。然而，除了认知功能，HiTOP在结果中表现出更大的预测能力-它解释了精神和身体健康结果的1.7倍以上的方差，社区功能的2.1倍以上的方差，神经反应的3.4倍以上的方差。即使在控制诊断时，HiTOP维度也能逐步预测几乎所有结果。这些发现支持从单独使用分类诊断转向纳入HiTOP维度，以更好地解释和与神经生物学联系。
The Hierarchical Taxonomy of Psychopathology (HiTOP) is an empirical, dimensional model of psychological symptoms and functioning. Its goals are to augment the use and address the limitations of traditional diagnoses, such as arbitrary thresholds of severity, within-disorder heterogeneity, and low reliability. HiTOP has made inroads to addressing these problems, but its prognostic validity is uncertain. The present study sought to test the prediction of long-term outcomes in psychotic disorders was improved when the HiTOP dimensional approach was considered along with traditional (ie, DSM) diagnoses. We analyzed data from the Suffolk County Mental Health Project (N = 316), an epidemiologic study of a first-admission psychosis cohort followed for 20 years. We compared 5 diagnostic groups (schizophrenia/schizoaffective, bipolar disorder with psychosis, major depressive disorder with psychosis, substanceinduced psychosis, and other psychoses) and 5 dimensions derived from the HiTOP thought disorder spectrum (reality distortion, disorganization, inexpressivity, avolition, and functional impairment). Both nosologies predicted a significant amount of variance in most outcomes. However, except for cognitive functioning, HiTOP showed consistently greater predictive power across outcomes-it explained 1.7-fold more variance than diagnoses in psychiatric and physical health outcomes, 2.1-fold more variance in community functioning, and 3.4-fold more variance in neural responses. Even when controlling for diagnosis, HiTOP dimensions incrementally predicted almost all outcomes. These findings support a shift away from the exclusive use of categorical diagnoses and toward the incorporation of HiTOP dimensions for better prognostication and linkage with neurobiology.