The psychoses: Cluster 3 of the proposed meta-structure for DSM-V and ICD-11

Abstract

Carpenter, W. T. Jr.; Bustillo, J. R.; Thaker, G. K.; van Os, J.; Krueger, R. F.; and Green, M. J., ,"The psychoses: Cluster 3 of the proposed meta-structure for DSM-V and ICD-11." Psychological Medicine.39,12. 2025-2042 The psychoses: Cluster 3 of the proposed meta-structure for DSM-V and ICD-11 Background. In an effort to group mental disorders on the basis of etiology, five clusters have been proposed. Here we consider the validity of the cluster comprising selected psychotic and related disorders.Method. A group of diagnostic entities classified under schizophrenia and other psychotic disorders in DSM-IV-TR were assigned to this cluster and the bordering disorders, bipolar (BD) and schizotypal personality disorders (SPD), were included. We then reviewed the literature in relation to 11 validating criteria proposed by the DSM-V Task Force Study Group.Results. Relevant comparisons on the 11 spectrum criteria are rare for the included disorders except for schizophrenia and the two border conditions, BD and SPD. The core psychosis group is congruent at the level of shared psychotic psychopathology and response to antipsychotic medication. BD and SPD are exceptions in that psychosis is not typical in BD-II disorder and frank psychosis is excluded in SPD. There is modest similarity between schizophrenia and BD relating to risk factors, neural substrates, cognition and endophenotypes, but key differences are noted. There is greater support for a spectrum relationship of SPD and schizophrenia. Antecedent temperament, an important validator for other groupings, has received little empirical study in the various psychotic disorders.Conclusions. The DSM-IV-TR grouping of psychotic disorders is supported by tradition and shared psychopathology, but few data exist across these diagnoses relating to the 11 spectrum criteria. The case for including BD is modest, and the relationship of BD to other mood disorders is addressed elsewhere. Evidence is stronger for inclusion of SPD, but the relationship with other personality disorders along the 11 criteria is not addressed and the absence of psychosis presents a conceptual problem. There are no data along the 11 spectrum criteria that are decisive for a cluster based on etiology, and inclusion of BD and SPD is questionable.

Common Proteomic Changes in the Hippocampus in Schizophrenia and Bipolar Disorder and Particular Evidence for Involvement of Cornu Ammonis Regions 2 and 3

“…87 Our findings therefore provide further support for a reappraisal of these disorders as distinct diagnostic entities, 32 although other evidence for the distinct character must also be considered in any such reappraisal. 32,49,88,89 In keeping with previous proteomic studies of schizophrenia and bipolar disorder, 38 including one of the hippocampus in schizophrenia, 90 our findings implicate proteins involved in cytoskeletal 42,46,90 and metabolic 42,45,46,48,58 cellular mechanisms and, specifically in bipolar disorder, cell death pathways. 91,92 The results complement findings of transcriptomic investigations in these brain regions.…”

The Hierarchical Taxonomy of Psychopathology (HiTOP): A dimensional alternative to traditional nosologies.

“…This meta-structure project examined internalizing/emotional (consisting of DSM-IV anxiety, depressive and somatoform disorders, and neurasthenia), disinhibited externalizing (conduct, antisocial personality, and substancerelated disorders), thought disorder/psychotic (schizophrenia spectrum disorders, schizotypal PD, and bipolar I disorder), neurocognitive (delirium, dementias, amnestic and other cognitive disorders), and neurodevelopmental (learning, motor skills and communication disorders, pervasive developmental disorders, and mental retardation) spectra. Overall, data for validators included in the reviews generally supported the coherence of these five spectra (Andrews, Pine et al, 2009;Carpenter et al, 2009;Goldberg, Krueger, Andrews, & Hobbs, 2009;Krueger & South, 2009;Sachdev et al, 2009), and more recent reviews have continued to support these conclusions (Beauchaine & McNulty, 2013;Eaton, Rodriguez-Seijas, Carragher, & Krueger, 2015;Nelson et al, 2013).…”

Dissection of the Phenotypic and Genotypic Associations With Nicotinic Dependence

“…This work informs our understanding of phenotypes and the mission to improve diagnostic validity. For example, a proposed test of the validity of mental disorder diagnosis for DSM-V includes identified genetic risk factors (Carpenter et al, 2009). If biological or genetic factors are an important test of the validity of mental disorder diagnosis, this evidence suggests the importance of measuring smoking heaviness and "Craving" to reflect part of the underlying genetic risk.…”