Categorical Diagnosis Research Articles

Reduced hippocampal gray matter volume is a common feature of patients with major depression, bipolar disorder, and schizophrenia spectrum disorders

Major depressive disorder (MDD), bipolar disorder (BD), and schizophrenia spectrum disorder (SSD, schizophrenia, and schizoaffective disorder) overlap in symptomatology, risk factors, genetics, and other biological measures. Based on previous findings, it remains unclear what transdiagnostic regional gray matter volume (GMV) alterations exist across these disorders, and with which factors they are associated. GMV (3-T magnetic resonance imaging) was compared between healthy controls (HC; n = 110), DSM-IV-TR diagnosed MDD (n = 110), BD (n = 110), and SSD patients (n = 110), matched for age and sex. We applied a conjunction analysis to identify shared GMV alterations across the disorders. To identify potential origins of identified GMV clusters, we associated them with early and current risk and protective factors, psychopathology, and neuropsychology, applying multiple regression models. Common to all diagnoses (vs. HC), we identified GMV reductions in the left hippocampus. This cluster was associated with the neuropsychology factor working memory/executive functioning, stressful life events, and with global assessment of functioning. Differential effects between groups were present in the left and right frontal operculae and left insula, with volume variances across groups highly overlapping. Our study is the first with a large, matched, transdiagnostic sample to yield shared GMV alterations in the left hippocampus across major mental disorders. The hippocampus is a major network hub, orchestrating a range of mental functions. Our findings underscore the need for a novel stratification of mental disorders, other than categorical diagnoses.

Disruptive Behaviors and Intellectual Disability: Creating a New Script

BackgroundTerms currently used to describe the so-called challenging and disruptive behaviors (CBDs) of children with intellectual disabilities (ID) have different connotations depending on guiding contextual frameworks, such as academic and cultural settings in which they are used. A non-judgmental approach, which does not attempt to establish existing categorical diagnoses, but which describes in a neutral way, is missing in the literature. Therefore, we tried to describe CDBs in youth with ID in an explorative study.MethodsInterviews with families investigated the CDBs of five youth with Down syndrome. At home, families tracked youth's sleep/wake behaviors and physical activity. Youth were observed in a summer school classroom. The collected information and suggested explanatory models for observed CDBs were reviewed with the families.ResultsWe grouped CDBs as challenging, if they were considered to be reactive or triggered, or unspecified, if no such explanatory model was available. A third category was created for light-hearted CDBs: goofy, acknowledging the right to laugh together with peers. We found some relationships between sleep, physical activity, and CDBs and developed an explorative approach, supporting a child-centered perspective on CDBs.ConclusionThe controversial discussions on terminology and management of CDBs in the literature demonstrate the need for a non-judgmental approach. Such an explorative approach, allowing non-professionals to not label, has been missing. The fact that, up to now, the light-hearted behaviors of an individual with ID have not been integrated in commonly-used behavioral checklists as their natural right, proves our concept and indicates that a paradigm change from judgment-based to exploratory-driven approaches is needed.

Schizotypal personality disorder in the alternative model for personality disorders.

Schizotypal personality disorder (SPD) first appeared in the American Psychiatric Association diagnostic nosology in 1980, although its roots stretch back more than 100 years under labels such as borderline, ambulatory, and latent schizophrenia. SPD is unique in that it is conceptualized both as stable personality pathology and also as a milder manifestation of schizophrenia-spectrum psychopathology. The categorical operationalization of SPD has remained largely unchanged for the last 40 years, with emphasis on interpersonal deficits, cognitive and perceptual distortions, and odd and eccentric behaviors. The alternative model for personality disorders (AMPD) retained many of the aspects of SPD while offering a hybrid model that includes both disturbances in personality functioning and specific pathological personality traits. The present review examined the empirical literature on the success of the AMPD model in capturing SPD. Although research specifically examining AMPD SPD is limited, there is converging evidence that the six trait facets proposed for the AMPD SPD provide good coverage of SPD and correspond closely to criterion counts from the categorical SPD diagnosis. Furthermore, most studies find that the inclusion of additional facets not proposed for SPD do not account for appreciable variance. However, SPD offers a rather heterogeneous construct, and future studies should consider whether specifying positive, negative, and disorganized traits within the disorder might improve the clarity of the diagnosis. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Criterion A: Level of personality functioning in the alternative DSM-5 model for personality disorders.

Criterion A, as represented by Level of Personality Functioning (LPF), offers a means by which to conceptualize the core impairment in self and interpersonal functioning that distinguishes personality disorder (PD) from other forms of psychopathology. One of the most widely cited criticisms of the current Section II in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition categorical diagnostic system is the high level of comorbidity among the categorical PD diagnoses. The Section III alternative Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition model for PDs (AMPD) addresses this problem by assessing the commonalities of the PDs using a single severity continuum, represented in the AMPD by the Level of Personality Functioning Scale (LPFS), which comprises both self and interpersonal pathology. Since its initial introduction, the LPFS has generated an expansive literature base and has also seen significant advancements in its measurement, including both semistructured and self-report methods. Such studies have generally demonstrated that the LPFS can be rated reliably, across both experienced and inexperienced raters, and demonstrates strong validity as evidenced by associations with relevant criterion variables and demonstrations of predictive and clinical utility. This review offers a brief history of the conceptualization and development of Criterion A and the LPFS, describes the major advancements in its measurement, and provides a summary of the status of the empirical literature regarding Criterion A's structure, reliability, and validity. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Transdiagnostic Associations With Interpersonal and Affective Variability in Borderline Personality Pathology.

Emotional and behavioral variability are unifying characteristics of borderline personality disorder (BPD). Ambulatory assessment (AA) has been used to quantify this variability in terms of the categorical BPD diagnosis, but evidence suggests that BPD instead reflects general personality pathology. This study aimed to clarify the conceptualization of BPD by mapping indices of variability in affect, interpersonal behavior, and perceptions of others onto general and specific dimensions of personality pathology. A sample of participants who met diagnostic criteria for BPD (n = 129) and healthy controls (n = 47) reported on their daily interactions during a 21-day AA protocol. Multilevel SEM was used to examine associations between shared and specific variance in maladaptive traits with dynamic patterns of functioning. The authors found that variability is an indicator of shared trait variance and Negative Affectivity, not any other specific traits, reinforcing the idea that BPD is best understood as general personality pathology.

Emotional Dysregulation: Epidemiology and Genetic Features from Childhood towards Adulthood

Emotional dysregulation (ED) is a dimensional, transdiagnostic domain that is associated with multiple categorical psychiatric diagnoses from childhood to adulthood, representing a risk for increased problems in affect, behavior, and cognition [1]. Traditionally, the nature of ED trait has been studied with top down approaches: quantitative evaluation of ED is possible through “Dysregulation Profile” scoring, which is measured through composite scales of the “Achenbach System of Empirically Based Assessment” (ASEBA) [2] questionnaires. Dysregulation profile is characterized by severe anxiety and affective symptoms, impulsive and/or aggressive behaviours and metacognitive difficulties. More recently, different researchers also applied bottom up approaches to evaluate the presence of ED in both general population and clinically referred samples [3]. Also in these cases, the results showed that ED is a trait, stable through time and across different cultures and societies, associated with higher presence of psychiatric diagnosis. It is important to note that these non-traditional statistical approaches highlighted that, in adulthood, ED is characterized by elevated scores in both externalizing and internalizing areas. In this contribution, the research aimed at disentangling the etiology of ED, which is crucial to treat and prevent worst evolution associated with this trait, will be revised. Many efforts have been done to understand the complex interaction between genetic and environmental risk factors which predispose patients to develop and maintain ED. [1] Aitken, et al. (2019). JAD, 253, 87-95. [2] Achenbach & Rescorla (2001). Manual for the ASEBA school-age forms and profiles. [3] Bianchi, et al (2017). ECAP, 26(5), 549-557.DisclosureNo significant relationships.

Kappa accuracy of prototypical diagnosis and ICD-10 criteria for mental disorders: A cross-sectional study in a real-life setting

IntroductionThe use of “operational criteria” in DSM-III was proposed as a solution to low reliability among psychiatrist’s diagnosis. It is considered a turning point in the psychiatric classification and diagnostic process, furtherly adopted in ICD. However, the utility of using such criteria in everyday clinical practice is still not clear.ObjectivesTo measure agreement between prototypical and ICD-10 categorical diagnosis.MethodsIn IPUB’s outpatient clinics, psychiatry residents work in a real-life clinical scenario, attending patients from Rio de Janeiro/RJ-Brazil. Although regularly trained in ICD criteria, it is not usual to check every criterion in their daily practice. Thus, patients are diagnosed with a prototype-based disorder, not necessarily strictly attached to ICD criteria. We propose a cross-sectional study, where psychiatry residents check their clinical diagnosis according to ICD criteria and compare its agreement with kappa statistics.ResultsThree of thirty residents joined the study, providing diagnosis for 146 patients under their care. Forty-five diagnoses were obtained before and 51 after ICD-10 criterion application. Diagnoses were grouped under 8 groups (Organic, Schizophrenia Spectrum Disorders, Bipolar Affective Disorder, Depression, Anxiety-Related Disorders, Personality Disorders, Neurodevelopmental Disorders), and kappa agreement obtained using ICD-10 diagnosis as the gold standard against prototypical diagnoses. Overall kappa was 0.77 (IC - 0.69 - 0.85), ranging from 0.58 (Personality Disorders) to 0.91 (Schizophrenia Spectrum Disorder). These findings also were reflected as high sensibility, specificity, Positive Predictive, and Negative Predictive values in all groups.ConclusionsPrototypical diagnostic elaboration, while probably based on previously learned, but not applied operational criteria, was equivalent to diagnostic obtained through ICD-10 categories.DisclosureNo significant relationships.

National Study on Mental Health and Emotional Wellbeing among Young People in Malta: Phase 1

IntroductionHalf of all mental disorders (MD) begin by age 14, however, the majority of disorders remain untreated well into adulthood due to inadequate service provision. Prevalence studies of MD among young people (YP) are needed to elucidate the current epidemiology and better service development to prevent and help YP with MD in the Maltese islands. This abstract describes the first phase of a 3-phase national study.Objectives1. To screen for MD among a sample of 5–16-year-olds. 2. To determine the presence or absence of a range of protective and risk factors among YP with and without a MD.MethodsA multi-stage random sample of 800 YP aged 5-16 years were recruited from 39 schools across the Maltese Islands. Participants were screened for MD using the SDQ, SCARED, AQ10, SCOFF and AUDIT, and asked questions on life experiences.Results25.2% of YP were identified as being at risk of suffering from a MD (T1). Only 10% of these were referred to MHS. A greater proportion of YP identified as having a possible MD (compared to those without), were found to have a physical impairment (19%), problematic family dynamics (12%), adverse life events (T2) and parents with a history of health/social problems (T3).ConclusionsThe K-SADS will be conducted on YP identified as having a possible MD to ascertain a categorical diagnosis and establish prevalence rates for MDs as defined by DSM-5 criteria. Recommendations to improve and develop new mental health services to meet the needs for these YP will be disseminated amongst commissioners.DisclosureNo significant relationships.

An Examination of the RDoC Negative Valence Systems Domain Constructs and the Self-Reports Unit of Analysis

In response to shortcomings with the current diagnostic classification system for mental health disorders, such as poor validity and reliability of categorical diagnoses, the National Institute of Mental Health proposed the Research Domain Criteria (RDoC) initiative to move towards a dimensional approach using translational research. The current study examined associations between measures of behaviors, cognitions, and mental health symptoms and how they overlap in the Negative Valence Systems (NVS) domain. Specifically, we examined how the Self-Reports unit of analysis reflects the RDoC NVS constructs of acute threat, potential threat, sustained threat, frustrative nonreward, and loss. The overall goal was to identify additional self-report measures that reflect these constructs. Participants, two student samples and two community samples (total N = 1,509), completed online self-reported measures. Questionnaire total and subscale scores were submitted to a principal-axis factor analysis with Promax rotation separately for each sample. For both student samples and one community sample six-factor solutions emerged reflecting major aspects of the RDoC NVS and positive valence systems, particularly acute threat (i.e., fear/panic), potential threat (i.e., inhibition/worry), sustained threat (i.e., chronic stress), loss (i.e., low well-being), frustrative nonreward (i.e., reactive aggression), and reduced behavioral activation. The second community sample differed in that fear/panic and frustration/anger was combined in a general distress factor. Recommendations for additional NVS self-report markers are discussed.

Using event-related potentials to characterize inhibitory control and self-monitoring across impulsive and compulsive phenotypes: a dimensional approach to OCD.

"Subsyndromal" obsessive-compulsive disorder symptoms (OCDSs) are common and cause impaired psychosocial functioning. OCDSs are better captured by dimensional models of psychopathology, as opposed to categorical diagnoses. However, such dimensional approaches require a deep understanding of the underlying neurocognitive drivers and impulsive and compulsive traits (ie, neurocognitive phenotypes) across symptoms. This study investigated inhibitory control and self-monitoring across impulsivity, compulsivity, and their interaction in individuals (n = 40) experiencing mild-moderate OCDSs. EEG recording concurrent with the stop-signal task was used to elicit event-related potentials (ERPs) indexing inhibitory control (ie, N2 and P3) and self-monitoring (ie, error-related negativity and correct-related negativity (CRN): negativity following erroneous or correct responses, respectively). During unsuccessful stopping, individuals high in both impulsivity and compulsivity displayed enhanced N2 amplitude, indicative of conflict between the urge to respond and need to stop (F(3, 33) = 1.48, P < .05, 95% Cl [-0.01, 0.001]). Individuals high in compulsivity and low in impulsivity showed reduced P3 amplitude, consistent with impairments in monitoring failed inhibitory control (F(3, 24) = 2.033, P < .05, 95% CI [-0.002, 0.045]). Following successful stopping, high compulsivity (independent of impulsivity) was associated with lower CRN amplitude, reflecting hypo-monitoring of correct responses (F(4, 32) = 4.76, P < .05, 95% CI [0.01, 0.02]), and with greater OCDS severity (F(3, 36) = 3.32, P < .05, 95% CI [0.03, 0.19]). The current findings provide evidence for differential, ERP-indexed inhibitory control and self-monitoring profiles across impulsive and compulsive phenotypes in OCDSs.

Research Audit on Clinical Utility of Dimensional Disruptive Mood and Behavior Psychopathologies in Child and Adolescent Psychiatry Practice

To investigate the utility of dimensional psychopathologies of disruptive mood and behavior disorders (DBDs) by applying latent profile analysis (LPA) for characterization of youth referred to the tertiary outpatient clinic of child and adolescent psychiatry clinic and pharmacological treatment choices. One hundred fifty-eight children and adolescents with significant DBDs symptoms participated. Core dimensional psychopathologies of DBDs (irritability, callous-unemotional trait, and reactive-proactive aggressive behavior), DSM diagnoses, prescribed medications, and behavioral and emotional problems (Child Behavior Checklist, CBCL) were measured at baseline (clinic intake) and at 3-month follow-up. Latent Profile Analysis (LPA) was applied to characterize the study population based on the levels and interrelations among the core dimensional DBDs psychopathologies. Following LPA, the differences in clinical and treatment features between the latent classes were analyzed. LPA revealed two latent classes based on severity of DBDs symptoms. Class 1 (the moderate group) was characterized by relatively low scores on all trans-diagnostic indicators, whereas class 2 (the severe/critical group) showed higher levels of the dimensional psychopathologies and the majority of CBCL subscales. In addition, the severe/critical group was more often prescribed antipsychotic medications, and also experienced more frequent medication changes (addition, increasing the dose, and trial of different medications). Our findings suggested that application of LPA to a cluster of dimensional DBDs psychopathologies may provide valuable characterization of the youths referred to a tertiary outpatient child and adolescent psychiatric clinic, and offer insight into the providers' decision making on psychotropic medications, by overall severity of these psychopathologies rather than by single categorical diagnosis or single externalizing psychopathology.

Youth depression and inflammation: Cross-sectional network analyses of C-Reactive protein, interleukin-6 and symptoms in a population-based sample

BackgroundInflammation-related proteins constitute a promising avenue in studying biological correlates of major depressive disorder (MDD). However, MDD is a heterogeneous condition – a crucial aspect to be considered in association studies. We examined whether inflammatory proteins are associated with categorical diagnosis, a dimensional total sum-score, and specific depressive symptoms among youths. MethodsWe analyzed data from the 1993 Pelotas Birth Cohort, a population-based study in Brazil that followed individuals up to age 22 years. Categorical psychiatric diagnoses were derived using adapted modules of the Mini International Neuropsychiatric Interview (MINI). Dimensional symptomatology was assessed using the Brazilian Portuguese version of the Center for Epidemiological Studies–Depression Scale–Revised (CESD-R). We estimated network structures that included individual depressive symptoms as measured by CESD-R items, peripheral inflammatory markers (C-Reactive Protein [CRP] and Interleukin-6 [IL-6]), as well as relevant covariates. ResultsWe evaluated 2586 participants (mean age = 22.5[SD = 0.33]) There were no associations between concentrations of inflammatory proteins and categorical diagnosis of MDD or with CESD-R total sum-scores. In symptom-specific analysis, CRP and IL-6 were positively connected to somatic and cognitive items. DiscussionWe found cross-sectional connections of two commonly studied inflammatory proteins and specific depressive symptoms. Conducting symptom-specific analyses in relation to biological markers might advance our understanding of the heterogeneity of MDD.

Prevalence and 10-Year Stability of Personality Disorders From Adolescence to Young Adulthood in a High-Risk Sample.

BackgroundWith the implementation of the 11th edition of the International Classification of Diseases (ICD-11) in early 2022, there will be a radical change in the framework and process for diagnosing personality disorders (PDs), indicating a transition from the categorical to the dimensional model. Despite increasing evidence that PDs are not as stable as previously assumed, the long-term stability of PDs remains under major debate. The aim of the current paper was to investigate the categorical and dimensional mean-level and rank-order stability of PDs from adolescence into young adulthood in a high-risk sample.MethodsIn total, 115 young adults with a history of residential child welfare and juvenile-justice placements in Switzerland were included in the current study. PDs were assessed at baseline and at a 10-year follow-up. On a categorical level, mean-level stability was assessed through the proportion of enduring cases from baseline to follow-up. Rank-order stability was assessed through Cohen’s κ and tetrachoric correlation coefficients. On a dimensional level, the magnitude of change between the PD trait scores at baseline and at follow-up was measured by Cohen’s d. Rank-order stability was assessed through Spearman’s ρ.ResultsThe prevalence rate for any PD was 20.0% at baseline and 30.4% at follow-up. The most frequently diagnosed disorders were antisocial, borderline, and obsessive-compulsive PDs, both at baseline and at follow-up. On a categorical level, the mean-level stability of any PD was only moderate, and the mean-level stability of specific PDs was low, except of schizoid PD. Likewise, the rank-order stability of any PD category was moderate, while ranging from low to high for individual PD diagnoses. On a dimensional level, scores increased significantly for most PDs, except for histrionic traits, which decreased significantly from baseline to follow-up. Effect sizes were generally low. The rank-order stability for dimensional scores ranged from low to moderate.ConclusionThe findings indicate low to moderate stability of Pds and Pd traits from adolescence to adulthood, which supports the growing evidence that categorical diagnoses of Pds are quite unstable. This in turn, emphasizes the use of the upcoming ICD-11 that Acknowledgments Pds to be only “relatively” stable.

Pain severity ratings in the 11th revision of the International Classification of Diseases : a versatile tool for rapid assessment.

An improved classification of chronic pain is included in the 11 th revision of the International Classification of Diseases and Related Health Problems . For all diagnoses of chronic pain, an optional dimensional code for the chronic pain severity will supplement the categorical diagnoses. Pain severity combines pain intensity, pain-related interference, and pain-related distress. Each component is rated by the patient on a numerical rating scale (NRS) from 0 to 10 and subsequently translated into severity stages ("mild," "moderate," and "severe"). This study aimed to evaluate this severity code by comparing the ratings with established psychometric measures of pain-related interference and distress. An online survey was posted to self-help groups for chronic pain, and 595 participants (88.7% women, 59.5 ± 13.5 years) rated each of the severity parameters (pain intensity, pain-related interference, and pain-related distress) on an NRS from 0 to 10 and completed the Pain Disability Index and the Pain Coping Questionnaire (FESV, 3 subscales). The participants reported a mean pain intensity of 6.4 ± 1.9, mean pain-related interference of 6.7 ± 2.1, and mean pain-related distress of 5.7 ± 2.5. The respective NRS ratings showed substantial correlations with the Pain Disability Index score ( r = 0.65) and the FESV subscales ( r = 0.65, r = 0.56, r = 0.37). The extension code for pain severity is a valid and efficient way of recording additional dimensional pain parameters, which can be used to monitor the course of chronic pain and its treatment. The specifier's efficiency makes it possible to use the code when a questionnaire would not be feasible due to time constraints, such as in primary care.

Genes To Mental Health (G2MH): A Framework to Map the Combined Effects of Rare and Common Variants on Dimensions of Cognition and Psychopathology.

Rare genomic disorders (RGDs) confer elevated risk for neurodevelopmental psychiatric disorders. In this era of intense genomics discoveries, the landscape of RGDs is rapidly evolving. However, there has not been comparable progress to date in scalable, harmonized phenotyping methods. As a result, beyond associations with categorical diagnoses, the effects on dimensional traits remain unclear for many RGDs. The nature and specificity of RGD effects on cognitive and behavioral traits is an area of intense investigation: RGDs are frequently associated with more than one psychiatric condition, and those studied to date affect, to varying degrees, a broad range of developmental and cognitive functions. Although many RGDs have large effects, phenotypic expression is typically influenced by additional genomic and environmental factors. There is emerging evidence that using polygenic risk scores in individuals with RGDs offers opportunities to refine prediction, thus allowing for the identification of those at greatest risk of psychiatric illness. However, translation into the clinic is hindered by roadblocks, which include limited genetic testing in clinical psychiatry, and the lack of guidelines for following individuals with RGDs, who are at high risk of developing psychiatric symptoms. The Genes to Mental Health Network (G2MH) is a newly funded National Institute of Mental Health initiative that will collect, share, and analyze large-scale data sets combining genomics and dimensional measures of psychopathology spanning diverse populations and geography. The authors present here the most recent understanding of the effects of RGDs on dimensional behavioral traits and risk for psychiatric conditions and discuss strategies that will be pursued within the G2MH network, as well as how expected results can be translated into clinical practice to improve patient outcomes.

Aberrant salience relationship with first rank symptoms

BackgroundAberrant salience is the incorrect assignment of salience, significance, or value to different innocuous stimuli that might precede the onset of psychotic symptoms. The present study aimed to perform a preliminary evaluation of potentially different correlations between the Aberrant Salience Inventory (ASI) score and dimensional or categorical diagnostic approaches.Methods168 adult outpatients with a current psychiatric diagnosis were consecutively enrolled. Patients were evaluated using different psychometric scales. ASI was used to evaluate aberrant salience, and to evaluate the association between ASI scores and first rank symptoms (FRS), and/or with a psychiatric diagnosis. Principal dichotomic clusters of ASI were identified using the Chi-square automatic interaction detection (CHAID) method.ResultsCurrent (16.76 ± 6.02 vs 13.37 ± 5.76; p = 0.001), lifetime (15.74 ± 6.08 vs 13.16 ± 5.74; p = 0.005) and past (15.75 ± 6.01 vs 13.33 ± 5.80; p = 0.009) FRS were the main clusters dichotomizing ASI. The average ASI score did not significantly differ among patients with different diagnoses.ConclusionsASI could be used as a tool to identify psychopathological dimensions, rather than the categorical diagnoses, in the schizophrenic spectrum.

Reconstructing schizophrenia: Lessons from major mood disorders

The relationship between transdiagnostic, dimensional and categorical approaches to schizophrenia is under debate. We propose that if a categorical diagnosis of schizophrenia makes sense, points of rarity should be observable in causal risk factors, genetic or environmental, and/or the neural systems on which they impact. In our reading, the preponderance of the evidence supports the view that risk factors largely have a pleiotropic effect that is not restricted to schizophrenia. In cross-disorder neuroimaging studies, both structural and functional data likewise largely show transdiagnostic dimensional systems-level alterations, with the possible exception of hippocampal connectivity features linked to genetic risk. There is thus no clear neurobiological evidence to support the categorical construct of schizophrenia. Retaining this approach thus revolves primarily around clinical and pragmatic considerations.

Is our mistake trying to identify a “homogeneous” schizophrenia construct?

The relationship between transdiagnostic, dimensional and categorical approaches to schizophrenia is under debate. We propose that if a categorical diagnosis of schizophrenia makes sense, points of rarity should be observable in causal risk factors, genetic or environmental, and/or the neural systems on which they impact. In our reading, the preponderance of the evidence supports the view that risk factors largely have a pleiotropic effect that is not restricted to schizophrenia. In cross-disorder neuroimaging studies, both structural and functional data likewise largely show transdiagnostic dimensional systems-level alterations, with the possible exception of hippocampal connectivity features linked to genetic risk. There is thus no clear neurobiological evidence to support the categorical construct of schizophrenia. Retaining this approach thus revolves primarily around clinical and pragmatic considerations.

Retroverting schizophrenia

The relationship between transdiagnostic, dimensional and categorical approaches to schizophrenia is under debate. We propose that if a categorical diagnosis of schizophrenia makes sense, points of rarity should be observable in causal risk factors, genetic or environmental, and/or the neural systems on which they impact. In our reading, the preponderance of the evidence supports the view that risk factors largely have a pleiotropic effect that is not restricted to schizophrenia. In cross-disorder neuroimaging studies, both structural and functional data likewise largely show transdiagnostic dimensional systems-level alterations, with the possible exception of hippocampal connectivity features linked to genetic risk. There is thus no clear neurobiological evidence to support the categorical construct of schizophrenia. Retaining this approach thus revolves primarily around clinical and pragmatic considerations.

Gender modulation of psychopathological dimensions associated to suicidality.

The dimensional approach to psychopathology has been proposed to reliably evaluate suicidality. Potential gender modulation of psychopathological dimensions associated to suicide attempts was investigated. 91 subjects who committed a near-lethal suicide (SA group) and 374 who did not (nSA group) were recruited in a Psychiatric Intensive Care Unit regardless of their categorical diagnosis. The Hamilton Depression Rating Scale (HAM-D), the Brief Psychiatric Rating Scale - Expanded version (BPRS-E) and the Scale for Rapid Dimensional Evaluation (SVARAD) were administered at the admission. A Factorial Multivariate ANOVA was conducted according to General Linear Model: Sex and Suicidality were input as fixed factors, HAM-D, BPRS-E and SVARAD scores as dependent variables. Men with SA (MSA) displayed significant lower scores in SVARAD Activation dimension compared to women with SA (FSA) (p=0.049), men without SA (MnSA) (p<0.001) and women without SA (FnSA) (p<0.001). Both SA groups displayed significant higher scores compared to nSA groups in regard of Depression item (BPRS-E) (p<0,001). The MSA group displayed significant lower scores in Psychomotor agitation (HAM-D) compared to FSA (p=0,044), MnSA (p<0,001) and FnSA (p<0,001). By means of multifactorial statistics sex resulted a moderator of the relation between activation/agitation and suicidality, despite categorical diagnosis.