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Abstract
Previous factor analysis studies of psychotic symptomatology have demonstrated three psychopathological dimensions:
positive, negative and disorganization. However, few studies have analyzed non-schizophrenic samples and most use a
syndrome-level of analysis or only schizophrenic symptom scales. This study examined how many dimensions underlie
psychosis, and whether within psychosis there is a hierarchical organization of dimensions.
A total of 660 inpatients with an acute psychotic episode were studied. Psychopathology was measured through a wide
psychopathological assessment using the Manual for the Assessment and Documentation of Psychopathology (AMDP-system).
Principal component factor analysis was carried out on 64 psychopathological symptoms scoring 1 or higher in at least 10%
of the sample. A 15-factor solution was obtained which failed to depict a psychosis model on clinical and methodological
grounds. Further predetermined factor analyses ranging from 1 to 15 factors were carried out to examine alternative factor
solutions. A 10-dimensional model was the best model on clinical, statistical and conceptual grounds. Moreover, the examination of the 1 to 10 dimensional models allowed us to infer a hierarchical model of psychopathological dimensions, which can be
represented in the frame of a tree-structure. The model permitted transitions between psychiatric categories and psychopathological dimensions, and it was able to integrate previous factor solutions with different numbers of resulting dimensions.
The ndings have implications for the design of future studies and for the hierarchical conceptualization of psychopathological dimensions. q 2001 Elsevier Science B.V. All rights reserved.
Keywords: Psychosis; Schizophrenia; Psychopathological dimensions; Positive and negative symptoms; Positive and negative dimensions;
Hierarchy of dimensions; Assessment and documentation of psychopathology (AMDP)
1. Introduction
The great clinical variability within the same
patient across different episodes and between subjects
with the same diagnosis is the `core' problem in the
concept of schizophrenia. To date, it has not been
determined whether this phenomenological heterogeneity is related to the existence of discrete subtypes
with overlapping symptomatology (Tsuang et al.,
* Corresponding author. Fax: 134-948-429924.
E-mail address: mj.cuesta.zorita@cfnavarra.es (M.J. Cuesta).
0920-9964/01/$ - see front matter q 2001 Elsevier Science B.V. All rights reserved.
PII: S 0920-996 4(00)00190-0
216
217
3. Results
3.1. Psychopathological dimensions
Factor analysis of 64 AMDP symptoms resulted
in 15 factors with eigenvalue greater than unity,
accounting for 63.1% of the total variance. This factor
218
Number
of factor
solutions
Number of
non-clinically
interpretable
factors
Eigenvalue
Percentage
of variance
explained
Number of
items with
Communality
$0.40
Number of
factors with
#5 high
loading
symptoms
Number of
items loading
(.0.40) on only
one factor
Number of
items loading
(,0.40) on
any factor
Number of
items loading
(.0.40) on more
than one factor
Number of
signicant
correlations
between factors
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
0
0
0
0
0
0
0
0
0
0
1
2
3
3
4
7.59
5.69
4.80
4.06
3.06
2.48
2.04
1.73
1.56
1.51
1.40
1.19
1.16
1.04
1.00
11.9
20.8
28.3
34.6
39.4
43.3
46.5
49.2
51.6
54
56.2
58
59.9
61.5
63.1
0
2
10
25
32
35
43
45
50
54
56
60
64
64
64
0
0
0
0
0
0
0
1
1
1
3
4
6
5
9
20
36
42
49
52
49
52
49
53
53
55
52
50
45
51
44
28
18
12
7
5
4
4
4
2
1
0
5
6
2
0
4
3
5
10
8
12
7
9
8
12
9
13
11
0
0
1
0
1
4
5
6
6
9
11
11
11
16
Table 1
Statistical parameters of 1 to 10 factor solutions of psychopathological symptoms
219
Prevalence
%
21.2
51.2
22.6
31.8
34.5
22.3
17.4
17.3
38.6
15.2
20.5
43.1
63.8
61.1
29.8
54.8
91.5
69.1
80
57.3
70
19.2
36.2
55.9
23.3
17.7
24.5
21.2
25.2
33
13.3
33.3
30
24.4
11.6
44.5
11.6
26.5
0.53
0.52
20.43
Psychomotor
poverty
factor
0.79
0.49
20.65
20.74
20.49
0.57
0.56
0.45
0.60
20.77
0.50
0.51
0.43
0.36
0.59
0.57
0.49
0.68
Insight
factor
0.54
20.57
0.73
0.56
0.57
0.44
0.59
0.78
0.66
0.81
0.63
0.77
Schneiderian
factor
0.40
0.75
0.65
0.78
0.74
0.64
0.76
0.81
0.81
Positive
catatonic
factor
20.60
20.42
M.J. Cuesta, V. Peralta / Schizophrenia Research 52 (2001) 215229
Symptoms
Apperception
Concentration
Retarded thinking
Circumstantial
Restricted thinking
Perseveration
Rumination
Pressured thinking
Flight of ideas
Tangential
Blocking
Incoherence
Suspiciousness
Delusional mood
Delusional perception
Sudden delusional ideas
Delusional ideas
Systematized delusions
Delusional dynamics
Delusions of reference
Delusions of persecution
Delusions of grandeur
Other delusions
Verbal hallucinations
Other auditory hallucinations
Visual hallucinations a
Bodily hallucinations
Derealization
Depersonalization
Thought broadcasting
Thought withdrawal
Thought insertion
Other feelings of alien inuence
Perplexity
Feeling of loss feeling
Blunted affect
Loss of vitality
Depressed mood
220
Table 2
Factor loadings and Factor pattern correlation matrix of 10D model of psychopathological symptoms
Table 2 (continued)
Prevalence
%
Factor inter-correlations
1
1.00
20.01
0.02
20.09
0.11
0.14
0.25
0.02
20.24
20.06
0.78
0.74
Psychomotor
poverty
factor
Positive
catatonic
factor
20.31
0.56
0.74
0.43
20.58
20.47
20.46
0.75
0.63
0.52
0.73
0.40
20.56
20.49
0.47
0.53
0.64
0.72
0.74
0.73
0.41
0.49
11.8
0.85
Insight
factor
0.82
0.36
0.82
0.59
20.51
0.77
Schneiderian
factor
8.9
0.85
7.5
0.70
6.3
0.84
4.8
0.75
3.9
0.75
3.2
0.80
2.7
0.80
1.00
20.00
20.08
0.05
20.09
20.02
0.07
20.16
20.07
1.00
0.11
20.08
20.05
0.08
20.03
0.09
20.16
1.00
20.16
0.10
20.10
20.09
0.08
20.01
1.00
20.10
20.04
0.00
20.07
20.03
1.00
0.02
0.06
20.07
0.12
1.00
20.07
20.09
20.04
1.00
0.05
20.01
1.00
20.06
Only item loadings .40 are shown, except for visual hallucinations and anxiety, which had only inferior loadings.
0.44
2.4
0.81
10
1.00
2.4
0.67
221
1. Paranoid
2. Mania
3. Negative catatonia
4. Depression
5. Dysphoria
6. Disorganization
7. Scheneiderian
8. Insight
9. Psychomotor poverty
10. Positive catatonia
20.5
39.8
16.2
33.3
53
48.3
10
13.2
33.5
32.6
37.3
34.1
11.8
15.8
39.4
12.1
14.4
11.2
74.7
11.8
33.3
21.5
79.4
83.9
56.2
10
Hopelessness
Anxiety a
Euphoria
Dysphoria
Irritability
Inner restlessness
Feelings of inadequacy
Exaggerated self-condence
Ambivalence
Parathymia
Affective rigidity
Lack of drive
Inhibition of drive
Increased drive
Motor restlessness
Parakinesis
Mutism
Logorrhea
Reduced social contact
Excessive social contact
Aggressiveness
Suicidal tendencies
Lack of feeling of illness
Lack of insight
Refusal of treatment
Lack of self-care
% Variance accounted for
Reliability (a )
222
Table 3
Pearson correlation coefcients between psychopathological dimensions of the 10D model and sociodemographic, premorbid and outcome
variables r 0:12 or higher p , 0:001
Sociodemographic, premorbid and outcome variables
Gender
Paranoid
Mania
Negative catatonia
Depression
Dysphoria
Disorganization a
Schneiderian
Insight
Psychomotor poverty
Positive catatonia a
a
Single
0.12
20.13
Number of admissions
0.20
0.13
20.15
0.13
Age at onset
Education
Strauss/Carpenter scale
0.15
0.12
0.28
0.24
20.22
0.12
20.13
0.14
20.19
20.50
Phillips social
20.25
0.33
223
224
4. Comment
4.1. Psychopathological dimensions
In the present study the 10D model was the best
tting model of psychopathological symptoms of
psychosis, on conceptual, clinical and statistical
grounds. This 10D model reected the whole range
of psychotic symptomatology with the exception of
low prevalence symptoms. Dimensions were by order
of extraction: paranoid, manic, negative catatonia,
depressive, dysphoria, disorganization, schneiderian,
insight, psychomotor poverty and positive catatonia
225
226
227
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