Dimensions underlying psychotic and manic symptomatology: Extending normal-range personality traits to schizophrenia and bipolar spectra

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Objective Covariance among psychiatric disorders can be accounted for by higher-order internalizing, externalizing, and psychosis dimensions, but placement of bipolar disorder within this framework has been inconsistent. Moreover, whether deviations in normal-range personality can explain psychosis and vulnerability to severe mood lability, as seen in schizophrenia and bipolar disorder, remains unclear.

Methods Exploratory factor analysis of interviewer-rated clinical symptoms in patients with schizophrenia or bipolar disorder, their first-degree biological relatives, and nonpsychiatric controls (total N = 193), followed by examination of associations between symptom dimensions and self reports on personality questionnaires.

Results Covariance in symptoms was accounted for by five factors: positive symptoms of psychosis, negative symptoms of psychosis, disorganization, mania, and depression/anxiety. Schizophrenia and bipolar patients/relatives reported elevated negative emotionality and absorption and lower positive emotionality relative to controls. Personality did not differ between schizophrenia and bipolar patients/relatives, but there was a different pattern of associations between symptoms and personality in these groups.

Conclusions Discrete dimensions reflecting psychotic, manic, and depressive symptoms emerge when a broad set of clinical symptoms is examined in a sample overrepresented by psychotic experiences and affective disturbances. Although normal-range personality traits index common phenotypes spanning schizophrenia and bipolar spectra, the same symptoms may carry different significance across disorders.

Original languageEnglish (US)
Pages (from-to)1809-1819
Number of pages11
JournalComprehensive Psychiatry
Issue number8
StatePublished - Nov 1 2014

Bibliographical note

Funding Information:
This work was supported by grants from the Clinical Science Research and Development Program within the Veterans Health Administration ( I01CX000227-01 to S.R.S.). The authors would like to thank Katelynn McConnell, Anna Docherty, and Holly Weber for their help during subject recruitment and data collection, as well Snezana Urosevic for her consultation.

Publisher Copyright:
© 2014 Elsevier Inc.

Copyright 2014 Elsevier B.V., All rights reserved.


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