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Creating a map of psychiatric patients based on psychopathological symptom profiles

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Abstract

Background

In the current debate about the categorical or dimensional classification of mental disorders many fruitful methods to illustrate one or the other aspect are employed, and suggestions are made to combine the two perspectives.

Methods

We present such an approach to combine both perspectives at the same time. Based on psychopathological AMDP-symptom profiles, a map of psychiatric patients was calculated by robust nonmetric multidimensional scaling (NMDS).

Results

The sample from the Ludwig-Maximilians University in Munich included the records of patients, who were admitted and discharged in 2002 and 2003 with a diagnosis of either paranoid schizophrenia, (F20.00, N = 24), bipolar affective disorder, current episode manic without psychotic symptoms (F31.1, N = 32) or severe depressive episode without psychotic symptoms (F32.2, N = 78). In the resulting map of patients we found a clear categorical distinction according to the diagnostic groups, but also high regression values of AMDP-syndromes (manic syndrome: r = 0.83, depressive syndrome: r = 0.68, and paranoid-hallucinatory syndrome, r = 0.62).

Discussion

The map of psychiatric patients presents an approach to consider the categorical and dimensional aspects at the same time. We were able to identify meaningful delineations between diagnostic clusters as well as continuous transitions. This method allows the whole psychopathological profile of each individual patient to be considered and also to identify misdiagnosed cases at a glance.

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References

  1. Andreasen NC (2007) DSM and the death of phenomenology in America: an example of unintended consequences. Schizophr Bull 33:108–112

    Article  PubMed  Google Scholar 

  2. Arbeitsgemeinschaft für Methodik und Dokumentation in der Psychiatrie (1981) Das AMDP-System. Manual zur Dokumentation psychiatrischer Befunde. Springer, Berlin

  3. Baumann U, Stieglitz RD (1997) Das AMDP-system: ein psychologischer test? In: Haug H-J, Stieglitz RD (Hrsg.) Das AMDP-system in der klinischen Anwendung und Forschung. Hogrefe, Göttingen, S 30–45

  4. Baumann U, Stieglitz RD (1983) Testmanual zum AMDP-System: Empirische Studien zur Psychopathologie. Springer, Berlin

    Google Scholar 

  5. Benazzi F (2006) The continuum/spectrum concept of mood disorders: is mixed depression the basic link? Eur Arch Psychiatry Clin Neurosci 256:512–515

    Article  PubMed  Google Scholar 

  6. Berner P (1983) Diagnostic classification based on the AMDP-system. In: Bobon D, Baumann U, Angst J, Helmchen H, Hippius H (eds) The AMDP-system in pharmacopsychiatry. Karger, Basel, pp 68–73

    Google Scholar 

  7. Blashfield RK (1990) Comorbidity and classification. In: Maser JD, Cloninger CR (eds) Comorbidity of mood and anxiety disorders. American Psychiatric Press, Washington, DC, pp 61–82

    Google Scholar 

  8. Borg I, Groenen P (2005) Modern multidimensional scaling—theory and applications. Springer, New York

    Google Scholar 

  9. Bottlender R, Strauss A, Möller HJ (2000) Prevalence and background factors of depression in first admitted schizophrenic patients. Acta Psychiatr Scand 101:153–160

    Article  PubMed  CAS  Google Scholar 

  10. Brown TA, Barlow DH (2005) Dimensional versus categorical classification of mental disorders in the fifth edition of the diagnostic and statistical manual of mental disorders and beyond: comment on the special section. J Abnorm Psychol 114:551–556

    Article  PubMed  Google Scholar 

  11. Cattell RB (1966) The scree test for the number of factors. Multivariate Behav Res 1:245–276

    Article  Google Scholar 

  12. Cuesta MJ, Peralta V (2001) Integrating psychopathological dimensions in functional psychoses: a hierarchical approach. Schizophr Res 52:215–229

    Article  PubMed  CAS  Google Scholar 

  13. Cuesta MJ, Peralta V, Zarzuela A (2000) Reappraising insight in psychosis: multi-scale longitudinal study. Br J Psychiatry 177:233–240

    Article  PubMed  CAS  Google Scholar 

  14. De Boeck P, Wilson M, Acton GS (2005) A conceptual and psychometric framework for distinguishing categories and dimensions. Psychol Rev 112:129–158

    Article  PubMed  Google Scholar 

  15. Dilling H, Mombour W, Schmidt MH, Schulte-Markwort E (2004) Internationale Klassifikation psychischer Störungen ICD-10 Kapitel V (F) Diagnostische Kriterien für Forschung und Praxis. World Health Organization, Genf

    Google Scholar 

  16. Dragovic M, Hammond G, Badcock JC, Jablensky A (2005) Laterality phenotypes in patients with schizophrenia, their siblings and controls: associations with clinical and cognitive variables. Br J Psychiatry 187:221–228

    Article  PubMed  Google Scholar 

  17. Egli S, Schlatter K, Streule R, Läge D (2006) A structure-based expert model of the ICD-10 mental disorders. Psychopathology 39:1–9

    Article  PubMed  Google Scholar 

  18. Egli S, Streule R, Läge D (2008) The structure-based expert model of the mental disorders: a validation study. Psychopathology 41:286–293

    Article  PubMed  Google Scholar 

  19. First MB (2005) Mutually exclusive versus co-occurring diagnostic categories: the challenge of diagnostic comorbidity. Psychopathology 38:206–210

    Article  PubMed  Google Scholar 

  20. Gower JC, Legendre P (1986) Metric and euclidean properties of dissimilarity coefficients. J Classif 3:5–48

    Article  Google Scholar 

  21. Guy GW, Ban TA (1982) The AMDP system: manual for the assessment and documentation of psychopathology. Springer, Berlin

    Google Scholar 

  22. Haslam N (2003) Categorical versus dimensional models of mental disorder: the taxometric evidence. Aust NZ J Psychiatry 37:696–704

    Article  Google Scholar 

  23. Haug HJ, Ahrens B (2002) Affektive Störungen. In: Freyberger HJ, Schneider W, Stieglitz R-D (Hrsg.) Kompendium Psychiatrie, Psychotherapie, psychosomatische Medizin. Karger, Basel, S 100–118

  24. Jablensky A (2005) Boundaries of mental disorders. Curr Opin Psychiatry 18:653–658

    Article  PubMed  Google Scholar 

  25. Jablensky A (2005) Categories, dimensions and prototypes: critical issues for psychiatric classification. Psychopathology 38:201–205

    Article  PubMed  Google Scholar 

  26. Jäger M, Bottlender R, Strauss A, Möller HJ (2004) Fifteen-year follow-up of ICD-10 schizoaffective disorders compared with schizophrenia and affective disorders. Acta Psychiatr Scand 109:30–37

    Article  PubMed  Google Scholar 

  27. Jaspers K (1997) General psychopathology (1913). Johns Hopkins University Press, Baltimore

    Google Scholar 

  28. Kempf L, Hussain N, Potash JB (2005) Mood disorder with psychotic features, schizoaffective disorder, and schizophrenia with mood features: trouble at the borders. Int Rev Psychiatry 17:9–19

    Article  PubMed  CAS  Google Scholar 

  29. Kendell R, Jablensky A (2003) Distinguishing between the validity and utility of psychiatric diagnoses. Am J Psychiatry 160:4–12

    Article  PubMed  Google Scholar 

  30. Kraemer HC (2007) DSM categories and dimensions in clinical and research contexts. Int J Methods Psychiatr Res 16:S8–S15

    Article  PubMed  Google Scholar 

  31. Kraemer HC, Noda A, O’Hara R (2004) Categorical versus dimensional approaches to diagnosis: methodological challenges. J Psychiatr Res 38:17–25

    Article  PubMed  Google Scholar 

  32. Kruskal JB, Wish M (1978) Multidimensional scaling. Sage Publications, Beverly Hills

    Google Scholar 

  33. Läge D, Daub S, Bosia L, Jäger C, Ryf S (2005). Die Behandlung ausreißerbehafteter Datensätze in der Nonmetrischen Multidimensionalen Skalierung—Relevanz, Problemanalyse und Lösungsvorschlag (Forschungsberichte aus der Angewandten Kognitionspsychologie Nr. 21). Universität Zürich, Psychologisches Institut

  34. Läge D, Egli S, Möller HJ, Strauss A, Riedel M (2008) Exploring the structure of psychopathological symptoms—a re-analysis of AMDP data by robust nonmetric multidimensional scaling. Manuscript submitted for publication

  35. Lauterbach E, Rumpf HJ, Ahrens B, Haug HJ, Schaub R, Schonell H, Stieglitz RD, Hohagen F (2005) Assessing dimensional and categorical aspects of depression: validation of the AMDP depression scale. Eur Arch Psychiatry Clin Neurosci 255:15–19

    Article  PubMed  CAS  Google Scholar 

  36. Lecrubier Y (2008) Refinement of diagnosis and disease classification in psychiatry. Eur Arch Psychiatry Clin Neurosci 258(Suppl 1):6–11

    Article  PubMed  Google Scholar 

  37. Lopez MF, Compton WM, Grant BF, Breiling JP (2007) Dimensional approaches in diagnostic classification: a critical appraisal. Int J Methods Psychiatr Res 16(Suppl 1):S6–S7

    Article  PubMed  Google Scholar 

  38. Manton KG, Korten A, Woodbury MA, Anker M, Jablensky A (1994) Symptom profiles of psychiatric disorders based on graded disease classes: an illustration using data from the WHO international pilot study of schizophrenia. Psychol Med 24:133–144

    Article  PubMed  CAS  Google Scholar 

  39. Maser JD, Cloninger CR (1990) Comorbidity of anxiety and mood disorders: introduction and overview. In: Maser JD, Cloninger CR (eds) Comorbidity of mood and anxiety disorders. American Psychiatric Press, Washington, DC, pp 3–12

    Google Scholar 

  40. Overall JE, Woodward JA (1975) Conceptual validity of a phenomenological classification of psychiatric patients. J Psychiatr Res 12:215–230

    Article  PubMed  CAS  Google Scholar 

  41. Peralta V, Cuesta MJ (2007) A dimensional and categorical architecture for the classification of psychotic disorders. World Psychiatry 6:36–37

    Google Scholar 

  42. Peralta V, Cuesta MJ (2007) Exploring the borders of the schizoaffective spectrum: a categorical and dimensional approach. J Affect Disord (in press)

    Google Scholar 

  43. Pickles A, Angold A (2003) Natural categories or fundamental dimensions: on carving nature at the joints and the rearticulation of psychopathology. Dev Psychopathol 15:529–551

    Article  PubMed  Google Scholar 

  44. Regier DA (2007) Dimensional approaches to psychiatric classification: refining the research agenda for DSM-V: an introduction. Int J Methods Psychiatr Res 16:S1–S5

    Article  PubMed  Google Scholar 

  45. Salvatore P, Khalsa HMK, Hennen J, Tohen M, Yurgelun-Todd D, Casolari F, DePanfilis C, Maggini C, Baldessarini RJ (2007) Psychopathology factors in first-episode affective and non-affective psychotic disorders. J Psychiatr Res 41:724–736

    Article  PubMed  CAS  Google Scholar 

  46. Sato T, Bottlender R, Kleindienst N, Möller HJ (2002) Syndromes and phenomenological subtypes underlying acute mania: a factor analytic study of 576 manic patients. Am J Psychiatry 159:968–974

    Article  PubMed  Google Scholar 

  47. Schneider K (1959) Clinical psychopathology. Grune and Stratton, New York

    Google Scholar 

  48. Watson D (2005) Rethinking the mood and anxiety disorders: a quantitative hierarchical model for DSM-V. J Abnorm Psychol 114:522–536

    Article  PubMed  Google Scholar 

  49. Widiger TA, Samuel DB (2005) Diagnostic categories or dimensions? A question for the diagnostic and statistical manual of mental disorders—fifth edition. J Abnorm Psychol 114:494–504

    Article  PubMed  Google Scholar 

  50. Woodbury MA, Clive J, Garson A Jr (1978) Mathematical typology: a grade of membership technique for obtaining disease definition. Comput Biomed Res 11:277–298

    Article  PubMed  CAS  Google Scholar 

  51. Woodbury MA, Manton KG (1982) A new procedure for analysis of medical classification. Methods Inf Med 21:210–220

    PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This study was supported by a grant from the Swiss National Science Foundation (fellowship, project no. 117011).

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Authors and Affiliations

  1. Institute of Psychology, Applied Cognitive Psychology, University of Zurich, Binzmühlestrasse 14/28, 8050, Zurich, Switzerland

    Samy Egli &  Damian Läge

  2. Schlössli Privatklinik für Psychiatrie, Oetwil, Switzerland

    Samy Egli

  3. Department of Psychiatry, Psychiatric Hospital of the Ludwig-Maximilans-University, Munich, Germany

    Michael Riedel,  Hans-Jürgen Möller &  Anton Strauss

  4. Department of Psychiatry, Ludwig-Maximilians-University, Nussbaumstr. 7, 80336, Munich, Germany

    Michael Riedel

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  1. Samy Egli
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  2. Michael Riedel
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  3. Hans-Jürgen Möller
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  4. Anton Strauss
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  5. Damian Läge
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Correspondence to Damian Läge.

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Egli, S., Riedel, M., Möller, HJ. et al. Creating a map of psychiatric patients based on psychopathological symptom profiles. Eur Arch Psychiatry Clin Neurosci 259, 164–171 (2009). https://doi.org/10.1007/s00406-008-0848-1

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  • DOI: https://doi.org/10.1007/s00406-008-0848-1

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