TY - JOUR
T1 - Identification of distinct psychosis biotypes using brain-based biomarkers
AU - Clementz, Brett A.
AU - Sweeney, John A.
AU - Hamm, Jordan P.
AU - Ivleva, Elena I.
AU - Ethridge, Lauren E.
AU - Pearlson, Godfrey D.
AU - Keshavan, Matcheri S.
AU - Tamminga, Carol A.
PY - 2016/4/1
Y1 - 2016/4/1
N2 - Objective: Clinical phenomenology remains the primary means for classifyingpsychosesdespiteconsiderableevidence that this method incompletely captures biologically meaningful differentiations.Rather than relying onclinical diagnoses as the gold standard, this project drew on neurobiological heterogeneity among psychosis cases to delineate subgroups independent of their phenomenological manifestations. Method: A large biomarker panel (neuropsychological, stop signal, saccadic control, and auditory stimulation paradigms) characterizing diverse aspects of brain functionwascollected on individuals with schizophrenia, schizoaffective disorder, and bipolar disorder with psychosis (N=711), their first-degree relatives (N=883), and demographically comparable healthy subjects (N=278). Biomarker variance across paradigms was exploited to create nine integrated variables that were used to capture neurobiological varianceamongthe psychosis cases. Data on external validating measures (social functioning, structural magnetic resonance imaging, family biomarkers, and clinical information) were collected. Results: Multivariate taxometric analyses identified three neurobiologically distinct psychosis biotypes that did not respect clinical diagnosis boundaries. The same analysis procedure using clinical DSM diagnoses as the criteria was best described by a single severity continuum (schizophrenia worse than schizoaffective disorder worse than bipolar psychosis); this was not the case for biotypes. The external validating measures supported the distinctiveness of these subgroups compared with clinical diagnosis, highlighting a possible advantage of neurobiological versus clinical categorization schemesfor differentiatingpsychotic disorders. Conclusions: These data illustrate how multiple pathways may lead to clinically similar psychosis manifestations, and they provide explanations for the marked heterogeneity observed across laboratories on the same biomarker variables when DSM diagnoses are used as the gold standard.
AB - Objective: Clinical phenomenology remains the primary means for classifyingpsychosesdespiteconsiderableevidence that this method incompletely captures biologically meaningful differentiations.Rather than relying onclinical diagnoses as the gold standard, this project drew on neurobiological heterogeneity among psychosis cases to delineate subgroups independent of their phenomenological manifestations. Method: A large biomarker panel (neuropsychological, stop signal, saccadic control, and auditory stimulation paradigms) characterizing diverse aspects of brain functionwascollected on individuals with schizophrenia, schizoaffective disorder, and bipolar disorder with psychosis (N=711), their first-degree relatives (N=883), and demographically comparable healthy subjects (N=278). Biomarker variance across paradigms was exploited to create nine integrated variables that were used to capture neurobiological varianceamongthe psychosis cases. Data on external validating measures (social functioning, structural magnetic resonance imaging, family biomarkers, and clinical information) were collected. Results: Multivariate taxometric analyses identified three neurobiologically distinct psychosis biotypes that did not respect clinical diagnosis boundaries. The same analysis procedure using clinical DSM diagnoses as the criteria was best described by a single severity continuum (schizophrenia worse than schizoaffective disorder worse than bipolar psychosis); this was not the case for biotypes. The external validating measures supported the distinctiveness of these subgroups compared with clinical diagnosis, highlighting a possible advantage of neurobiological versus clinical categorization schemesfor differentiatingpsychotic disorders. Conclusions: These data illustrate how multiple pathways may lead to clinically similar psychosis manifestations, and they provide explanations for the marked heterogeneity observed across laboratories on the same biomarker variables when DSM diagnoses are used as the gold standard.
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U2 - 10.1176/appi.ajp.2015.14091200
DO - 10.1176/appi.ajp.2015.14091200
M3 - Article
C2 - 26651391
AN - SCOPUS:84962355574
SN - 0002-953X
VL - 173
SP - 373
EP - 384
JO - American Journal of Psychiatry
JF - American Journal of Psychiatry
IS - 4
ER -