Mental Health Center and Psychiatric Laboratory, the State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
Institute of Emergency Management and Post-disaster Reconstruction, Sichuan University, Chengdu, Sichuan, China.
BMC Psychiatry. 2021 Nov 16;21(1):574. doi: 10.1186/s12888-021-03498-3.
It is unclear whether psychotic experiences (PEs) gradually merge into states of clinical psychosis along a continuum which correspond to a dimensional classification or whether latent classes appear above a certain severity threshold which correspond better to diagnostic categories of psychosis.
Annual cross-sectional surveys, 2014-19, among Chinese undergraduates (N = 47,004) measured PEs, depression and etiological risk factors using standardized self-report instruments. We created a psychosis continuum with five levels and tested linear and extra-linear contrasts in associated etiological risk factors, before and after adjustment for depression. We carried out latent class analysis.
Categorical expression of psychosis, including hallucinations and delusions, nuclear symptoms, and nuclear symptoms and depression were found at severe level 5. Etiological risk factors which impacted linearly across the continuum were more common for depression. Child maltreatment impacted extra-linearly on both psychosis and depression. Family history of psychosis impacted linearly on psychosis; male sex and urban birth impacted extra-linearly and were specific for psychosis. Four latent classes were found, but only at level 5. These corresponded to nuclear schizophrenia symptoms, nuclear schizophrenia and depressive symptoms, severe depression, and an unclassified category with moderate prevalence of PEs.
Quantitative and qualitative changes in the underlying structure of psychosis were observed at the most severe level along a psychosis continuum, where four latent classes emerged. These corresponded to existing categorical classifications but require confirmation with clinical interview. PEs are non-specific and our findings suggest some are on a continuum with depression, whilst others are on a continuum with non-affective psychosis. Differing patterns of impact from etiological risk factors across the spectrum of psychopathology determine outcome at the most severe level of these continua.
目前尚不清楚精神病性体验（PEs）是否沿着与维度分类相对应的连续体逐渐融合为临床精神病状态，或者是否在某个严重程度阈值之上出现潜在类别，这些潜在类别与精神病的诊断类别更为对应。
我们使用标准化的自我报告工具，在 2014 年至 2019 年期间，对中国大学生（N=47004）进行了年度横断面调查，以测量 PEs、抑郁和病因风险因素。我们创建了一个具有五个水平的精神病连续体，并在调整抑郁后，测试了与病因风险因素相关的线性和非线性对比。我们进行了潜在类别分析。
在严重程度 5 级，发现了精神病的类别表达，包括幻觉和妄想、核心症状以及核心症状和抑郁。在线性跨越连续体的病因风险因素更为常见的是抑郁。儿童虐待对精神病和抑郁都有非线性影响。精神病家族史对精神病有线性影响；男性和城市出生对精神病有非线性影响，且特异性较高。发现了四个潜在类别，但仅在 5 级。这些对应于核心精神分裂症症状、核心精神分裂症和抑郁症状、严重抑郁以及一个具有中度 PEs 流行率的未分类类别。
在精神病连续体的最严重水平观察到精神病潜在结构的定量和定性变化，出现了四个潜在类别。这些与现有的分类相对应，但需要通过临床访谈进行确认。PEs 是非特异性的，我们的研究结果表明，一些 PEs 与抑郁相关，而另一些则与非情感性精神病相关。在精神病病理学的整个范围内，病因风险因素的不同影响模式决定了这些连续体最严重水平的结果。
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