Is there a symptomatic distinction between the affective psychoses and schizophrenia? A machine learning approach
Open accessAbstract
Dubiety exists over whether clinical symptoms of schizophrenia can be distinguished from affective psychosis, the assumption being that absence of a "point of rarity" indicates lack of nosological distinction, based on prior group-level analyses. Advanced machine learning techniques, using unsupervised (hierarchical clustering) and supervised (regularized logistic regression algorithm and nested-cross-validation) were applied to a dataset of 202 patients with functional psychosis (schizophrenia n = 120, affective psychosis, n = 82). Patients were initially assessed with the Present State Examination (PSE), and followed up 2.5 years later, when DSM III diagnoses were applied (independent of initial PSE). Based on PSE syndromes, unsupervised learning discriminated depressive (approximately unbiased probability, AUP = 0.92) and mania/psychosis (AUP = 0.94) clusters. The mania/psychosis cluster further split into two groups - a mania (AUP = 0.84) and a psychosis cluster (AUP = 0.88). Supervised machine learning classified schizophrenia or affective psychosis with 83.66% (95% CI = 77.83% to 88.48%) accuracy. Area under the ROC curve (AUROC) was 89.14%. True positive rate for schizophrenia was 88.24% (95%CI = 81.05-93.42%) and affective psychosis 77.11% (95%CI = 66.58-85.62). Classification accuracy and AUROC remained high when PSE syndromes corresponding to affective symptoms (those that corresponded to the depressive and mania clusters) were removed. PSE syndromes, based on clinical symptoms, therefore discriminated between schizophrenia and affective psychosis, suggesting validity to these diagnostic constructs.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
There is also evidence for diagnostic specificity: machine learning reclassification studies demonstrated a distinction between schizophrenia and affective disorders; treatment requirements and outcomes also differ.
“However, there is also evidence for diagnostic specificity: machine learning reclassification studies demonstrated a distinction between schizophrenia and affective disorders 213 ; treatment requirements and outcomes also differ 55”
From Preventive psychiatry: a blueprint for improving the mental health of young people (2021) · cites this paper as [213]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Diagnostic and Statistical Manual of Mental Disorders
Williams, J. B. W., & First, M. B. (2013) · Oxford University Press eBooks · doi:10.1093/acrefore/9780199975839.013.104 · Cited by 109,841 · see citing works
Regularization Paths for Generalized Linear Models via Coordinate Descent
Friedman, J., Hastie, T., & Tibshirani, R. (2010) · Journal of Statistical Software · doi:10.18637/jss.v033.i01 · Cited by 19,927 · see citing works
Biological insights from 108 schizophrenia-associated genetic loci
Schizophrenia Working Group of the Psychiatric Genomics Consortium (2014) · Nature · doi:10.1038/nature13595 · Cited by 7,577 · see citing works
Insel, T., Cuthbert, B., Garvey, M., Heinssen, R., Pine, D. S., Quinn, K., Sanislow, C., & Wang, P. (2010) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2010.09091379 · Cited by 7,067 · see citing works
Some Studies in Machine Learning Using the Game of Checkers
Samuel, A. L. (1959) · IBM Journal of Research and Development · doi:10.1147/rd.33.0210 · Cited by 4,443 · see citing works
Pvclust: an R package for assessing the uncertainty in hierarchical clustering
Suzuki, R., & Shimodaira, H. (2006) · Bioinformatics · doi:10.1093/bioinformatics/btl117 · Cited by 2,456 · see citing works
Book Review: Measurement and Classification of Psychiatric Symptoms
Priest, R. G. (1975) · Proceedings of the Royal Society of Medicine · doi:10.1177/003591577506800751 · Cited by 2,268 · see citing works
Cochrane Database of Systematic Reviews
Lyons, R. (2006) · Progress in Neurology and Psychiatry · doi:10.1002/pnp.208 · Cited by 1,907 · see citing works
Distinguishing between the validity and utility of psychiatric diagnoses.
Kendell, R., & Jablensky, A. (2003) · American Journal of Psychiatry · doi:10.1176/appi.ajp.160.1.4 · Cited by 1,294 · see citing works
Bischl, B., Lang, M., Kotthoff, L., Schratz, P., Schiffner, J., Richter, J., Jones, Z., Casalicchio, G., Gallo, M., & Binder, M. (2013) · doi:10.32614/cran.package.mlr · Cited by 506 · see citing works
Confidence intervals for predictive values with an emphasis to case–control studies
Mercaldo, N. D., Lau, K. F., & Zhou, X. (2006) · Statistics in Medicine · doi:10.1002/sim.2677 · Cited by 413 · see citing works
Schizophrenia, “Just the Facts”: What we know in 2008
Tandon, R., Keshavan, M. S., & Nasrallah, H. A. (2008) · Schizophrenia Research · doi:10.1016/j.schres.2008.01.022 · Cited by 412 · see citing works
Are There Pathognomonic Symptoms in Schizophrenia?
Carpenter, W. T. (1973) · Archives of General Psychiatry · doi:10.1001/archpsyc.1973.01750360069010 · Cited by 355 · see citing works
Genetic overlap between autism, schizophrenia and bipolar disorder
Carroll, L. S., & Owen, M. J. (2009) · Genome Medicine · doi:10.1186/gm102 · Cited by 326 · see citing works
The slow death of the concept of schizophrenia and the painful birth of the psychosis spectrum
Gülöksüz, S., & van Os, J. (2017) · Psychological Medicine · doi:10.1017/s0033291717001775 · Cited by 325 · see citing works
The diagnostic concept of schizophrenia: its history, evolution, and future prospects
Jablensky, A. V. (2010) · Dialogues in Clinical Neuroscience · doi:10.31887/dcns.2010.12.3/ajablensky · Cited by 309 · see citing works
Jauhar, S., Nour, M. M., Veronese, M., Rogdaki, M., Bonoldi, I., Azis, M., Turkheimer, F., McGuire, P., Young, A. H., & Howes, O. D. (2017) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2017.2943 · Cited by 233 · see citing works
Self-citationThe Clinical Distinction between the Affective Psychoses and Schizophrenia
Kendell, R. E., & Gourlay, J. (1970) · The British Journal of Psychiatry · doi:10.1192/s0007125000193225 · Cited by 220 · see citing works
Rethinking psychosis: the disadvantages of a dichotomous classification now outweigh the advantages.
Craddock, N. J., & Owen, M. J. (2007) · Europe PMC (PubMed Central) · Cited by 184 · see citing works
The Diagnostic Status of First-Rank Symptoms
Nordgaard, J., Arnfred, S. M., Handest, P., & Parnas, J. (2007) · Schizophrenia Bulletin · doi:10.1093/schbul/sbm044 · Cited by 157 · see citing works
Prognostic Implications of Six Alternative Definitions of Schizophrenia
Kendell, R. E. (1979) · Archives of General Psychiatry · doi:10.1001/archpsyc.1979.01780010031002 · Cited by 148 · see citing works
Diagnostic significance of Schneider's first-rank symptoms in schizophrenia
Peralta, V., & Cuesta, M. J. (1999) · The British Journal of Psychiatry · doi:10.1192/bjp.174.3.243 · Cited by 135 · see citing works
Phenomenology of Schizophrenia and the Representativeness of Modern Diagnostic Criteria
Kendler, K. S. (2016) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2016.1976 · Cited by 115 · see citing works
The ‘continuum of psychosis’: scientifically unproven and clinically impractical
Lawrie, S. M., Hall, J., McIntosh, A. M., Owens, D. G. C., & Johnstone, E. C. (2010) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.109.072827 · Cited by 110 · see citing works
Self-citationThe Distinction Between the Affective Psychoses and Schizophrenia
Brockington, I., Kendell, R. E., Wainwright, S., Hillier, V. F., & Walker, J. (1979) · The British Journal of Psychiatry · doi:10.1192/bjp.135.3.243 · Cited by 101 · see citing works
First rank symptoms for schizophrenia
Soares‐Weiser, K., Maayan, N., Bergman, H., Davenport, C. F., Kirkham, A. J., Grabowski, S., & Adams, C. E. (2015) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd010653.pub2 · Cited by 93 · see citing works
Shall we really say goodbye to first rank symptoms?
Heinz, A., Voss, M., Lawrie, S. M., Mishara, A. L., Bauer, M., Gallinat, J., Juckel, G., Lang, U. E., Rapp, M. A., Falkai, P., et al. (2016) · European Psychiatry · doi:10.1016/j.eurpsy.2016.04.010 · Cited by 87 · see citing works
Self-citationMurray, V., McKEE, I., Miller, P. M., Young, D., Muir, W. J., Pelosi, A. J., & Blackwood, D. (2004) · Psychological Medicine · doi:10.1017/s0033291704003745 · Cited by 81 · see citing works
Jablensky, A. V., Hugler, H., Cranach, M., & Kalinov, K. (1993) · Psychological Medicine · doi:10.1017/s0033291700026337 · Cited by 74 · see citing works
Mantón, K. G., Korten, A. E., Woodbury, M. A., et al. (1994) · Psychological Medicine · doi:10.1017/s0033291700026908 · Cited by 66 · see citing works
Mechelli, A., Lin, A. P., Wood, S. J., McGorry, P. D., Amminger, G. P., Tognin, S., McGuire, P. K., Young, J., Nelson, B., & Yung, A. R. (2016) · Schizophrenia Research · doi:10.1016/j.schres.2016.11.047 · Cited by 65 · see citing works
Implications of Genetic Findings for Understanding Schizophrenia
Owen, M. J. (2012) · Schizophrenia Bulletin · doi:10.1093/schbul/sbs103 · Cited by 58 · see citing works
The Northwick Park ‘Functional’ Psychosis Study: diagnosis and outcome
Johnstone, E. C., Frith, C., Crow, T. J., et al. (1992) · Psychological Medicine · doi:10.1017/s0033291700030270 · Cited by 55 · see citing works
Self-citationPayá, B., Rodríguez-Sánchez, J. M., Otero, S., Muñoz, P., Castro-Fornieles, J., Parellada, M., Gonzalez-Pinto, A., Soutullo, C., Baeza, I., Rapado-Castro, M., et al. (2013) · Schizophrenia Research · doi:10.1016/j.schres.2013.01.029 · Cited by 35 · see citing works
Improving classification of psychoses
Lawrie, S. M., O’Donovan, M. C., Saks, E. R., Burns, T., & Lieberman, J. A. (2016) · The Lancet Psychiatry · doi:10.1016/s2215-0366(15)00577-5 · Cited by 29 · see citing works
Self-citationAre There Valid Subtypes of Schizophrenia? A Grade of Membership Analysis
Pomarol‐Clotet, E., Salvador, R. M., Murray, G. K., et al. (2009) · Psychopathology · doi:10.1159/000260044 · Cited by 16 · see citing works
Continua or Classes? Vexed Questions on the Latent Structure of Schizophrenia
Linscott, R. J., Lenzenweger, M. F., & van Os, J. (2009) · Springer eBooks · doi:10.1007/978-1-4419-0913-8_18 · Cited by 12 · see citing works
Flagged first, then by citations
Research works printed but not linked: 2
- Kraepelin, E., 1987. Dementia praecox. Cambridge University Press.
- Linscott, R.J., Allardyce, J., Van Os, J., 2010a. Seeking verisimilitude in a class: a systematic review of evidence that the criterial clinical symptoms of schizophrenia are taxonic. Schizophrenia bulletin 36, 811.
Cited by
Sorted by citations
Preventive psychiatry: a blueprint for improving the mental health of young people
Fusar‐Poli, P., Correll, C. U., Arango, C., Berk, M., Patel, V., & Ioannidis, J. P. A. (2021) · World Psychiatry · doi:10.1002/wps.20869 · Cited by 497 · see citing works
Transdiagnostic psychiatry: a systematic review
Fusar‐Poli, P., Solmi, M., Brondino, N., Davies, C., Chae, C., Politi, P., Borgwardt, S., Lawrie, S. M., Parnas, J., & McGuire, P. (2019) · World Psychiatry · doi:10.1002/wps.20631 · Cited by 409 · see citing works
Self-citationLalousis, P. A., Wood, S. J., Schmaal, L., Chisholm, K., Griffiths, S. L., Reniers, R. L. E. P., Bertolino, A., Borgwardt, S., Brambilla, P., Kambeitz, J., et al. (2021) · Schizophrenia Bulletin · doi:10.1093/schbul/sbaa185 · Cited by 42 · see citing works
- Authors
- Jauhar, S., Krishnadas, R., Nour, M. M., Cunningham-Owens, D., Johnstone, E. C., & Lawrie, S. M.
- Affiliations
- King's College London (GB)
- Queen Elizabeth University Hospital (GB)
- Royal Edinburgh Hospital (GB)
- Corresponding author
- Jauhar, S.
- Venue
- Schizophrenia Research
- Publisher
- Elsevier BV
- Published
- 2018-12
- Volume
- 202
- Pages
- 241-247
- ISSN
- 0920-9964 (ISSN-L)
- OpenAlex
- W2883616798
- Cited by
- 23
- References
- 37
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2023: 2 · 2022: 1 · 2021: 4 · 2020: 8 · 2019: 4
- FWCI
- 3.14
- Type
- journal article
- Language
- en
- Open access
- green
- eprints.gla.ac.uk
- Licence
- Locations
- Schizophrenia Research (publishedVersion)
- PubMed (publishedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion, cc-by-sa)
- UCL Discovery (University College London) (submittedVersion)
- Research Portal (King's College London) (submittedVersion, cc-by-nc-nd)
- Funders
- NIHR Biomedical Research Centre, Royal Marsden NHS Foundation Trust/Institute of Cancer Research
- National Institute for Health and Care Research (ACF-2016-17-005)
- King's College London
- Menzies Centre for Australian Studies, King's College London, University of London
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Keywords
- schizophrenia, affective psychosis
- MeSH terms
- Machine Learning, Adolescent, Adult, Affective Disorders, Psychotic, Aged, Diagnosis, Computer-Assisted, Female, Humans, Male, Middle Aged, ROC Curve, Schizophrenia, Schizophrenic Psychology, Cohort Studies, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
