Cited by 768Schizophrenia research and treatmentMental Health and PsychiatryBipolar Disorder and Treatment

Identification of Distinct Psychosis Biotypes Using Brain-Based Biomarkers

Open access
Clementz, Brett A., Sweeney, John A., Hamm, Jordan P., Ivleva, Elena I., Ethridge, Lauren E., Pearlson, Godfrey D., Keshavan, Matcheri S., Tamminga, Carol A.·2016·American Journal of Psychiatry

Abstract

OBJECTIVE: Clinical phenomenology remains the primary means for classifying psychoses despite considerable evidence that this method incompletely captures biologically meaningful differentiations. Rather than relying on clinical 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 function was collected 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 variance among the 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 schemes for differentiating psychotic 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.

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.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1176/appi.ajp.2015.14091200

Cites

50 of 50 references verified0 citation errors · 0 not checkable

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.

A few free checks a day · papers already verified open instantly · results are public

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?

  • Clusters of individuals with neural network alterations have been identified in depression, psychotic disorders, and ADHD.

    “Indeed, clusters of individuals with neural network alterations have been identified in depression [7–8], psychotic disorders [9] and attention-deficit/hyperactivity disorder (ADHD [10]).”

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

Flagged first, then by citations

Research works printed but not linked: 2

  1. [7]National Research Council (US) Committee on a Framework for Developing a New Taxonomy of Disease: Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease 2011 Washington, DC National Academies Press 22536618
  2. [50]Rosenberg RN Pascual JN Rosenberg’s Molecular and Genetic Basis of Neurological and Psychiatric Diseases 2014 5th Waltham, Mass Academic Press

Cited by

Sorted by citations

Authors
Clementz, B. A., Sweeney, J. A., Hamm, J. P., Ivleva, E. I., Ethridge, L. E., Pearlson, G. D., Keshavan, M. S., & Tamminga, C. A.
Affiliations
Hartford Hospital (US)
Venue
American Journal of Psychiatry
Published
2016-04-01
Volume
173
Issue
4
Pages
373-384
ISSN
  • 0002-953X (ISSN-L)
  • 1535-7228
OpenAlex
W2190536949
Cited by
768
References
50
Citations by year
2026: 64 · 2025: 59 · 2024: 58 · 2023: 61 · 2022: 70 · 2021: 78 · 2020: 72 · 2019: 122 · 2018: 68 · 2017: 75 · 2016: 40
FWCI
49.56
Type
journal article
Language
en
Open access
Locations
  • American Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health (R01MH077852, MH‐077945, MH 077852, R01MH077851, MH-078113, MH077851, R01MH096913, MH‐077862, R01MH078113, R01MH077862, R01MH077945)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
Keywords
schizophrenia, schizoaffective disorder, taxometric analysis, neuropsychological assessment, stop-signal task, auditory stimulation, first-degree relatives, social functioning, structural MRI
MeSH terms
Acoustic Stimulation, Adult, Bipolar Disorder, Brain, Electroencephalography, Evoked Potentials, Auditory, Family, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Neuropsychological Tests, Phenotype, Psychotic Disorders, Saccades, Schizophrenia, Schizophrenic Psychology, Case-Control 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