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Evaluation of the validity and utility of a transdiagnostic psychosis dimension encompassing schizophrenia and bipolar disorder

  • Ulrich Reininghaus (a1), Jan R. Böhnke (a2), Georgina Hosang (a3), Anne Farmer (a4), Tom Burns (a5), Peter McGuffin (a4) and Richard P. Bentall (a6)...

In recent years, the Kraepelinian dichotomy has been challenged in light of evidence on shared genetic and environmental factors for schizophrenia and bipolar disorder, but empirical efforts to identify a transdiagnostic phenotype of psychosis remain remarkably limited.


To investigate whether schizophrenia spectrum and bipolar disorder lie on a transdiagnostic spectrum with overlapping non-affective and affective psychotic symptoms.


Multidimensional item-response modelling was conducted on symptom ratings of the OPerational CRITeria (OPCRIT) system in 1168 patients with schizophrenia spectrum and bipolar disorder.


A bifactor model with one general, transdiagnostic psychosis dimension underlying affective and non-affective psychotic symptoms and five specific dimensions of positive, negative, disorganised, manic and depressive symptoms provided the best model fit and diagnostic utility for categorical classification.


Our findings provide support for including dimensional approaches into classification systems and a directly measurable clinical phenotype for cross-disorder investigations into shared genetic and environmental factors of psychosis.

Corresponding author
Ulrich Reininghaus, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, PO Box 616 (VIJV1), 6200 MD Maastricht, The Netherlands. Email:
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These authors are joint first authors.

U.R. is supported by a Postdoctoral Research Fellowship of the UK National Institute of Health Research (grant no. NIHR-PDF-201104065) and a Veni grant from the Netherlands Organisation for Scientific Research (grant no. 451-13-022). The report is independent research and the views expressed in this publication are those of the authors and not necessarily those of the National Health Service, the National Institute for Health Research or the Department of Health.

Declaration of interest


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Evaluation of the validity and utility of a transdiagnostic psychosis dimension encompassing schizophrenia and bipolar disorder

  • Ulrich Reininghaus (a1), Jan R. Böhnke (a2), Georgina Hosang (a3), Anne Farmer (a4), Tom Burns (a5), Peter McGuffin (a4) and Richard P. Bentall (a6)...
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