The underlying structure of diagnostic systems of schizophrenia: a comprehensive polydiagnostic approach

The objective was to ascertain the underlying factor structure of alternative definitions of schizophrenia, and to examine the distribution of schizophrenia-related variables against the resulting factor solution. Twenty-three diagnostic schemes of schizophrenia were applied to 660 patients presenting with psychotic symptoms regardless of the specific diagnosis of psychotic disorder. Factor analysis of the 23 diagnostic schemes yielded three interpretable factors explaining 58% of the variance, the first factor (general schizophrenia factor) accounting for most of the variance (36%). On the basis of the general schizophrenia factor score, the sample was divided in quintile groups representing 5 levels of schizophrenia definition (absent, doubtful, very broad, broad and narrow) and the distribution of a number of schizophrenia-related variables was examined across the groups. This grouping procedure was used for examining the comparative validity of alternative levels of categorically defined schizophrenia and an ordinal (i.e. dimensional) definition. Overall, schizophrenia-related variables displayed a dose-response relationship with level of schizophrenia definition. Logistic regression analyses revealed that the dimensional definition explained more variance in the schizophrenia-related variables than the alternative levels for defining schizophrenia categorically. These results are consistent with a unitary and dimensional construct of schizophrenia with no clear "points of rarity" at its boundaries, thus supporting the continuum hypothesis of the psychotic illness.