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Psychosis superspectrum I: Nosology, etiology, and lifespan development

Molecular Psychiatry (2024)Cite this article

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Abstract

This review describes the Hierarchical Taxonomy of Psychopathology (HiTOP) model of psychosis-related psychopathology, the psychosis superspectrum. The HiTOP psychosis superspectrum was developed to address shortcomings of traditional diagnoses for psychotic disorders and related conditions including low reliability, arbitrary boundaries between psychopathology and normality, high symptom co-occurrence, and heterogeneity within diagnostic categories. The psychosis superspectrum is a transdiagnostic dimensional model comprising two spectra—psychoticism and detachment—which are in turn broken down into fourteen narrow components, and two auxiliary domains—cognition and functional impairment. The structure of the spectra and their components are shown to parallel the genetic structure of psychosis and related traits. Psychoticism and detachment have distinct patterns of association with urbanicity, migrant and ethnic minority status, childhood adversity, and cannabis use. The superspectrum also provides a useful model for describing the emergence and course of psychosis, as components of the superspectrum are relatively stable over time. Changes in psychoticism predict the onset of psychosis-related psychopathology, whereas changes in detachment and cognition define later course. Implications of the superspectrum for genetic, socio-environmental, and longitudinal research are discussed. A companion review focuses on neurobiology, treatment response, and clinical utility of the superspectrum, and future research directions.

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Fig. 1: HiTOP model of psychosis superspectrum.

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Authors and Affiliations

  1. Department of Psychiatry & Behavioral Health, Stony Brook University, Stony Brook, NY, USA

    Katherine G. Jonas & Roman Kotov

  2. Department of Psychology, Yale University, New Haven, CT, USA

    Tyrone D. Cannon

  3. Department of Psychiatry, Yale University, New Haven, CT, USA

    Tyrone D. Cannon

  4. Huntsman Mental Health Institute, Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA

    Anna R. Docherty

  5. Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany

    Dominic Dwyer

  6. Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia

    Dominic Dwyer & Barnaby Nelson

  7. Brain Behavior Laboratory, Department of Psychiatry and the Penn-CHOP Lifespan Brain Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    Ruben C. Gur & Raquel E. Gur

  8. Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany

    Ulrich Reininghaus

  9. ESRC Centre for Society and Mental Health and Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK

    Ulrich Reininghaus

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  1. Katherine G. Jonas
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  2. Tyrone D. Cannon
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  3. Anna R. Docherty
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  4. Dominic Dwyer
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  6. Raquel E. Gur
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  7. Barnaby Nelson
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  9. Roman Kotov
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All authors contributed to the drafting the article. KJ and RK also revised it critically for important intellectual content.

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Correspondence to Katherine G. Jonas.

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Competing interests

This research was supported by the National Institute of Mental Health: R21MH123908 (KG Jonas) and R01MH122537 (R Kotov).

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Jonas, K.G., Cannon, T.D., Docherty, A.R. et al. Psychosis superspectrum I: Nosology, etiology, and lifespan development. Mol Psychiatry (2024). https://doi.org/10.1038/s41380-023-02388-2

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