The Hierarchical Taxonomy of Psychopathology (HiTOP) is a scientific effort to address shortcomings of traditional mental disorder diagnoses, which suffer from arbitrary boundaries between psychopathology and normality, frequent disorder co‐occurrence, heterogeneity within disorders, and diagnostic instability. This paper synthesizes evidence on the validity and utility of the thought disorder and detachment spectra of HiTOP. These spectra are composed of symptoms and maladaptive traits currently subsumed within schizophrenia, other psychotic disorders, and schizotypal, paranoid and schizoid personality disorders. Thought disorder ranges from normal reality testing, to maladaptive trait psychoticism, to hallucinations and delusions. Detachment ranges from introversion, to maladaptive detachment, to blunted affect and avolition. Extensive evidence supports the validity of thought disorder and detachment spectra, as each spectrum reflects common genetics, environmental risk factors, childhood antecedents, cognitive abnormalities, neural alterations, biomarkers, and treatment response. Some of these characteristics are specific to one spectrum and others are shared, suggesting the existence of an overarching psychosis superspectrum. Further research is needed to extend this model, such as clarifying whether mania and dissociation belong to thought disorder, and explicating processes that drive development of the spectra and their subdimensions. Compared to traditional diagnoses, the thought disorder and detachment spectra demonstrated substantially improved utility: greater reliability, larger explanatory and predictive power, and higher acceptability to clinicians. Validated measures are available to implement the system in practice. The more informative, reliable and valid characterization of psychosis‐related psychopathology offered by HiTOP can make diagnosis more useful for research and clinical care.

中文翻译：

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精神病理学层次分类法 (HiTOP) 的有效性和实用性：I. 精神病超谱。


精神病理学层次分类法（HiTOP）是一项科学努力，旨在解决传统精神障碍诊断的缺点，即精神病理学与正常状态之间存在任意界限、频繁的疾病共现、疾病内部的异质性以及诊断的不稳定。本文综合了 HiTOP 思维障碍和脱离谱的有效性和实用性的证据。这些谱系由目前归入精神分裂症、其他精神障碍以及精神分裂型、偏执型和分裂样人格障碍中的症状和适应不良特征组成。思维障碍的范围从正常的现实测试到适应不良特质精神病，再到幻觉和妄想。脱离的范围包括内向、适应不良的脱离、情感和意志迟钝。大量证据支持思维障碍和脱离谱的有效性，因为每个谱都反映了常见的遗传学、环境风险因素、童年经历、认知异常、神经改变、生物标志物和治疗反应。其中一些特征是某一谱系特有的，而另一些则是共有的，这表明存在一个总体的精神病谱系。需要进一步的研究来扩展这个模型，例如澄清躁狂和解离是否属于思维障碍，并解释驱动光谱及其子维度发展的过程。与传统诊断相比，思维障碍和脱离谱显示出显着提高的实用性：更高的可靠性、更强的解释和预测能力以及更高的临床医生可接受性。经过验证的措施可用于在实践中实施该系统。 HiTOP 提供的精神病相关精神病理学的信息更丰富、更可靠、更有效的表征可以使诊断对研究和临床护理更加有用。