Psychosis Biotypes: Replication and Validation from the B-SNIP Consortium

Schizophr Bull. 2022 Jan 21;48(1):56-68. doi: 10.1093/schbul/sbab090.


Current clinical phenomenological diagnosis in psychiatry neither captures biologically homologous disease entities nor allows for individualized treatment prescriptions based on neurobiology. In this report, we studied two large samples of cases with schizophrenia, schizoaffective, and bipolar I disorder with psychosis, presentations with clinical features of hallucinations, delusions, thought disorder, affective, or negative symptoms. A biomarker approach to subtyping psychosis cases (called psychosis Biotypes) captured neurobiological homology that was missed by conventional clinical diagnoses. Two samples (called "B-SNIP1" with 711 psychosis and 274 healthy persons, and the "replication sample" with 717 psychosis and 198 healthy persons) showed that 44 individual biomarkers, drawn from general cognition (BACS), motor inhibitory (stop signal), saccadic system (pro- and anti-saccades), and auditory EEG/ERP (paired-stimuli and oddball) tasks of psychosis-relevant brain functions were replicable (r's from .96-.99) and temporally stable (r's from .76-.95). Using numerical taxonomy (k-means clustering) with nine groups of integrated biomarker characteristics (called bio-factors) yielded three Biotypes that were virtually identical between the two samples and showed highly similar case assignments to subgroups based on cross-validations (88.5%-89%). Biotypes-1 and -2 shared poor cognition. Biotype-1 was further characterized by low neural response magnitudes, while Biotype-2 was further characterized by overactive neural responses and poor sensory motor inhibition. Biotype-3 was nearly normal on all bio-factors. Construct validation of Biotype EEG/ERP neurophysiology using measures of intrinsic neural activity and auditory steady state stimulation highlighted the robustness of these outcomes. Psychosis Biotypes may yield meaningful neurobiological targets for treatments and etiological investigations.

Keywords: Biotypes; EEG; biomarkers; classification; cognition; psychosis; saccades.

Publication types

  • Research Support, N.I.H., Extramural
  • Validation Study

MeSH terms

  • Adult
  • Biomarkers
  • Bipolar Disorder / classification*
  • Bipolar Disorder / physiopathology*
  • Cluster Analysis
  • Datasets as Topic
  • Electroencephalography
  • Endophenotypes
  • Evoked Potentials, Auditory / physiology
  • Female
  • Humans
  • Inhibition, Psychological
  • Longitudinal Studies
  • Male
  • Psychomotor Performance / physiology
  • Psychotic Disorders / classification*
  • Psychotic Disorders / physiopathology*
  • Saccades / physiology
  • Schizophrenia / classification*
  • Schizophrenia / physiopathology*


  • Biomarkers