The case for including Attenuated Psychotic Symptoms Syndrome in DSM-5 as a psychosis risk syndrome

Abstract

The American Psychiatric Association Task Force on DSM-5 has recently proposed consideration of Attenuated Psychotic Symptoms Syndrome as a new diagnosis, based on nearly 15 years of prospective research in centers across the globe. The condition is also known as "psychosis risk syndrome," "at-risk mental state," "ultra-high risk," and "putative prodrome." We review evidence favoring its inclusion as a new diagnosis in DSM-5 and report new preliminary findings on DSM-IV diagnoses in current clinical use for these patients and on results of diagnostic interviews in unselected volunteers.The main evidence supporting inclusion is: (1) the patients are currently ill, (2) the patients are at high risk for getting worse, (3) no DSM-IV diagnosis accurately captures their current illness or future risk, (4) the diagnosis has been made with reliability and validity in the research setting, and (5) placement in DSM-5 would help promote the needed treatment and prevention research to enable articulation of a standard of care to benefit these patients and their families. Potential harms can be minimized by patient, family, and provider education. It will be important to demonstrate through well-designed field trials whether the diagnostic criteria can be used with reliability in everyday clinical practice.

Mental health-related stigma and pathways to care for people at risk of psychotic disorders or experiencing first-episode psychosis: a systematic review

“…For example, the subgroup comparisons showed that facilitative destigmatizing features of services were reported more frequently among at-risk than FEP groups. Rather than indicating experiential differences, this could reflect an increased interest in exploring positive aspects of detecting and treating high-risk states of psychotic illnesses, given the debate of whether risks of stigmatization outweigh the benefits of at-risk labels/services Woods et al 2010;Yang et al 2010), and a lack of research exploring this among FEP groups. Further, seemingly no studies have examined stigma and pathways to care among significant others of people in at-risk groups.…”

Self-Reported Psychotic-Like Experiences Are a Poor Estimate of Clinician-Rated Attenuated and Frank Delusions and Hallucinations

“…In the discussion about inclusion of an Attenuated Psychosis Syndrome based on APS in the fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders [12,13], it was, therefore, cautioned that APS might, in fact, be a common feature in adolescents and young adults from the general population and of no psychopathological significance by themselves [14,15]. …”

INTERVENÇÃO PRECOCE NA PSICOSE: DE ESTRATÉGIA CLÍNICA A POSSÍVEL CATEGORIA DIAGNÓSTICA

“…In addition to the debate held on the internet, many articles were published reflecting about the risks and benefits that the new diagnostic category could bring to the attention in mental health aimed at adolescents and young adults (Corcoran, First, & Cornblatt, 2010;McGorry, 2010;Yung, Nelson, Thompson & Wood, 2010;Woods et al, 2010). Among the risks discussed, there is a special highlight to false positives and the lack of safe information about the best options of treatment or intervention to be offered to this population.…”