The case for including Attenuated Psychotic Symptoms Syndrome in DSM-5 as a psychosis risk syndrome.
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.
Woods
Scott W
SW
Connecticut Mental Health Center, CT, USA. scott.woods@yale.edu
Walsh
Barbara C
BC
Saksa
John R
JR
McGlashan
Thomas H
TH
D000293:Adolescent; D000328:Adult; D002648:Child; D039721:Diagnostic and Statistical Manual of Mental Disorders; D042241:Early Diagnosis; D005190:Family / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis / Q000523:psychology; D015203:Reproducibility of Results; D018570:Risk Assessment; D012494:Sampling Studies; D012569:Schizotypal Personality Disorder / Q000175:diagnosis / Q000523:psychology; D013577:Syndrome; D055815:Young Adult