title: Values and DSM-5: looking at the debate on attenuated psychosis syndrome.
abstract: BACKGROUND
  Although values have increasingly received attention in psychiatric literature over the last three decades, their role has been only partially acknowledged in psychiatric classification endeavors. The review process of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) received harsh criticism, and was even considered secretive by some authors. Also, it lacked an official discussion of values at play. In this perspective paper we briefly discuss the interplay of some values in the scientific and non-scientific debate around one of the most debated DSM-5 category proposals, the Attenuated Psychosis Syndrome (APS). Then, we point out some ethical consequences of a facts-plus-values perspective in psychiatric classification.
  
  
  CONCLUSIONS
  Different stakeholders participated in the APS-debate and for analytical purposes we divided them into four groups: (i) researchers in the field of high-risk mental states; (ii) the DSM-5 Psychotic Disorders Work Group; (iii) patient, carers and advocacy groups; and (iv) external stakeholders, not related to the previous groups, but which also publicly expressed their opinions about APS inclusion in DSM-5. We found that each group differently stressed the role of values we examined in the APS-debate. These values were ethical, but also epistemic, political, economic and ontological. The prominence given to some values, and the lack of discussion about others, generated divergent positions among stakeholders in the debate. As exemplified by the APS discussion, although medicine is primarily an ethical endeavor, values of different kinds that take part in it also shape to a large extent the profession. Thus, it may be strategic to openly discuss values at play in the elaboration of diagnostic tools and classificatory systems. This task, more than scientifically or politically significant, is ethically important.
authors.affiliation: Department of Psychiatry, Medical School, University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126 - Cidade Universitária, Campinas, 13083-887,, SP, Brazil. arthurmaciel@gmail.com.
authors.forename: Arthur Maciel Nunes
authors.initials: AM
authors.lastname: Gonçalves
authors.affiliation: Department of Psychiatry, Medical School, University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126 - Cidade Universitária, Campinas, 13083-887,, SP, Brazil. crdantas@fcm.unicamp.br.
authors.forename: Clarissa de Rosalmeida
authors.initials: Cde R
authors.lastname: Dantas
authors.affiliation: Department of Psychiatry, Medical School, University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126 - Cidade Universitária, Campinas, 13083-887,, SP, Brazil. cbanzato@fcm.unicamp.br.
authors.forename: Claudio E M
authors.initials: CE
authors.lastname: Banzato
mesh_terms: D001290:Attitude; D026688:Bioethical Issues; D039721:Diagnostic and Statistical Manual of Mental Disorders; D034462:Dissent and Disputes; D004467:Economics; D006801:Humans; D019359:Knowledge; D010344:Patient Advocacy; D010361:Patients; D011057:Politics; D011570:Psychiatry / Q000941:ethics; D011618:Psychotic Disorders / Q000145:classification / Q000175:diagnosis* / Q000209:etiology; D011639:Public Opinion; D012108:Research Personnel; D012720:Severity of Illness Index; D012945:Social Values; D013577:Syndrome