Hostname: page-component-cd9895bd7-jn8rn Total loading time: 0 Render date: 2024-12-26T16:16:57.126Z Has data issue: false hasContentIssue false
  • English
  • Français

The DSM-5 proposal for attenuated psychosis syndrome: a history

Published online by Cambridge University Press:  01 April 2020

Peter Zachar Open the ORCID record for Peter Zachar [Opens in a new window] ,
Michael B. First  and
Kenneth S. Kendler
Peter Zachar
Affiliation:
Department of Psychology, Auburn University Montgomery, Montgomery, AL, USA
Michael B. First
Affiliation:
Department of Psychiatry, Columbia University, New York, NY, USA
Kenneth S. Kendler*
Affiliation:
Virginia Institute for Psychiatry and Behavioral Genetics and Departments of Psychiatry, and Human Genetics, Medical College of Virginia of Virginia Commonwealth University, Richmond, VA, USA
*
Author for correspondence: Kenneth S. Kendler, E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

This article narrates a consensus history of the proposal to include diagnostic criteria for a psychosis risk syndrome in the DSM-5, in part, to document what happened, but also to potentially help focus future efforts at clinically useful early detection. The purpose of diagnosing a risk state would be to slow and ideally prevent the development of the full disorder. Concerns about diagnosing a psychosis risk state included a high false positive rate, potentially harmful use of anti-psychotic medication with people who would not transition to psychosis, and stigmatization. Others argued that educating professionals about what ‘risk’ entails could reduce inappropriate treatments. During the revision, the proposal shifted from diagnosing risk to emphasizing current clinical need associated with attenuated psychotic symptoms. Within the community of researchers who studied psychosis risk, people disagreed about whether risk and/or attenuated symptoms should be an official DSM-5 diagnosis. Once it became clear that the DSM-5 field trials did not include enough cases to establish the reliability of the proposed criteria, everyone agreed that the criteria should be put in a section on conditions for further study rather the main section of the DSM-5. We close with recommendations about some practical benchmarks that should be met for including criteria for early detection in the classification system.

Keywords

At-risk mental statebasic symptomsprodromepsychosisschizophreniaultra-high risk
Type
Review Article
Information
Psychological Medicine , Volume 50 , Issue 6 , April 2020 , pp. 920 - 926
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ajnakina, O., David, A. S., & Murray, R. M. (2019). ‘At risk mental state’ clinics for psychosis – an idea whose time has come – and gone!. Psychological Medicine, 49(4), 529–534.10.1017/S0033291718003859CrossRefGoogle Scholar
Cannon, T. D., Cornblatt, B., & McGorry, P. (2007). Editor's introduction: The empirical status of the ultra high-risk (prodromal) research paradigm. Schizophrenia Bulletin, 33(3), 661–664.10.1093/schbul/sbm031CrossRefGoogle Scholar
Carpenter, W. T. (2009). Anticipating DSM-V: Should psychosis risk become a diagnostic class? Schizophrenia Bulletin, 35(5), 841–843.10.1093/schbul/sbp071CrossRefGoogle ScholarPubMed
Carpenter, W. T., & Schiffman, J. (2015). Diagnostic concepts in the context of clinical high risk/attenuated psychosis syndrome. Schizophrenia Bulletin, 41(5), 1001–1002.CrossRefGoogle ScholarPubMed
Carpenter, W. T., & van Os, J. (2011). Should attenuated psychosis syndrome be a DSM-5 diagnosis? American Journal of Psychiatry, 168(5), 460–463.10.1176/appi.ajp.2011.10121816CrossRefGoogle ScholarPubMed
Corcoran, C. M., First, M. B., & Cornblatt, B. (2010). The psychosis risk syndrome and its proposed inclusion in the DSM-V: A risk-benefit analysis. Schizophrenia Research, 120(1), 16–22.10.1016/j.schres.2010.03.018CrossRefGoogle ScholarPubMed
Cornblatt, B. A., Heinssen, R. K., Cannon, T. D., & Lencz, T. (2003). Editors' introduction: New frontiers in prodromal research. Schizophrenia Bulletin, 29(4), 621–624.10.1093/oxfordjournals.schbul.a007034CrossRefGoogle Scholar
DSM-5 Psychosis Work Group. (2010). Psychosis risk syndrome. Retrieved from https://web.archive.org/web/20100215023016/; http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=412.Google Scholar
Falloon, I. R. H. (1992). Early intervention for first episodes of schizophrenia: A preliminary exploration. Psychiatry, 55(1), 4–15.10.1080/00332747.1992.11024572CrossRefGoogle ScholarPubMed
Falloon, I. R. H., Kydd, R. R., Coverdale, J. H., & Laidlaw, T. M. (1996). Early detection and intervention for initial episodes of schizophrenia. Schizophrenia Bulletin, 22(2), 271–282.CrossRefGoogle ScholarPubMed
Frances, A. (2009). A warning sign on the road to DSM-V: Beware of its unintended consequences. Psychiatric Times. Retrieved from http://www.psychiatrictimes.com/display/article/10168/1425378.Google Scholar
Frances, A. (2011). Seven questions for Professor Patrick McGorry. Psychiatric Times. Retrieved from https://www.psychiatrictimes.com/couch-crisis/seven-questions-professor-patrick-mcgorry.Google Scholar
Fusar-Poli, P., Borgwardt, S., Bechdolf, A., Addington, J., Riecher-Rössler, A., Schultze-Lutter, F., … Yung, A. (2013). The psychosis high-risk state: A comprehensive state-of-the-art review. JAMA Psychiatry, 70(1), 107–120.10.1001/jamapsychiatry.2013.269CrossRefGoogle ScholarPubMed
Fusar-Poli, P., Carpenter, W. T., Woods, S. W., & McGlashan, T. H. (2014). Attenuated psychosis syndrome: Ready for DSM-51? Annual Review of Clinical Psychology, 10, 155–192.10.1146/annurev-clinpsy-032813-153645CrossRefGoogle Scholar
Fusar-Poli, P., & Yung, A. R. (2012). Should attenuated psychosis syndrome by included in DSM-5. The Lancet, 379, 591–592.10.1016/S0140-6736(11)61507-9CrossRefGoogle ScholarPubMed
Huber, G., & Gross, G. (1989). The concept of basic symptoms in schizophrenic and schizoaffective psychoses. Recenti Progressi in Medicina, 80(12), 646–652.Google ScholarPubMed
Huber, G., Gross, G., Schüttler, R., & Linz, M. (1980). Longitudinal studies of schizophrenic patients. Schizophrenia Bulletin, 6(4), 592–605.10.1093/schbul/6.4.592CrossRefGoogle ScholarPubMed
Kaymaz, N., & van Os, J. (2010). DSM-5 and the ‘Psychosis Risk Syndrome’: Babylonic confusion. Psychosis: Psychological, Social and Integrative Approaches, 2(2), 100–103.10.1080/17522431003753233CrossRefGoogle Scholar
Larkin, W., & Marshall, M. (2010). DSM-5 and the ‘psychosis risk syndrome’: No different than any other diagnostic test. Psychosis: Psychological, Social and Integrative Approaches, 2(3), 191–195.10.1080/17522439.2010.509807CrossRefGoogle Scholar
Maxmen, A. (2010). Psychosis risk syndrome excluded from DSM-5. Nature\News.Google Scholar
McGlashan, T. H., & Johannessen, J. O. (1996). Early detection and intervention with schizophrenia: Rationale. Schizophrenia Bulletin, 22(2), 201–222.10.1093/schbul/22.2.201CrossRefGoogle ScholarPubMed
McGorry, P. D. (2010). Risk syndromes, clinical staging and DSM V: New diagnostic infrastructure for early intervention in psychiatry. Schizophrenia Research, 120(1), 49–53.10.1016/j.schres.2010.03.016CrossRefGoogle Scholar
McGorry, P. D., Edwards, J., Mihalopoulos, C., Harrigan, S. M., & Jackson, H. J. (1996). EPPIC: An evolving system of early detection and optimal management. Schizophrenia Bulletin, 22(2), 305–326.10.1093/schbul/22.2.305CrossRefGoogle ScholarPubMed
McGorry, P. D., Hickie, I. B., Yung, A. R., Pantelis, C., & Jackson, H. J. (2006). Clinical staging of psychiatric disorders: A heuristic framework for choosing earlier, safer and more effective interventions. Australian & New Zealand Journal of Psychiatry, 40(8), 616–622.10.1080/j.1440-1614.2006.01860.xCrossRefGoogle ScholarPubMed
Miller, T. J., McGlashan, T. H., Rosen, J. L., Cadenhead, K., Ventura, J., McFarlane, W., … Woods, S. W. (2003). Prodromal assessment with the structured interview for prodromal syndromes and the scale of prodromal symptoms: Predictive validity, interrater reliability, and training to reliability. Schizophrenia Bulletin, 29(4), 703–715.10.1093/oxfordjournals.schbul.a007040CrossRefGoogle ScholarPubMed
Moritz, S., Gawęda, Ł, Heinz, A., & Gallinat, J. (2019). Four reasons why early detection centers for psychosis should be renamed and their treatment targets reconsidered: We should not catastrophize a future we can neither reliably predict nor change. Psychological Medicine, 49(13), 2134–2140.10.1017/S0033291719001740CrossRefGoogle Scholar
Morrison, A. P., Byrne, R., & Bentall, R. P. (2010). DSM-5 and the ‘Psychosis Risk Syndrome’: Whose best interests would it serve? Psychosis, 2(2), 96–99.10.1080/17522431003759982CrossRefGoogle Scholar
Riecher-Rössler, A., Gschwandtner, U., Aston, J., Borgwardt, S., Drewe, M., Fuhr, P., … Stieglitz, R. D. (2007). The basel early-detection-of-psychosis (FEPSY)-study – design and preliminary results. Acta Psychiatrica Scandinavica, 115(2), 114–125.10.1111/j.1600-0447.2006.00854.xCrossRefGoogle ScholarPubMed
Ross, C. A. (2010). DSM-5 and the ‘Psychosis Risk Syndrome’: Eight reasons to reject it. Psychosis: Psychological. Social and Integrative Approaches, 2(2), 107–110.Google Scholar
Ruhrmann, S., Schultze-Lutter, F., & Klosterkötter, J. (2010). Probably at-risk, but certainly ill – Advocating the introduction of a psychosis spectrum disorder in DSM-V. Schizophrenia Research, 120(1), 23–37.10.1016/j.schres.2010.03.015CrossRefGoogle ScholarPubMed
Salazar de Pablo, G., Catalan, A., & Fusar-Poli, P. (forthcoming). DSM-5 attenuated psychosis syndrome: A systematic review and meta-analysis of the evidence. JAMA Psychiatry.Google Scholar
Schultze-Lutter, F., Debbané, M., Theodoridou, A., Wood, S. J., Raballo, A., Michel, C., … Uhlhaas, P. J. (2016). Revisiting the basic symptom concept: Toward translating risk symptoms for psychosis into neurobiological targets. Frontiers in Psychiatry, 7, 9–9.10.3389/fpsyt.2016.00009CrossRefGoogle ScholarPubMed
Schultze-Lutter, F., Picker, H., Ruhrmann, S., & Klosterkotter, J. (2008). The cologne early recognition and intervention center for mental crises (FETZ). evaluation of service use. Medizinische Klinik, 103(2), 81–89.10.1007/s00063-008-1012-4CrossRefGoogle ScholarPubMed
Schultze-Lutter, F., Ruhrmann, S., Picker, H., & Klosterkötter, J. (2006). WC1C Development and evaluation of the schizophrenia proneness instrument, adult version (SPI-A). Schizophrenia Research, 86, S4–S5.10.1016/S0920-9964(06)70014-7CrossRefGoogle Scholar
Tandon, R., & Carpenter, W. T. Jr. (2012). DSM-5 status of psychotic disorders: 1 year prepublication. Schizophrenia Bulletin, 38(3), 369–370.10.1093/schbul/sbs048CrossRefGoogle ScholarPubMed
Tandon, N., Shah, J., Keshavan, M. S., & Tandon, R. (2012). Attenuated psychosis and the schizophrenia prodrome: Current status of risk identification and psychosis prevention. Neuropsychiatry (London), 2(4), 345–353.10.2217/npy.12.36CrossRefGoogle ScholarPubMed
Tsuang, M. T., Van Os, J., Tandon, R., Barch, D. M., Bustillo, J., Gaebel, W., … Carpenter, W. (2013). Attenuated psychosis syndrome in DSM-5. Schizophrenia Research, 150(1), 31–35.10.1016/j.schres.2013.05.004CrossRefGoogle ScholarPubMed
van Os, J., & Guloksuz, S. (2017). A critique of the “ultra-high risk” and “transition” paradigm. World Psychiatry, 16(2), 200–206.10.1002/wps.20423CrossRefGoogle ScholarPubMed
van Os, J., & Murray, R. M. (2013). Can we identify and treat “schizophrenia light” to prevent true psychotic illness? Bmj, 346, f304.10.1136/bmj.f304CrossRefGoogle ScholarPubMed
Woods, S. W., Carlson, J. P., & McGlashan, T. H. (2010a). DSM-5 and the ‘psychosis risk syndrome’: The DSM-5 proposal is better than DSM-IV. Psychosis: Psychological, Social and Integrative Approaches, 2(3), 187–198.10.1080/17522439.2010.511719CrossRefGoogle Scholar
Woods, S. W., Walsh, B. C., Powers, A. R. III, & McGlashan, T. H. (2019). Reliability, validity, epidemiology, and cultural variation of the Structured Interview for Psychosis Risk Syndrome (SIPS) and the Scale of Psychosis Risk Symptoms (SOPS). In Huijun, L., Shapiro, D. I. & Seidman, L. J. (Eds.), Handbook of attenuated psychosis syndrome across cultures (pp. 85–113). Cham, Switzerland: Springer Nature.10.1007/978-3-030-17336-4_5CrossRefGoogle Scholar
Woods, S. W., Walsh, B. C., Saksa, J. R., & McGlashan, T. H. (2010b). The case for including attenuated psychotic symptoms syndrome in DSM-5 as a psychosis risk syndrome. Schizophrenia Research, 123(2–3), 199–207.10.1016/j.schres.2010.08.012CrossRefGoogle Scholar
Yang, L. H., Wonpat-Borja, A. J., Opler, M. G., & Corcoran, C. M. (2010). Potential stigma associated with inclusion of the psychosis risk syndrome in the DSM-V: An empirical question. Schizophrenia Research, 120(1), 42–48.10.1016/j.schres.2010.03.012CrossRefGoogle ScholarPubMed
Yung, A. R., & McGorry, P. D. (1996a). The prodromal phase of first-episode psychosis: Past and current conceptualizations. Schizophrenia Bulletin, 22(2), 353–370.10.1093/schbul/22.2.353CrossRefGoogle Scholar
Yung, A. R., McGorry, P. D., McFarlane, C. A., Jackson, H. J., Patton, G. C., & Rakkar, A. (1996b). Monitoring and care of young people at incipient risk of psychosis. Schizophrenia Bulletin, 22(2), 283–303.10.1093/schbul/22.2.283CrossRefGoogle Scholar
Yung, A. R., Nelson, B., Thompson, A. D., & Wood, S. J. (2010a). The psychosis threshold in ultra high risk (prodromal) research: Is it valid? Schizophrenia Research, 120(1), 1–6.10.1016/j.schres.2010.03.014CrossRefGoogle Scholar
Yung, A. R., Nelson, B., Thompson, A. D., & Wood, S. J. (2010b). Should a “risk syndrome for psychosis” be included in the DSMV? Schizophrenia Research, 120(1), 7–15.10.1016/j.schres.2010.03.017CrossRefGoogle Scholar
Yung, A. R., Wood, S. J., Malla, A., Nelson, B., McGorry, P., & Shah, J. (2019) The reality of at risk mental state services: A response to recent criticisms. Psychological Medicine, 1–7. doi: 10.1017/S003329171900299X [Epub ahead of print].Google Scholar
Yung, A. R., Yuen, H. P., Berger, G., Francey, S., Hung, T.-C., Nelson, B., … McGorry, P. (2007). Declining transition rate in ultra high risk (prodromal) services: Dilution or reduction of risk? Schizophrenia Bulletin, 33(3), 673–681.10.1093/schbul/sbm015CrossRefGoogle ScholarPubMed
Yung, A. R., Yuen, H. P., McGorry, P. D., Phillips, L. J., Kelly, D., Dell'Olio, M., … Buckby, J. (2005). Mapping the onset of psychosis: The comprehensive assessment of at-risk mental states. Australian and New Zealand Journal of Psychiatry, 39(11–12), 964–971.10.1080/j.1440-1614.2005.01714.xCrossRefGoogle ScholarPubMed
Zachar, P., First, M. B., & Kendler, K. S. (2017). The bereavement exclusion debate in the DSM-5: A history. Clinical Psychological Science, 5(5), 890–906.10.1177/2167702617711284CrossRefGoogle Scholar
Zachar, P., & Kendler, K. S. (2014). A diagnostic and statistical manual of mental disorders history of premenstrual dysphoric disorder. Journal of Nervous & Mental Disease, 202(4), 346–352.10.1097/NMD.0000000000000128CrossRefGoogle ScholarPubMed
Zachar, P., Krueger, R. F., & Kendler, K. S. (2016). Personality disorder in the DSM-5: An oral history. Psychological Medicine, 46(1), 1–10.CrossRefGoogle Scholar
Zachar, P., Regier, D. A., & Kendler, K. S. (2019). The aspirations for a paradigm shift in DSM-5: An oral history. Journal of Nervous & Mental Disease, 202(4), 346–352.10.1097/NMD.0000000000000128CrossRefGoogle Scholar