Conceptual problems with early detection of prodromal psychosis

Abstract

Background and aims:

The prospect of early identification of psychotic development before the first overt psychosis confronts us with novel problems, not encountered in clinical work with psychotic patients. The target of prevention, usually “psychosis”, is a fuzzy concept with indeterminate boundaries and unclear content. Consequently, the prospective setting of early detection and intervention is rife with problems both of conceptual (What are the meanings inherent in the diagnostic concepts we use?) and of ethical (What are the consequences thereof?) nature. In this paper I will discuss the grammatical features of various conceptualizations of pre-stages of psychotic disorders, specifically their clinical, nosological and existential significance. This discussion has relevance for both diagnostic practices and ethical debate on the early intervention agenda.

Methods:

Conceptual analysis. Material source for this analysis was representative literature and publications from the time period 1990-2006. Five different conceptualizations of pre-stages of psychotic disorders were investigated as to their their clinical, nosological and existential significance.

Results:

“At-risk-mental state” emerged as the most prudent and contextually relevant formulation of psychosis risk in preventive setting as it implies clinical significance, is nosologically a weak concept and does not directly imply mental disordedness or psychoticism, thus retaining some degree of existential neutrality. The shortcomings of other available options were described.

Discussion:

This conceptual analysis provides us with a meaningful tool for distinguishing the differential clinical, nosological and ethical implications of available (forthcoming)conceptualizations of early stages of psychosis.