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Online Discussions

Updated 26 June 2009
Printable version

Live Discussion: Is the Risk Syndrome for Psychosis Risky Business?

William T. Carpenter Jr.

Barbara Cornblatt

Howard H. Goldman

Thomas McGlashan

Patrick McGorry

Scott Woods

Alison Yung

Click here to view slidecasts.

SRF Live Discussion Series: Anticipating the DSM-V
Over the next few months, Schizophrenia Research Forum will present a series of live discussions focusing on areas of contention within the evolution of the Diagnostic and Statistical Manual (DSM) psychotic disorders area. You will have an opportunity to view several brief slidecasts that represent differing views within the mental health treatment, research, and policy communities before each discussion. Our goal is to spark commentary, so be sure to view the slidecasts and post your comments…don’t be left out of the debate! While you don’t need to be a member to view the slidecasts, you do have to register in order to leave comments below. (We invite you to join SRF—it’s free and we do not share your membership information with other organizations.)

This past spring, many researchers got together at the International Prodromal Research Network Psychosis Satellite Meeting in San Diego to review and decipher the latest psychosis prodrome data. One topic in particular—whether to include a diagnostic "at-risk" category in DSM-V—was discussed up and down the hallways, both at the satellite meeting and at a Workshop at the ICOSR. Clearly this proposal is controversial, and Schizophrenia Research Forum opened this debate up to you via a series of short slidecasts, the opportunity to provide comments, and a special live discussion on 22 July at 8 p.m. EST.

Read the backgrounder below, prepared by our discussion organizer, William T. Carpenter Jr., director of the Maryland Psychiatric Research Center and leader of the DSM-V psychosis work group. After that, click the link below to view the slidecasts prepared by the invited presenters, and return to this page to submit your comments.

See Draft of DSM-V Criteria.

See also Anticipating DSM-V and Validity of the Prodromal Risk Syndrome.

Click here to view slidecasts.

View Transcript of Live Discussion — Posted 4 October 2009

View Comments By:
Daniel Mathalon — Posted 10 July 2009
Dirk van Kampen — Posted 16 July 2009
Scott Woods — Posted 17 July 2009
Lois Oppenheim — Posted 17 July 2009
Dolores Malaspina — Posted 20 July 2009
Philip Seeman — Posted 20 July 2009
Norman Sartorius — Posted 21 July 2009
Todd Lencz — Posted 21 July 2009
Gary Remington — Posted 21 July 2009
Amresh Shrivastava — Posted 21 July 2009
Helen Stain — Posted 22 July 2009
Amresh Shrivastava — Posted 22 July 2009
Andrew Thompson — Posted 22 July 2009
Ashok Malla — Posted 22 July 2009
Roger Peele — Posted 22 July 2009
Anthony Morrison — Posted 22 July 2009
Paul French — Posted 22 July 2009
Patrick McGorry — Posted 22 July 2009
Cheryl Corcoran — Posted 22 July 2009
Michael Hwang — Posted 24 July 2009
Thomas McGlashan — Posted 27 July 2009
Anthony Grace — Posted 2 August 2009
Joachim Klosterkötter — Posted 24 August 2009
Danny Koren — Posted 10 September 2009
Eileen McGinn — Posted 4 December 2009

Background Text
By William Carpenter, Maryland Psychiatric Research Center
Leader, DSM-V Psychotic Disorders Workgroup

Early detection and intervention is a compelling goal throughout medicine. Has the time come to formally endorse this for psychotic illnesses? Research on this issue has been conducted on a large, international scale during the past decade. It is clear that experts can define risk and that a non-trivial proportion of at-risk individuals convert to a psychotic illness. But, is the evidence sufficient to establish psychosis risk as a diagnostic class within the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V)? Is enough known about intervention to assure an effective application?

A DSM-V endorsement raises a number of serious concerns. Will false positive diagnoses stigmatize non-ill individuals? Will medications be widely used with more harm than good resulting? Will non-experts, including primary care doctors, be able to make reliable and valid diagnoses? Will the APA be vulnerable to allegations that another category has been created to serve pharmaceutical marketing?

Criteria for diagnoses may include help seeking, distress, and/or disability. A category can be established as a risk syndrome similar to hyperlipidemia of elevated blood pressure, marking the need for clinical care to prevent progression. Text and educational programs can give emphasis to evidence-based therapeutic interventions and reduce risk of harm from unwarranted treatments. Can such procedures reduce stigma and harm?

It seems likely that in the near future we will establish interventions with efficacy for secondary prevention. Should DSM-V be prepared to facilitate broad-based application and the translation of research to clinical practice?

There is a compelling need for clinical attention for individuals meeting psychosis risk syndrome criteria, but much to be debated as to the most effective way to address this need. The Report of the DSM-V Psychotic Disorders Work Group will eventually make a recommendation. Feedback from the field is critically important at this time, and the 22 July SRF Live Discussion provides this opportunity.

Click here to view slidecasts.

Comments on Online Discussion
Comment by:  Daniel Mathalon
Submitted 8 July 2009 Posted 10 July 2009

When diagnoses enter the DSM, they become reified in the...  Read more

View all comments by Daniel Mathalon

Comment by:  Dirk van Kampen
Submitted 16 July 2009 Posted 16 July 2009

In my opinion, there are several arguments to not include...  Read more

View all comments by Dirk van Kampen

Comment by:  Scott Woods (Disclosure)
Submitted 17 July 2009 Posted 17 July 2009

The risks of including a risk syndrome for psychosis have...  Read more

View all comments by Scott Woods

Comment by:  Lois Oppenheim
Submitted 17 July 2009 Posted 17 July 2009

Carpenter notes that "It is clear that experts can define...  Read more

View all comments by Lois Oppenheim

Comment by:  Dolores Malaspina
Submitted 20 July 2009 Posted 20 July 2009

Given the morbidity and difficulty of treating psychotic...  Read more

View all comments by Dolores Malaspina

Comment by:  Philip Seeman (Disclosure)
Submitted 20 July 2009 Posted 20 July 2009

The psychosis-risk syndrome is worth being recognized by...  Read more

View all comments by Philip Seeman

Comment by:  Norman Sartorius
Submitted 20 July 2009 Posted 21 July 2009

The idea of helping people when they are at high risk for...  Read more

View all comments by Norman Sartorius

Comment by:  Todd Lencz
Submitted 21 July 2009 Posted 21 July 2009

While the arguments for and against inclusion of a risk...  Read more

View all comments by Todd Lencz

Comment by:  Gary Remington
Submitted 21 July 2009 Posted 21 July 2009

I side with Drs. Cornblatt and Yung on this controversy....  Read more

View all comments by Gary Remington

Comment by:  Amresh Shrivastava
Submitted 20 July 2009 Posted 21 July 2009

The “at-risk” state is an interesting clinical condition,...  Read more

View all comments by Amresh Shrivastava

Comment by:  Helen Stain
Submitted 22 July 2009 Posted 22 July 2009

I agree with the concerns raised by Barbara Cornblatt. The...  Read more

View all comments by Helen Stain

Comment by:  Amresh Shrivastava
Submitted 22 July 2009 Posted 22 July 2009

At this site there are very interesting observations which...  Read more

View all comments by Amresh Shrivastava

Comment by:  Andrew Thompson
Submitted 22 July 2009 Posted 22 July 2009

I agree with Dr. Cornblatt and Professor Yung that it is...  Read more

View all comments by Andrew Thompson

Comment by:  Ashok Malla
Submitted 22 July 2009 Posted 22 July 2009

The intention to include the "at risk syndrome for...  Read more

View all comments by Ashok Malla

Comment by:  Roger Peele
Submitted 22 July 2009 Posted 22 July 2009

In addition to echoing Carpenter’s points, I would like to...  Read more

View all comments by Roger Peele

Comment by:  Anthony Morrison
Submitted 22 July 2009 Posted 22 July 2009

I am rather skeptical about the benefits of inclusion of...  Read more

View all comments by Anthony Morrison

Comment by:  Paul French
Submitted 22 July 2009 Posted 22 July 2009

Firstly, it is exciting to see that this debate is even...  Read more

View all comments by Paul French

Comment by:  Patrick McGorry, SRF Advisor
Submitted 22 July 2009 Posted 22 July 2009

The concept of a psychosis risk syndrome based on 15 years...  Read more

View all comments by Patrick McGorry

Comment by:  Cheryl Corcoran
Submitted 22 July 2009 Posted 22 July 2009

Let's do a cost-benefit analysis.

In prodromal...  Read more

View all comments by Cheryl Corcoran

Comment by:  Michael Hwang
Submitted 24 July 2009 Posted 24 July 2009

Schizophrenic disorder has been known as a psychotic...  Read more

View all comments by Michael Hwang

Comment by:  Thomas McGlashan
Submitted 23 July 2009 Posted 27 July 2009

In 1900 Freud declared dreams to be the royal road to the...  Read more

View all comments by Thomas McGlashan

Comment by:  Anthony Grace, SRF Advisor (Disclosure)
Submitted 30 July 2009 Posted 2 August 2009

There is always a concern about treating individuals at...  Read more

View all comments by Anthony Grace

Comment by:  Joachim Klosterkötter
Submitted 24 August 2009 Posted 24 August 2009

During regular periodic revisions of the diagnostic...  Read more

View all comments by Joachim Klosterkötter

Comment by:  Danny Koren
Submitted 9 September 2009 Posted 10 September 2009

At-risk states can be viewed in one of two ways. Namely,...  Read more

View all comments by Danny Koren

Comment by:  Eileen McGinn
Submitted 4 December 2009 Posted 4 December 2009

Weighing the benefits and harms of adding a "prodrome" for...  Read more

View all comments by Eileen McGinn
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