Live Discussion: Is the Risk Syndrome for Psychosis Risky Business?
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 2009View 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
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.