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Is the Risk Syndrome for Psychosis Risky Business?

Posted on 21 Jul 2009
William T. Carpenter Jr. Barbara Cornblatt Howard H. Goldman Thomas McGlashan Patrick McGorry Scott Woods Alison Yung NA 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.


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.