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

While the arguments for and against inclusion of a risk syndrome have been well aired in this forum, less attention has been paid to the potential content of the proposed criteria.

Current research criteria for the risk syndrome were developed and operationalized more than a decade ago. The primary basis for diagnosis was presence of a single attenuated (subpsychotic) positive symptom. However, these original criteria have exhibited a pattern of decreasing predictive value as study populations have expanded over time (Yung et al., 2008; Cannon et al., 2008).

At the same time, numerous studies have demonstrated that predictive validity of these criteria can be enhanced by 1) increasing the threshold of attenuated positive symptoms required at baseline; and 2) addition of attenuated negative symptoms, basic symptoms, and/or functional deficits to the prediction model (Cornblatt et al., 2003; Lencz et al., [...continued] 2003; Yung et al., 2003, 2004, 2006; Cannon et al., 2008; Velthorst et al., 2009). Additional efforts at refining and operationalizing these criteria are ongoing.

If a risk syndrome is to be introduced in DSM-V (or any future edition), the existing body of empirical evidence should serve as a useful guide to criteria development prior to initiation of any large-scale field trials.


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