0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

1
Letters to the Editor   |    
The Risk-Benefit Ratio of the Proposed DSM-5 Attenuated Psychosis Syndrome
Scott W. Woods, M.D.; Thomas H. Mcglashan, M.D.
Am J Psychiatry 2011;168:1338-1338. doi:10.1176/appi.ajp.2011.11081276
View Author and Article Information

Dr. Woods has received grant support from NIMH and Pfizer and has consulted to Merck and Otsuka. Dr. McGlashan has received support from NIMH, the Norwegian Research Council, and Stavanger University Hospital in Rogaland County, Norway.

Accepted for publication in October 2011.

New Haven, Conn.

Copyright © American Psychiatric Association

Accepted October , 2011.

To the Editor: We commend Dr. Weiser's editorial on early intervention in patients at risk for schizophrenia in the August 2011 issue of the Journal (1) and in particular his conclusion that current evidence does not support the practice of routinely offering such patients clinical treatment with antipsychotic medication. However, we must take issue with the hypothetical clinical case patient who displays the attenuated positive symptoms used to identify risk. Because the attenuated positive symptoms cause the patient no distress and his sole reason for seeking treatment is unrelated to the specific symptoms, his risk is presumably low.

As Dr. Weiser notes, such a patient might meet research criteria for ultra high risk (2) or a psychosis risk syndrome (3) if the nondistressing attenuated positive symptoms were rated as sufficiently severe to pass threshold, but this hypothetical case would not meet the proposed DSM-5 criteria for attenuated psychosis syndrome. The criteria currently being tested in field trials do not permit such presumably low-risk patients to receive the diagnosis because criterion D requires that the attenuated positive symptoms themselves must be “sufficiently distressing and disabling to the patient and/or parent/guardian to lead them to seek help” (4, 5). The field trials should help determine whether these criteria can be applied with reliability in the clinical setting.

Weiser  M:  Early intervention for schizophrenia: the risk-benefit ratio of antipsychotic treatment in the prodromal phase.  Am J Psychiatry 2011; 168:761–763
 
Yung  A;  Phillips  L;  McGorry  PD:  Treating Schizophrenia in the Prodromal Phase .  London,  Taylor & Francis, 2004
 
McGlashan  TH;  Walsh  BC;  Woods  SW:  The Psychosis-Risk Syndrome: Handbook for Diagnosis and Follow-Up .  New York,  Oxford University Press, 2010
 
American Psychatric Association:  DSM-5 Development: Proposed Revisions: B 06 Attenuated Psychosis Syndrome . http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=412
 
Carpenter  WT;  van Os  J:  Should attenuated psychosis syndrome be a DSM-5 diagnosis? Am J Psychiatry 2011; 168:460–463
 
References Container
+

References

Weiser  M:  Early intervention for schizophrenia: the risk-benefit ratio of antipsychotic treatment in the prodromal phase.  Am J Psychiatry 2011; 168:761–763
 
Yung  A;  Phillips  L;  McGorry  PD:  Treating Schizophrenia in the Prodromal Phase .  London,  Taylor & Francis, 2004
 
McGlashan  TH;  Walsh  BC;  Woods  SW:  The Psychosis-Risk Syndrome: Handbook for Diagnosis and Follow-Up .  New York,  Oxford University Press, 2010
 
American Psychatric Association:  DSM-5 Development: Proposed Revisions: B 06 Attenuated Psychosis Syndrome . http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=412
 
Carpenter  WT;  van Os  J:  Should attenuated psychosis syndrome be a DSM-5 diagnosis? Am J Psychiatry 2011; 168:460–463
 
References Container
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Related Content
Books
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 24.  >
The American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th Edition > Chapter 6.  >
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 50.  >
Textbook of Traumatic Brain Injury, 2nd Edition > Chapter 6.  >
The American Psychiatric Publishing Textbook of Psychopharmacology, 4th Edition > Chapter 45.  >
Topic Collections
Psychiatric News
PubMed Articles