Response to Woods and McGlashan Letter

To the Editor: I thank Drs. Woods and McGlashan for reading and commenting on the editorial. Their letter examines the hypothetical case of a young man with attenuated psychotic symptoms who has “an emotional crisis when his girlfriend leaves him.” Their understanding is that the symptoms “cause the patient no distress” and hence would not meet the proposed DSM-5 criteria for attenuated psychosis syndrome.

In the editorial, our hypothetical patient “might be upset, have difficulty sleeping at night, have difficulties concentrating, have decreased functioning at school or at work, and have more attenuated psychotic symptoms. If this person goes to a psychiatrist presenting with this clinical picture, he might very well meet criteria for the prodromal phase.”

This is clearly a description of a distressed person who seeks the help of a psychiatrist. Since criterion D of the proposed DSM-5 criteria for attenuated psychotic syndrome 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,” our patient would meet the criteria.

I join Drs. Woods and McGlashan in their hope that the DSM-5 field trials will help determine whether these criteria can be applied with reliability in the clinical setting.