DSM‐5 and the ‘Psychosis Risk Syndrome’: Whose best interests would it serve?

Morrison, Anthony P.; Byrne, Rory; Bentall, Richard P.

doi:10.1080/17522431003759982

Cited by 8 publications

(3 citation statements)

References 15 publications

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“…This has sparked much controversy and debate (Corcoran et al 2010; Yung et al 2010), and it seems such proposals have now been set aside. One objection was that inclusion would lead to many young people being unnecessarily treated with antipsychotic drugs (Bentall & Morrison, 2002; Morrison et al 2010; Fusar-Poli & Yung, 2012), drugs that may be associated with a range of adverse effects, including weight gain (McGlashan et al 2006), diabetes (Mitchell et al 2012), reduced cognitive functioning (Faber et al 2012; Bowie et al 2012) and reductions in brain tissue (Moncrieff & Leo, 2010; Tost et al 2010; Ho et al 2011; Radua et al 2012). Although off-label prescription of antipsychotics is now not uncommon (Broome et al 2005; Nieman et al 2009; Fusar-Poli et al 2012 b ), and although they lead to moderate improvements in symptoms for people with established psychosis (Leucht et al 2009), whether they are beneficial, acceptable or harmful to young people at risk of developing psychosis remains unclear (McGorry et al 2002; McGlashan et al 2006; Bechdolf et al 2011; Marshall & Rathbone, 2011).…”

Section: Introductionmentioning

confidence: 99%

Cognitive behavioural therapy for psychosis prevention: a systematic review and meta-analysis

2013

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Section: Introductionmentioning

confidence: 99%

Cognitive behavioural therapy for psychosis prevention: a systematic review and meta-analysis

2013

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“…Morrison, Byrne, and Bentall (2010) addressed the potential for false positives, which could lead to the harmful use of antipsychotics with those not at risk for psychosis. For instance, a recent estimate of the 3-year rate of the psychosis onset for those considered at risk across studies is 23%, making the false positive rate 77% (Salazar de Pablo, Catalan, & Fusar-Poli, forthcoming).…”

Section: During the Dsm-5 Revision – From Psychosis Risk To Attenuatementioning

confidence: 99%

The DSM-5 proposal for attenuated psychosis syndrome: a history

2020

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This article narrates a consensus history of the proposal to include diagnostic criteria for a psychosis risk syndrome in the DSM-5, in part, to document what happened, but also to potentially help focus future efforts at clinically useful early detection. The purpose of diagnosing a risk state would be to slow and ideally prevent the development of the full disorder. Concerns about diagnosing a psychosis risk state included a high false positive rate, potentially harmful use of anti-psychotic medication with people who would not transition to psychosis, and stigmatization. Others argued that educating professionals about what ‘risk’ entails could reduce inappropriate treatments. During the revision, the proposal shifted from diagnosing risk to emphasizing current clinical need associated with attenuated psychotic symptoms. Within the community of researchers who studied psychosis risk, people disagreed about whether risk and/or attenuated symptoms should be an official DSM-5 diagnosis. Once it became clear that the DSM-5 field trials did not include enough cases to establish the reliability of the proposed criteria, everyone agreed that the criteria should be put in a section on conditions for further study rather the main section of the DSM-5. We close with recommendations about some practical benchmarks that should be met for including criteria for early detection in the classification system.

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“…These criteria have now been widely adopted internationally, and there have been recent debates about the utility and potential stigma 2 of including an attenuated psychosis syndrome in DSM-5. 3,4 Several randomised controlled trials (RCTs) have evaluated the impact of psychosocial and pharmacological interventions 5-12 on transition to psychosis and severity of psychotic symptoms within this population, and a recent meta-analysis concluded that cognitive therapy may offer a particularly encouraging approach to prevention of psychosis. 13 However, there is debate about the ethics and unintended consequences of identifying people as being at risk of psychosis and providing any treatment to such a population.…”

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confidence: 99%