DSM5 in Distress

The DSM's impact on mental health practice and research

Psychosis Risk: Three Strikes and You Are Out

Too risky by far.

Psychosis Risk (AKA attenuated psychotic symptoms disorder) has always had three strikes against it:

1) A ridiculously high false positive rate of 70-90%

2) No treatment of proven efficacy

3) Terrible risks of antipsychotic side effects and stigma.

Now there are three additional new strikes:

1) Recent publications in the American Journal of Psychiatry further document the pitfalls of the proposed diagnosis and explicitly advise against its inclusion in DSM 5.

2) Withdrawal of support for DSM 5 inclusion from two of its previous strongest backers- pioneers in this field of research, Patrick McGorry and Alison Yung. They join many other researchers in the early intervention field who care a great deal about helping to reduce the burdens of schizophrenia, but recognize that the DSM 5 psychosis risk proposal is a premature and fatally flawed means to this end.

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3) Continuing shocking evidence of the extensive off label use of antipsychotic medications that has made them the highest revenue producing class of drugs in the US.

It is long past time for DSM 5 to accept that psychosis risk, however renamed or repackaged, simply won't fly. There is much work to be done on DSM 5 and very little time to do it in. All needless distractions should be off-loaded. At this point, psychosis risk is a needless distraction. It should have an honored place in the appendix and be the subject of extensive research, but is not near ready for serious consideration as an official category.

Allen Frances, M.D., was chair of the DSM-IV Task Force and is currently professor emeritus at Duke.

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