DSM 5 continues to propose inclusion of a ill conceived and ill named new disorder variously labeled 'psychosis risk' or 'attenuated psychotic symptoms'. It is long past time for this risky proposed diagnosis be dropped from consideration. Previous studies showing that psychosis risk does not predict psychosis have just received ringing confirmation and there is really nothing attenuated or psychotic about the people who are so misidentified.
In the September Issue of Schizophrenia Research, Roessler et al report the results of a large (n=591), 30 year, well conducted longitudinal study on 18-20 year olds drawn from the general population. They evaluated initially for psychotic risk type symptoms (eg blaming others, lack of trust, believing others don't give proper credit, loneliness, and never feeling close to anyone, etc) and then performed repeated follow-ups to see if these predicted the later development of schizophrenia.
The resounding answer- not at all.
Roessler stated "We could not identify any person fulfilling the criteria for full-blown psychosis." This is a remarkable nail in the coffin of 'psychosis risk' or 'attenuated psychotic symptoms' or however its authors choose to mislabel it.
And this is just the latest in a lengthening list of coffin nails: 1) no effective treatment according to a recent Cochrane report; 2) risk of expanding the inappropriate use of dangerous antipsychotics; 3) opposition from many researchers in the field and (I am told) even within the DSM 5 work group; and, finally withdrawal of support from the two leading champions of psychosis risk prediction- Patrick McGorry and Alison Yung.
Interestingly the mislabeled 'schizotypal' or 'attenuated psychotic symptoms were associated in a non-specific way with later increased risk for bipolar disorder, dysthymia, obsessive-compulsive disorder, panic disorder, simple phobia, and social phobia. So having some psychiatric symptoms early in life is one predictor of having more psychiatric problems later- but with very low specificity. This is mildly interesting, but does not come close to qualifying these non-specific symptoms as a psychiatric disorder. And we still don't have a clue on whether and how to intervene.
The inescapable conclusion: 'Psychosis Risk' should be dropped forthwith. It has survived this long only because it has friends in high DSM 5 places. This is a risky, scientifically unsupported idea that simply can't stand on its own feet and needs to be dropped.
