Psychosis Risk: Three Strikes and You're Out

August 24, 2011

Psychosis Risk (AKA attenuated psychotic symptoms disorder) has always had 3 strikes against it.

Psychosis Risk (AKA attenuated psychotic symptoms disorder) has always had 3 strikes against it: 

1. A ridiculously high false positive rate of 70% to 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 2 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.

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.