Attenuated Psychosis Syndrome

Abstract

Byline: M. Reddy Diagnostic and Statistical Manual of Mental Disorders, 5 [sup]th edition (DSM - 5) included attenuated psychosis syndrome (APS) in Section III under conditions for further study. DSM - 5 task force determined that there was insufficient evidence to warrant inclusion of APS as official mental disorder diagnosis in Section II. The proposed criteria (APS) are not intended for clinical use; only the criteria sets and disorders in Section II of DSM - 5 are officially recognized and can be used for clinical purposed. [sup][1] In a study by Tsuang et al . [sup][2] explains the position as despite advances in the treatment of schizophrenia over the past half-century, the illness is frequently associated with a poor outcome. This is principally related to the late identification and intervention in the course of the illness … can be difficult to reverse. emphasis has therefore shifted to defining psychosis-risk syndromes and evaluating treatments that can prevent transition to psychosis in these ultra-high risk groups. To consider the appropriateness of adding psychosis risk syndrome to our diagnostic nomenclature, the psychotic disorders work group extensively reviewed all available data, consulted a range of experts and carefully the variety of expert and public comments on the topic. It was clear that reliable methods were available to define a syndrome characterized by sub-threshold psychotic symptoms (in severity or duration) and which was associated with a very significant increase in the risk of development of a full-fledged psychotic disorder …within the next year. Shrivastava et al . [sup][3] reviewed the current status of research…. arguments for, against and alternatives for inclusion (APS) as a diagnosis and made an attempt to provide a critical synthesis of opinions on this… APS denotes a kind of temporary culmination of a quarter century of research on early psychosis, the prime goal being to reduce/eliminate duration of untreated psychosis (DUP). DUP is a well-documented and accepted prognostic indicator in Schizophrenia - longer the DUP, worse the outcome - keeping all other factors controlled. For long researchers, especially McGory and his group have been working on identifying and diagnosing psychosis at its earliest presentation, prodromal state and even prior to prodrome At risk state, with the hope of bettering the outcome in Schizophrenia. Identification of persons with clinically high risk/ultra high risk/at risk mental state (ARMS) stays as the essential component of primary prevention (akin to diabetes mellitus!!!) in schizophrenia. There has been reasonable progress in this area with identification of patients termed ARMS, the risk predominantly meaning progression into schizophrenia. Specific diagnostic symptoms have been enumerated and for better objectivity several scales have been used - comprehensive assessment of at-risk mental states; structured interview for prodromal syndromes/scale of prodromal symptoms, prodromal questionnaire (PQ) 16 [sup][4],[5] which can be administered with reasonable inter rater reliability to identify patients with ARMS. Of course, there always was a note of caution about high risk of false positives, the stigma and inappropriate interventions! Attempts to identify specific markers for APS in neuroimaging studies have not been successful and there is an overall lack of consistency as to which of these alterations predict the development of psychosis. [sup][6] Literature review regarding intervention benefits has been summed up - benefits for any specific intervention is not conclusive… it might be possible to delay or prevent transition to psychosis. Although clinical trial findings have been inconsistent, psychosocial approaches …may reduce the risk of transition to psychosis! [sup][7],[8] As there was much work going on in some specific centers about the early psychosis, significant changes have occurred in the field of schizophrenia in the last 2-3 decades on a parallel stream. …