Conceptual issues in the classification of psychosis

Abstract

To provide an update on the conceptual status of attenuated psychosis syndrome (APS) as a psychiatric disorder. In May 2012, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) Task Force announced that the planned introduction of APS as a new diagnosis in DSM-5 was cancelled and that APS was being moved to 'Section III' of the manual as a diagnostic construct requiring more work. Recent studies of APS have reflected this uncertainty and debate over its validity. Before and after the decision in May 2012 to remove APS as a new diagnosis in DSM-5, scientific work has proceeded in a robust manner to shore up the validity of APS as a diagnostic construct. Recent work on APS has revolved around a series of unresolved questions: the actual incidence of conversion of APS to full-blown psychosis, the identification of the subgroup that will convert, the appropriate treatment for APS, the ability of treatment to prevent conversion to psychosis, the wide range of long-term outcomes of APS and finally the decision whether to include APS as a formal psychiatric diagnosis. Although the debate continues, a substantial number of the major researchers have argued that APS does not yet enjoy a degree of validity that warrants inclusion as a formal diagnosis.