20 June 2012. The American Psychiatric Association (APA) has announced that the main text of the revised fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) will likely not include attenuated psychosis syndrome as a formal diagnosis. Instead, the controversial syndrome is slated to appear in the appendix, along with other categories that the APA deems in need of further study (read the full announcement on their website). The decision is based on the recommendation of the APA’s Psychotic Disorders workgroup, which has been considering if and how attenuated psychosis syndrome should appear in the DSM-5, due to be published in May of 2013, for the past several years.
Attenuated psychosis syndrome (APS) is characterized by mild psychotic symptoms that don’t meet the diagnostic criteria for a full-blown psychotic disorder, as well as significant distress and disability that bring the individual to clinical attention. Individuals with these symptoms are at an increased risk of later developing a psychotic disorder, with transition risks of 18 percent at six months and about 40 percent after three years (Fusar-Poli et al., 2012). Nearly three-quarters of those who do transition receive a diagnosis of schizophrenia, schizophreniform disorder, or schizoaffective disorder (Fusar-Poli et al., 2012).
The question of whether or not DSM-5 should include an APS diagnosis has sparked a lively debate (see SRF Live Discussion), with scores of researchers and clinicians on both sides of the issue. Although APS has been widely studied (see SRF related news story) and several interventions have been proposed to reduce conversion rates (Preti and Cella, 2010), the Psychotic Disorders workgroup has decided that more information is needed before the diagnosis can be included in the main text. In particular, the high comorbidity of APS with other psychiatric illnesses, such as depression and anxiety, is one reason cited for the workgroup’s decision. The APA cautions that more data are needed to determine if APS is a distinct illness or merely a subtype of the comorbid disorders, and if the distress and disability experienced with APS may be due to these other illnesses. In addition, in a preliminary study, the workgroup found that physicians may not be able to reliably identify APS based on the current diagnostic criteria.
For more information about the community’s reaction to the APA announcement, check out a recent Nature News article.—Allison A. Curley.