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Prediction of psychosis: setting the stage

  • Alison R. Yung (a1) and Patrick D. McGorry (a1)

Summary

Treating psychotic disorders in their earliest stages has become a key focus for research and clinical care. This paper reviews evidence of the capacity to identify those at increased risk for psychotic disorder and to intervene in the identified, high-risk individuals to ameliorate the course of disorder. Issues involved in preventive oriented clinical care are addressed, such as risk/benefit considerations, ethical and safety issues and the value of stage-specific interventions. Clinical predictors identified in recent research, promising intervention trials and proposed clinical practice guidelines are described. An approach based on active engagement, support and monitoring, yet with a conservative approach to medication use is advocated at present. Potential neurobiological processes have been studied and reinforce the sense that this is a critical phase for active treatment, and may prove helpful in understanding the process of transition across stages of illness. More research is required in prediction, neurobiology and treatment

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Copyright

Corresponding author

Alison Yung, ORYGEN Research Centre, Locked Bag 10, Parkville, Victoria, Australia. Tel: +61 3 9342 2000; fax +61 3 9342 2948; email: aryung@unimelb.edu.au

Footnotes

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Declaration of interest

None.

Footnotes

References

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Prediction of psychosis: setting the stage

  • Alison R. Yung (a1) and Patrick D. McGorry (a1)
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eLetters

Early psychosis: diagnostic uncertainty or insufficient phenomenology?

Massimo Lanzaro, Consultant Psychiatrist
10 November 2010

I should like to thank Pat McGorry for his extremely interesting paper, which attempts to shed some light on the area of so called "diagnostic uncertainty", an expression which I believe constitutes a peculiar oxymoron. One of the problems resides however in the poor conceptualisation found in most widely used diagnostic manuals, where the approximate description of the early stages of psychoses and its operativeconsequences raise many issues. I will examine for example the strengths and weaknesses of the current DSM-IV-TR definitions:

1. DSM-IV offers only one vague sentence about the words that other informants might use for a description of the person’s behaviour (“family members assume that he is going through a phase”);

2. The five symptoms that are mentioned and listed as examples in DSM-IV are merely residua of DSM-III-R operational criteria for the schizophrenia prodromal period, which have been dropped from the DSM-IV because of their poor reliability and validity (DSM-III defined eight features as making up the prodrome and DSM-III-R defined nine);

3. The duration criterion was dropped too and no chronological specifications are now assumed;

4. A specific list of prodromal features conflicted with ICD-10 that,on the other hand, does not describe a clustering of symptoms at all.

A general consensus about a valid early-recognition inventory of sufficient diagnostic and prognostic power is currently lacking. This complicates communication between researchers. Moreover, the resulting diagnostic heterogeneity affects the efficacy and promptness of early intervention services (EIS) and the liaison between secondary and primary care (with a possible significant delay in detection and intervention).

The aim of this short letter is to stimulate further discussions and to suggest the possible role of a renaissance of psychopatholgy in the field of prevention that may also inform criterion selection for DSM-V.

Bibliography

1. Early intervention for people with psychosis. NIMHE, Department ofHealth , UK , 2003.

2. International Classification of Diseases, 10th Revision (ICD- 10),WHO, 2003.

3. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text revision (DSM-IV-TR). American Psychiatric Association, 2004.
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Conflict of interest: None Declared

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