Also To Be Included In the DSM-V, Psychosis Risk Syndrome

The upcoming DSM-V is expected to cover a certain “psychosis risk syndrome”. My worry with this diagnostic category is that the prevention might become part of the epidemic. How, for example, are we going treat people at risk for psychosis? Is this to be the same way we treat people who are overtly psychotic? If so then you’ve just increased the number of people on psychiatric drugs, and suffering from the slew of health complications that arise from doing so. Should a person pegged with this “psychosis risk syndrome” receive the same treatment as other people thought to have full blown psychosis? Answer yes, and you’ve just increased markedly the number of people in treatment for a “mental illness”. Next question: is this treatment all that effective?

How big of a step do you need to take to get from being “at risk” to being stark raving “psychotic”? My guess is that that step would not be very big, and if that is the case, why have any “pre-psychosis” designation what-so-ever? Isn’t this a little like pushing your luck?

There is a body of evidence suggesting that drug maintenance is at a remove from any treatment that would lead to a full recovery, and that such maintenance on neuroleptic drugs may actually impede the recovery process, and that, in some instances, such drug maintenance will prevent any recovery from taking place at all.

When people are being labeled at ridiculously young ages, 2-7 years old in some cases, and when some people I have known personally in the mental health system entered at a very early age, and have not gotten out of that system to this day, I don’t find this development a particularly positive one.

This category will have its field trials, of course, but I imagine the results will be subject to a variety of differing interpretations. Some people think that because you are treating more people, the treatments you are using must be more effective. Let me just say that, no, quantity is not synonymous with quality.

Yesterday, in the comment section to the post on temper dysregulation with dysphoria (TDD), I had referred to the DSM as a Pandora’s Box from which the last plague had not yet escaped. Today I find published an article on the matter using the exact same metaphor. This article, from a prominent well articulated critic of the current revisions taking place to the DSM, Dr. Frances Allen of Duke University, is called Opening Pandora’s Box: The 19 Worst Suggestions For DSM5. Anybody concerned about the future of mental health care in America might consider giving this article a peek. His criticism is unlikely to keep many of these suggestions out of the next edition of the Manual scheduled for release in 2013.