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.

2 Responses

  1. As far as I know, there is absolutely no evidence that antipsychotics prevent psychosis in people who haven’t had one. My inclination is that this is an attempt at broadening the use of antipsychotics even further. Don’t they have enough patients to market their products to, anyway?: people diagnosed with schizophrenia, bipolar (for Seroquel and maybe others even depression in bipolar II), autism-associated irritability, suicide prevention (for clozapine), etc. These are FDA approvals; I don’t count off-label prescription here. I really don’t think we need another dubious, diagnostic category for pharma’s benefit, and for purely diagnostic purposes, this syndrome doesn’t seem to have much validity.

    • Not only won’t neuroleptic (antipsychotic) drugs prevent psychosis in a person who has no psychosis, but there is much question as to the amount of benefit, if any, these drugs have on people with psychosis. Neuroleptic drugs can do much harm, and there is much indication that rather than helping the patient recover, the drugs may work as an impediment to recovery. Nobody should be forced to take neuroleptic drugs against their will.

      I work with an organization, MindFreedom International, and this organization is pro-choice when it comes to the taking of psychiatric drugs. Often consent is less informed than it should be, but you can go to the MindFreedom International website, and get the goods on these pharmaceutical products and the companies that market them if you need that information.

      You mention ‘off label’ marketing, well, now the FDA has approved a number of psychiatric drugs for purposes besides those for which they were designed. Abilify, for instance, a neuroleptic (or antipsychotic) drug has been approved for use as an antidepressant drug. This in effect is making “off label” marketing on label marketing by getting FDA approval. The extent to which a drug used to treat psychosis can alleviate depression is a matter for debate, but let me just say I’m not going to be recommending any neuroleptic drug for anybody who has depression.

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