Controversial changes to DSM

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There is at least one controversial change in the revised Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5). The DSM provides the standard criteria for mental health diagnoses. The latest version of DSM, the first revisions since 1994, will include attenuated psychosis syndrome (APS) for the first time. This would identify those impaired by preliminary psychotic symptoms that do not meet the threshold for an existing diagnosis as having a psychotic disorder.

Original reason for including APS not valid

Trying to understand this new inclusion, researchers at Butler Hospital, Brown University and Rhode Island Hospital studied how APS applied in an outpatient clinic, and found reasons for concern. One of the original reasons for including APS was to help identify patients who are at high risk for transition to a psychotic disorder in the near future but not currently experiencing psychosis. During the team’s research, they did not find a single patient who would benefit from this scenario. Patients in that category met the criteria for another existing DSM disorder so the need for another DSM qualified mental health condition is not necessary.

Could be emotional consequences to diagnosis

Additionally these patients often suffer from other mental health conditions which may in fact explain the symptomology better than the APS diagnosis. Depression and anxiety were among those issues and they are definitely treated better on their own rather than as a psychotic symptom. The very real concern is that more patients will unnecessarily be labeled as “psychotic” and there could be social and emotional repercussions.

Could lead to inappropriate treatments

“APS has been a controversial topic because the introduction of this diagnosis would basically lower the threshold for diagnosing someone with a psychotic-type disorder. Making such diagnosis has serious implications because it could lead to inappropriate treatments such as antipsychotic medications that could pose more risks than benefits for these patients or increased stigma,” explained Gaudiano.

Source: MedicalNewsToday, Journal of Clinical Psychology

 
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