Dangerous Doses
Nevertheless, critics contend that accurately identifying a person at risk for psychosis is very difficult and far from foolproof. Although severe cases of psychosis are generally easy to recognize, early warning signs can be subtle. Is Mike’s increasing paranoia a harbinger of an imminent psychotic episode, or does it reflect a slightly more extreme version of teenage difficulties? Symptoms of drug addiction, depression or other medical conditions can also be mistaken for those of psychosis.
Perhaps because of such ambiguities, most people who receive the psychosis-risk label will never actually become psychotic, according to Allen Francis, a psychiatrist emeritus at Duke University and chair of the group that created the DSM-IV. In a 2003 study, for example, a team led by psychiatrist Patrick McGorry of the University of Melbourne in Australia found that six out of every 10 people deemed at high risk of psychosis did not end up developing it.
False diagnoses are problematic, Francis says, because of the perils of unnecessary treatment. People recognized as having mental health disorders are often prescribed antipsychotic drugs, which can be dangerous, he notes. Side effects can include significant weight gain, increases in blood glucose and cholesterol levels, and movement problems. If a patient is falsely labeled, he or she can end up enduring those side effects unnecessarily.
To improve the accuracy of such verdicts, researchers are trying to identify better warning signs of psychosis, such as finding genetic signatures that may foretell the illness and anatomical patterns that doctors might see in brain scans. (Some scientists are working on parallel projects geared toward finding biological markers that can help them predict other mental disorders, such as bipolar disorder and major depression.)
At the moment, treating people such as Mike with nondrug remedies can minimize the hazards of misdiagnoses. For Mike, a course of cognitive-behavior therapy and, eventually, a low dose of antidepressants controlled the worst of his symptoms. No one knows for sure whether Mike was in danger of becoming psychotic, but he is slowly improving. Such cases will warrant consideration as the DSM-5 Psychotic Disorders Work Group decides whether to adopt attenuated psychosis syndrome as a valid diagnosis, reject it entirely, or include it as a provisional diagnosis and request more research. The final decision will be made public by May 2013.
This article was originally published with the title At Risk for Psychosis?.
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8 Comments
Add Comment"Preliminary studies, he says, show that individuals who fit the putative criteria for the psychosis risk syndrome—now officially dubbed attenuated psychosis syndrome—are tens to hundreds of times more likely to develop schizophrenia and psychosis than the average person."
Reply | Report Abuse | Link to thisI think this should be rephrased to say, "individuals are ...tens to hundreds of times more likely to BE DIAGNOSED WITH schizophrenia and psychosis than the average person"
Mental health diagnosis are incredibly subjective and changeable. There is no blood test for schizophrenia. It's really just a matter of a "clinician" thinking, "hmmm, seems like schizophrenia" and then the patients whole life can be sent in a different direction. I'm glad the article focused on the dangers of mis-diagnosis. The dangers are even more extreme when talking about diagnosing children who are still in the process for forming their identity. Expectation predicts outcome - both for the client and the psychiatrist.
A highly informative and up-to-date article. The population with "atenuated psychosis" described here may be the "prone to schyzophrenia" people that should never try Cannabis and other abuse drugs. When I first read the comment about "prone to schyzophrenia" advised not to smoke Marihuana, I wondered who was able to describe the traits to identify such people. Now a population subset at special risk for mental disorders when on abuse drugs is finally described by this research. Very practical !.
Reply | Report Abuse | Link to thisEvery US President since Truman has been willing to destroy all human life, via nuclear war, in defense of US interests. Might not accepting this be a sign of insanity? Might not even a willingness to run for that office be an indication of insanity?
Reply | Report Abuse | Link to thisI am not a physician but it is said first be your physician.
Reply | Report Abuse | Link to thisI think the problem could be reduced if we feed correctly the patient. Food supplements are a good choice but kidney and glands problems later might force the patient to cut these supplements. Besides, the good nutritive supplement is another aspect of the problem. The regular prescription is another aspect. The patient should the least and if he or she feels the need. Soon it might become a addiction if not correctly handled. Sometimes he or she likes too much fatty cheese or dairy. It might cover the brain blood capillaries and causes problems. In other aspects the brain needs some fat for proper function and you should take care for each patient separately.
“so-called atypical antipsychotic medications such as risperidone and olanzapine, which help to reduce hallucinations and delusions”.
This is like having a quite room that allows you to have some rest, but does not cure the patient. Of course we have recently the food supplements diseases that should be studied and find out why they are not helpful.
I am one of those psychotic people you love to talk about. I have contracted for a number of years now with a Department of Psychiatry out West, working directly with psychiatrists in that Department and nationally. I even worked to help set up one of these prodromal psychosis programs.
Reply | Report Abuse | Link to thisLet me tell you: they are making this up as they go along. Psychiatrists are being marginalized by their reliance on drugs and on seeing mental illness as a manifestation of brain illness, so the only way they can stay valuable is to expand their territory: hence prodromal youth.
The DSM-V committee was hand picked to produce results consistent with the desires of the psychiatric elite. They are the same people who make the same decisions about medicines and people with mental illness all the time. Even those people with mental illness included on the DSM-V review panel are the usual suspects, comfortable for the psychiatric elite, and bound to be open to the expansion of psychiatry into, to use the word from this article, "aggressive," treatment of youth with antipsychotics.
Most of the review of the DSM-V has taken place in secret, with brief periods of public comment allowed, and then back behind closed doors. Psychiatry is about to spring a doozy on those with mental illness.
As far as prodromal psychosis, I did see young people in the one program who were legitimately ill. But these were people approaching their 20's, around the time psychosis would emerge anyway. The younger people were either drug addicts their parents could not control so they desperately wanted a mental health diagnosis, or right brain thinkers stuck in left brain families.
There is a whole contingent of psychiatrists who now have their professional reputations built around this territory grab into prodromal psychosis, so it is not going to go away. More and more kids are going to be sucking Risperdal like candy. "Johnny, why did you quit soccer?" "Because I can't get off the couch, I gained 30 pounds, got diabetes and drool on myself." "Oh."
Most of what I saw with young people were parents who were so overwhelmed that they saw no way to deal with their child than to say that he or she was sick. Teenagers are weird, moody things. Don't you remember being one? Wouldn't your mother have loved to take you to the doctor to get a pill for you? Nice and compliant, calm and directable - you needed that, didn't you?
Re: Blood test to diagnose schizophrenia.
Reply | Report Abuse | Link to thisI think visual, tactile, and auditory hallucinations are one of the good indicators of schizophrenia in a person who is not on a prescribed or unprescribed medication.
There should be a helluvalot more psychotherapy for such teen-agers and alot less "anti-psychotic" drugs used by psychiatrists who cannot be bothered to spend the time necessary with patients. The basic cause of this deficiency is the payment-system for psychiatrists ie money need ie greed. Psychiatrists themselves have the highest incidence of mental illness of all the medical specialties, and of suicide. But keep in mind that the entire economic system under which they work is literally insane.
Reply | Report Abuse | Link to thisYou sound paranoid. I never take the word of a junky about the impact of their drug of choice so I'm not about to take the word of a psychotic about psychosis.
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