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?.