Tuesday, February 16, 2010

Watch this one take off

Thanks to Gianna Kali for alerting me to this article in the Psychiatric Times: Opening Pandora’s Box: The 19 Worst Suggestions For DSM5. Dr. Allen Frances was the chair of the DSM-IV Task Force and is professor emeritus at Duke University School, Durham, NC. An excerpt from Dr. France's article appears below.

The road to hell is paved with good intentions. Since when is a risk a syndrome? When the DSM says so, apparently. Watch Psychosis Risk Syndrome take off. What could be more humane, after all, than preventing young people (and their families) from (in theory) the avoidable pain of mental illness? The reason I am raising my own alarm here is that early intervention programs appear to pay no heed to mental illness as a deep-rooted coping mechanism that is a response to a trauma in the particular individual's family background. Mental illness comes from somewhere, and you need look no further than than your own family to begin to understand that the problem is psycho-spiritual not biochemical in origin.

Sure, early intervention programs have staffs of psychiatrists, social workers, psychologists, etc. Their presence lulls people into believing that the psychospiritual and personal origin of mental illness is being paid attention to, and it is not. Resolving schizophrenia, for example, often takes some very intense therapies that don't exist in these programs. If there is any early intervention program where Transactional Analysis, Family Constellation Therapy, Direct Confrontation Therapy, etc. are the mainstays, please let me know. Let me know, too, if there is a program that incorporates energy medicine into its daily routine. People are duped into believing that the mere presence of staff psychiatrists and other professionals is sufficient focus on the problems of the individual, whereas in reality they are there to deal with the effects of the medication while treating all individuals alike.

Dr. Frances writes
The Psychosis Risk Syndrome is certainly the most worrisome of all the suggestions made for DSM5. The false positive rate would be alarming―70% to 75% in the most careful studies and likely to be much higher once the diagnosis is official, in general use, and becomes a target for drug companies. Hundreds of thousands of teenagers and young adults (especially, it turns out, those on Medicaid) would receive the unnecessary prescription of atypical antipsychotic drugs. There is no proof that the atypical antipsychotics prevent psychotic episodes, but they do most certainly cause large and rapid weight gains (see the recent FDA warning) and are associated with reduced life expectancy―to say nothing about their high cost, other side effects, and stigma.

This suggestion could lead to a public health catastrophe and no field trial could possibly justify its inclusion as an official diagnosis. The attempt at early identification and treatment of at risk individuals is well meaning, but dangerously premature. We must wait until there is a specific diagnostic test and a safe treatment.


  1. i am a social worker in an early intervention in psychosis team and can relate to what you are saying, unfortunately many psychiatristare rather old fashioned in their medical model view of mental illness our EIPS team fight very hard against tis model and try and work with people to see their experinces as just that experiences and not a sign that they are deficit in some way of unwell, like you say mental illness is often a response to a trauma rather than a biochemical problem. i aso share your concerns about the new at risk of psychosis syndrome proposed for the dsm-v, i blogged about it the other day and the concerns about medication being given to children unessercarily, which appears to happen already in some places ,

  2. To me "Psychosis Risk Syndrome" looks like psychiatry's answer to the Hearing Voices Network's, and others', efforts to de-medicalize, normalize, experiences like hearing voices. Fear mongering in favor of Big Pharma at its best. The moment this appears in the DSM even more people will become even more vigilant and frightened out of their wits: "OMG! Wasn't this a voice, I just heard?! I better go see a psychiatrist, or I might become psychotic!" Or: "OMG! The idea that psychiatry is out to label me (and everybody else) only to get me (and everybody else) hooked on Big Pharma's drugs just crossed my mind. That can't be but a paranoid delusion. I better (etc.)."

  3. I am laughing as I hit the allow comment button but your points are well taken.

  4. Apparently some have undertaken studies of childhood videos of young adults subsequently diagnosed with psychosis and have concluded there were definitive signs visible in the childhood videos. Nonsense of course and alarmingly as Dr. Frances indicates this will become a target for drug companies.

    They base their proposition on the false theory that schizophrenia results in prefrontal cortex deterioration and that early intervention with neuroleptics curbs this. It would seem obvious to anyone who employed the lease bit of logic that the drugs will result in more damage to a developing brain than any real or perceived risk for psychosis.

    If the good Dr.'s advice is taken insofar as waiting until there is a specific diagnostic test there is nothing to worry about because there will never be a specific diagnostic test for actual psychosis or schizophrenia let alone psychotic risk.


I am no longer approving comments. All I ask is that you be respectful of others and refrain from using profanity.