A historical account of schizophrenia proneness categories from DSM-I to DSM-5 (1952-2013) / Uma revisão histórica das categorias de propensão à esquizofrenia do DSM-I ao DSM-5 (1952-2013) / Un rappel historique des catégories de prédisposition à la schizophrénie du DSM-I au DSM-5 [1952-2013] / Una revisión histórica de las categorías de propensión a la esquizofrenia del DSM-I al DSM-5 [1952-2013]

The history of diagnostic classifications in psychiatry has been recognized as a privileged means of access to the vicissitudes inherent to the configuration of a scientific and professional field, also bringing significant contributions to conceptual history. We have taken as primary sources the five editions of the DSM (1952-2013) to examine the construction of diagnostic categories related to schizophrenia proneness, indicating the scientific and social contexts related to the development of DSM and psychiatry itself. Along this process we highlight the conditions of possibility for the emergence of the Attenuated Psychosis Syndrome, a highly controversial diagnostic proposal, in the elaboration of DSM-5. This proposal ended up being rejected not only on scientific grounds, but also because of feared unintended consequences.

A história das classificações diagnósticas na psiquiatria tem sido reconhecida como meio privilegiado de acesso às vicissitudes inerentes à configuração do campo científico e profissional, além de trazer aportes significativos para a história conceitual. Tomamos como principais fontes primárias as cinco edições do DSM (1952-2013) para examinar a construção de categorias diagnósticas relacionadas à propensão para a esquizofrenia, indicando os contextos sociais e científicos relacionados ao desenvolvimento do DSM e da própria psiquiatria. Nesse processo, destacamos as condições de possibilidade para a emergência da Síndrome Psicótica Atenuada, uma proposta diagnóstica altamente controversa, na preparação do DSM-5. Essa proposta foi rejeitada não somente no plano científico, mas também em razão de temidas consequências indesejadas.

L'histoire des classifications diagnostiques en psychiatrie a été reconnue comme un moyen privilégié d'accès aux vicissitudes inhérentes à la configuration du champ scientifique et professionnel, apportant également des contributions importantes à l'histoire conceptuelle. Comme sources primaires principales, nous avons utilisé les cinq éditions du DSM (1952-2013) pour examiner la construction des catégories diagnostiques liées à la prédisposition à la schizophrénie, en indiquant les contextes scientifiques et sociaux du développement du DSM et de la psychiatrie elle-même. Au cours de ce processus, nous mettons en évidence les conditions de possibilité d'émergence du Syndrome Psychotique Atténué, une proposition diagnostique fortement controversée, dans l'élaboration du DSM-5. Cette proposition a fini par être rejetée, non seulement pour des raisons scientifiques, mais aussi par crainte des conséquences non désirées.

La historia de las clasificaciones diagnósticas en psiquiatría, ha sido reconocida como un medio privilegiado de acceso a las vicisitudes inherentes a la configuración de un campo científico y profesional, además de traer aportes significativos a la historia conceptual. Como recursos primarios, hemos utilizado las cinco ediciones del DSM (1952-2013), para examinar la construcción de categorías de diagnóstico relacionadas a la propensión a la esquizofrenia, indicando los contextos sociales y científicos relacionados al desarrollo del DSM y de la propia psiquiatría. A lo largo del proceso, destacamos las condiciones de posibilidad para el surgimiento del Síndrome de Psicosis Atenuada, una propuesta de diagnóstico altamente controvertida, durante la elaboración del DSM-5. Esta propuesta fue rechazada, no solo por motivos científicos, sino también por las temidas consecuencias indeseadas.

Die Geschichte der diagnostischen Klassifizierungen in der Psychiatrie wird als privilegiertes Mittel des Zuganges zu dem Wandel im Rahmen der Gestaltung eines wissenschaftlichen, beruflichen Gebietes anerkannt und trägt wesentlich zur Begriffsgeschichte bei. Als primäre Quellen wurden die fünf Auflagen des DSM (1952-2013) berücksichtigt, um den Aufbau der diagnostischen Kategorien mit Neigung zur Schizophrenie und den sozialen und wissenschaftlichen Zusammenhang der Entwicklung des DSM und der Psychiatrie zu untersuchen. Dabei heben wir die Möglichkeiten der Notbehandlung für „Attenuated Psychosis Syndrome", eines sehr umstrittenen diagnostischen Vorschlages bei der Vorbereitung des DSM-5, hervor. Dieser Vorschlag wurde nicht nur aus wissenschaftlichen Gründen, sondern auch aufgrund befürchteter, unerwünschter Folgen abgelehnt.

Validation of the Korean version of the 16-Item Prodromal Questionnaire in a Non-Help-Seeking College Population

OBJECTIVE: To examine the reliability and validity of the Korean version of the 16-item Prodromal Questionnaire (KPQ-16) in non-help-seeking university students. METHODS: Among 2,246 university students participated in the initial screening, 257 subjects with KPQ-16 scores ≥4 were interviewed. The criteria for ultra-high risk (UHR) of psychosis of the Comprehensive Assessment of At-Risk Mental States (CAARMS) were the gold standard for diagnosis. An exploratory modified version of the questionnaire (mKPQ-16), to which three items from the Eppendorf Schizophrenia Inventory were added, was also used to compensate for items on thought and cognitive problems. RESULTS: Seventeen subjects met the CAARMS criteria for UHR of psychosis. The area under the receiver operating characteristic curve (AUROC) was highest for the mKPQ-16 total score (AUROC=0.831, p < 0.001). The use of cutoff total scores of 7 for the mKPQ-16 and 6 for the KPQ-16 resulted in the best balance of sensitivity (76.5% and 64.7%, respectively) and specificity (75.4% and 71.2%, respectively). CONCLUSION: The Korean versions of the PQ-16 are good instruments for screening for psychosis risk in university students. This validation of a questionnaire version with a small number of items may make it feasible to screen large numbers of young adults in the community.

Social Cognition and Its Correlation with Social Function in Attenuated Psychosis Syndrome / 中国康复理论与实践

Objective To investigate the social cognition and its correlation with social function for attenuated psychosis syndrome (APS). Methods From August, 2014 to December, 2015, 39 patients with APS were recruited as research group. Another 40 normal healthy persons with similar gender, ages, and education levels were selected as control group. The Faux Pas Recognition Test (FPR) and Yoni Task Test were used to evaluate the social cognition, and Social Disability Screening Schedule (SDSS) was used to evaluate the social function. The correlation between FPR, Yoni Task Test and SDSS in the research group was analyzed. Results In FPR test, the faux pas questions score, control questions score and total score of FPR were significantly lower in the research group than in the normal control group (t>2.378, P2.341, P0.05). The SDSS total score was signifi-cantly higher in the research group than in the normal control group (t=13.032, P0.473, P0.448, P<0.01). Conclusion Social cognition func-tion in APS is impaired. It is associated with social dysfunction in APS.

Valores conflitantes na produção do DSM-5: o “caso” da síndrome psicótica atenuada / Conflicting values in the production of DSM-5: the “case” of the attenuated psychotic syndrome / Conflit de valeurs dans la production de DSM-5: le “cas” du syndrome psychotique atténué / Valores en conflicto en la producción de DSM-5: el “caso” del síndrome de la psicosis atenuada

O debate sobre a possível inclusão da síndrome psicótica atenuada como diagnóstico oficial no DSM-5 foi atravessado por diversos valores em torno dos quais argumentadores a favor ou contra a criação dessa nova categoria se dividiram. As defesas de tais valores geraram posições divergentes, mas igualmente legítimas e bem fundamentadas, e trouxeram consigo questionamentos importantes para o cenário potencialmente inovador da psiquiatria preventiva contemporânea. Entre eles, a preocupação ética com o sofrimento, os riscos associados às ações de prevenção e a importância do papel dos valores na formulação de categorias diagnósticas e na própria prática psiquiátrica.

The discussion on the possible inclusion of Attenuated Psychosis Syndrome as an official diagnosis of the DSM-5 was permeated by different values, which underpinned the division between those who argued in favor and those who were against the creation of that new category. The prominence given to certain values generated divergent positions, but which were equally legitimate and well grounded, and which brought up significant questions regarding the potentially innovative scenario of contemporary preventive psychiatry. The ethical preoccupation with suffering, the risks associated with preventive actions and the importance of the role of values in the formulation of diagnostic categories and in psychiatric practice were some of the key issues raised by that debate.

La discussion sur la possible inclusion du Syndrome Psychotique Atténué comme diagnostique officiel dans le DSM-5 a été traversée par diverses valeurs, autour desquelles les argumentateurs, en faveur ou à l’opposé de la création de cette catégorie, se sont séparés. Les soutenances de telles valeurs ont suscité des positions divergentes, mais aussi légitimes et bien fondées, qui ont conduit à des questionnements importants pour le cadre potentiellement novateur de la psychiatrie préventive contemporaine. Parmi ces valeurs, il existe la préoccupation éthique par rapport à la souffrance, les risques associés aux actions de prévention, l’importance du rôle des valeurs dans la formulation des catégories diagnostiques, ainsi que dans la pratique psychiatrique.

El debate sobre la posible inclusión del síndrome de psicosis atenuada como un diagnóstico oficial en el DSM-5 fue atravesado por numerosos valores, que dividieron a los que estaban a favor o en contra de la creación de esta nueva categoría. Las defensas de tales valores generaron posturas divergentes, pero igualmente legítimas y con fundamento, y trajeron consigo puntos de discusión importantes para el escenario potencialmente innovador de la psiquiatría preventiva contemporánea, incluyendo la preocupación ética por el sufrimiento, los riesgos asociados a la prevención y la importancia del papel de los valores en la formulación de las categorías diagnósticas y en la propia práctica psiquiátrica.

Revisión crítica de la propuesta del DMS-5: el "síndrome de síntomas psicóticos atenuados" / Critical revision of the proposed DSM-5

Se considera la propuesta del Grupo de Trabajo en Psicosis del DSM‑5 de incluir el ®síndrome de síntomas psicóticos atenuados¼ (previamente: ®riesgo de psicosis¼) como categoría diagnóstica. Es un paso necesario, ya que el DSM‑IV no posibilita diagnosticar formas psicóticas menores o en fase inicial, pero el intento evidencia que la nosología actual no permite hacerlo. Los criterios diagnósticos propuestos son semejantes a los criterios nucleares de los trastornos psicóticos del DSM‑IV, con dos variantes: a) que los síntomas son atenuados y con prueba de realidad conservada y b) que la sumatoria propuesta es dimensional y no categorial (estructural), como lo es la sumatoria algorítmica y disyuntiva del DSM‑IV. Para que la construcción de la categoría diagnóstica exprese la realidad clínica que fundamenta la propuesta son necesarios principios psicopatológicos diferentes a los que organizan el proyecto del DSM‑5.

The proposal of the DSM‑5’s Psychosis Work Group to include “attenuated psychotic symp‑toms syndrome” (previously: “psychosis risksyndrome”) as a diagnostic category is consi‑dered. To identify the first phase of psychosisis a necessary step, taking into account thatthe DSM‑IV does not allow to diagnose neitherminor psychotic forms, nor initial phase forms. However, the attempt makes evident that the current nosology does not enable to do so. The suggested diagnostic criteria are similar to the nuclear criteriafor Psychotic Disorders of theDSM‑IV, but with two variants: a) that the symptoms are “in attenuated form with intact reality testing” and b) that the proposed summationis dimensional and not categorical (structural),as well as the algorithmic and disjunctive sum‑mation of the DSM‑IV. In order to build the diagnostic category expressing the clinical reality underlying the proposal of the Psychosis WorkGroup, different psychopathological principlesthan those that organize the draft of the DSM‑5are required.

At Risk State for Psychosis: Related Issues and Future Directions

In medicine, general clinical practice moves in the direction of early detection and intervention for the prevention of progressive disease. In psychiatry, research in subjects with the risk syndrome for psychosis, has been conducted for the prevention of schizophrenia, known as a devastating chronic disease. The inclusion of 'attenuated psychosis syndrome', based on the results of early intervention studies, is one of the major issues in the upcoming DSM-V. Further investigations are needed to find biological markers and endophenotypes to supplement the diagnostic criteria. In the future, adoption of clinical staging is promising to overcome the shortcoming of current diagnosis of schizophrenia. In clinical practice, more concerns are needed about attenuated psychotic symptoms which might be risk signals for the transition to psychosis.