Counterpoint. Early intervention for psychosis risk syndromes: Minimizing risk and maximizing benefit.
Autonomy
Beneficence
Biomarkers
Clinical high risk (CHR)
Psychosis
Stigma
Journal
Schizophrenia research
ISSN: 1573-2509
Titre abrégé: Schizophr Res
Pays: Netherlands
ID NLM: 8804207
Informations de publication
Date de publication:
01 2021
01 2021
Historique:
received:
09
03
2020
revised:
16
04
2020
accepted:
16
04
2020
pubmed:
14
5
2020
medline:
22
6
2021
entrez:
14
5
2020
Statut:
ppublish
Résumé
Malhi et al. in this issue critique the clinical high risk (CHR) syndrome for psychosis. Response to points of critique. We agree that inconsistency in CHR nomenclature should be minimized. We respectfully disagree on other points. In our view: a) individuals with CHR and their families need help, using existing interventions, even though we do not yet fully understand disease mechanisms; b) substantial progress has been made in identification of biomarkers; c) symptoms used to identify CHR are specific to psychotic illnesses; d) CHR diagnosis is not "extremely difficult"; e) the pattern of progression, although heterogenous, is discernible; f) "psychosis-like symptoms" are common but are not used to identify CHR; and g) on the point described as 'the real risk,' CHR diagnosis does not frequently cause harmful stigma. Malhi et al.'s arguments do not fairly characterize progress in the CHR field nor efforts to minimize stigma. That said, much work remains in areas of consistent nomenclature, mechanisms of disease, dissecting heterogeneity, and biomarkers. With regard to what the authors term the "real risk" of stigma associated with a CHR "label," however, our view is that avoiding words like "risk" and "psychosis" reinforces the stigma that both they and we mean to oppose. Moreover, patients and their families benefit from being given a term that describes what is happening to them.
Sections du résumé
BACKGROUND
Malhi et al. in this issue critique the clinical high risk (CHR) syndrome for psychosis.
METHOD
Response to points of critique.
RESULTS
We agree that inconsistency in CHR nomenclature should be minimized. We respectfully disagree on other points. In our view: a) individuals with CHR and their families need help, using existing interventions, even though we do not yet fully understand disease mechanisms; b) substantial progress has been made in identification of biomarkers; c) symptoms used to identify CHR are specific to psychotic illnesses; d) CHR diagnosis is not "extremely difficult"; e) the pattern of progression, although heterogenous, is discernible; f) "psychosis-like symptoms" are common but are not used to identify CHR; and g) on the point described as 'the real risk,' CHR diagnosis does not frequently cause harmful stigma.
DISCUSSION
Malhi et al.'s arguments do not fairly characterize progress in the CHR field nor efforts to minimize stigma. That said, much work remains in areas of consistent nomenclature, mechanisms of disease, dissecting heterogeneity, and biomarkers. With regard to what the authors term the "real risk" of stigma associated with a CHR "label," however, our view is that avoiding words like "risk" and "psychosis" reinforces the stigma that both they and we mean to oppose. Moreover, patients and their families benefit from being given a term that describes what is happening to them.
Identifiants
pubmed: 32402605
pii: S0920-9964(20)30227-9
doi: 10.1016/j.schres.2020.04.020
pmc: PMC8218020
mid: NIHMS1593100
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
10-17Subventions
Organisme : NIMH NIH HHS
ID : R01 MH111448
Pays : United States
Organisme : NIMH NIH HHS
ID : U01 MH081902
Pays : United States
Organisme : NIMH NIH HHS
ID : R01 MH105178
Pays : United States
Organisme : NIMH NIH HHS
ID : K23 MH115252
Pays : United States
Organisme : NIMH NIH HHS
ID : R01 MH105084
Pays : United States
Organisme : Wellcome Trust
Pays : United Kingdom
Organisme : NIMH NIH HHS
ID : R01 MH116039
Pays : United States
Organisme : NIMH NIH HHS
ID : R01 MH113533
Pays : United States
Organisme : NIMH NIH HHS
ID : U01 MH081928
Pays : United States
Organisme : NIMH NIH HHS
ID : R01 MH112613
Pays : United States
Organisme : NIMH NIH HHS
ID : R33 MH111850
Pays : United States
Organisme : NIMH NIH HHS
ID : U01 MH082022
Pays : United States
Organisme : NIMH NIH HHS
ID : U01 MH081984
Pays : United States
Organisme : NIMH NIH HHS
ID : R01 MH115332
Pays : United States
Organisme : NIMH NIH HHS
ID : R01 MH112612
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR001863
Pays : United States
Organisme : NIMH NIH HHS
ID : R34 MH110506
Pays : United States
Organisme : NIMH NIH HHS
ID : R01 MH113565
Pays : United States
Organisme : NIMH NIH HHS
ID : R01 MH120088
Pays : United States
Organisme : NIMH NIH HHS
ID : R01 MH112189
Pays : United States
Organisme : NIMH NIH HHS
ID : U01 MH076989
Pays : United States
Organisme : NIMH NIH HHS
ID : R01 MH121095
Pays : United States
Organisme : NIMH NIH HHS
ID : R01 MH107558
Pays : United States
Organisme : NIMH NIH HHS
ID : R01 MH107250
Pays : United States
Organisme : NIMH NIH HHS
ID : K23 MH116130
Pays : United States
Organisme : NIMH NIH HHS
ID : R01 MH112545
Pays : United States
Organisme : NIMH NIH HHS
ID : R01 MH115000
Pays : United States
Organisme : NIMH NIH HHS
ID : R01 MH119219
Pays : United States
Organisme : NIMH NIH HHS
ID : R21 MH119438
Pays : United States
Organisme : NIMH NIH HHS
ID : U01 MH081857
Pays : United States
Organisme : NIMH NIH HHS
ID : U01 MH082004
Pays : United States
Organisme : NIMH NIH HHS
ID : R01 MH105243
Pays : United States
Organisme : NIMH NIH HHS
ID : U01 MH081944
Pays : United States
Informations de copyright
Copyright © 2020 Elsevier B.V. All rights reserved.
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