What Is Attenuated Psychotic Symptoms Syndrome?

Does the concept of attenuated psychotic symptoms syndrome sound familiar to you? It is a diagnostic proposal to be further investigated  that is found in the current DSM-5 ( Diagnostic and Statistical Manual of mental disorders ).

It involves attenuated psychotic symptoms, but causing distress and interference. Many of us are familiar with the most common psychotic disorders, such as schizophrenia or delusional disorder.

However, it has been discovered that there is some attenuated symptoms, which do not meet criteria for a psychotic disorder, but which could be the first “step” towards one of them. This is what the DSM-5 refers to with this “new” possible diagnosis.

Attenuated psychotic symptoms syndrome and DSM-5

Attenuated psychotic symptoms syndrome is classified as such in the “Other Psychotic Disorders” section of the DSM-5. Specifically, it is located in Section 3 of the DSM-5, an appendix of the manual that includes, among other contents, new possible diagnostic categories for which its evidence is still being evaluated.

In the case of this syndrome, in English  Attenuated Psychosis Syndrome,  we speak of a risk syndrome for the types of psychosis that would include, for example, many adolescents with symptoms such as thought disorders or sensory-perceptual disturbances.

These adolescents would not meet the criteria for the diagnosis of a psychotic disorder; however, according to this syndrome proposal, they could develop it in the future.

Definition and description: diagnostic criteria

It is not a new official diagnosis, but rather a proposal to be the object of further study (APA, 2013). This means that in the future it can become a new diagnostic category. But what exactly is attenuated psychotic symptoms syndrome?

Your criteria on the DSM-5 include the following:

1. Delusions, hallucinations, or disorganized language

At least one of the following symptoms must appear in an attenuated form : delusions, hallucinations or disorganized language. The judgment of reality is relatively intact, but the severity or frequency of the above symptoms is sufficient to require clinical attention.

2. Frequency of 1 time / week

The mentioned symptoms should occur with an average frequency of at least once a week  during the last month.

3. Onset or worsening

Another criterion of attenuated psychotic symptoms syndrome is that which refers to the onset or worsening of symptoms. Thus, these must have started (or worsened), significantly, in the last year.

4. Upset

Discomfort or psychological suffering is usually the limit that allows us to diagnose or not, a mental disorder. Thus, in this case, an intense discomfort produced by the explained symptoms also appears.

Instead of discomfort, dysfunction or interference with daily functioning may appear, of such intensity that it requires clinical attention (discomfort may also require it).

5. Not explained by other disorders / substances

The attenuated psychotic symptoms syndrome cannot be better explained or justified by the presence of another mental disorder. This includes bipolar or major depressive disorder with psychotic features.

Nor can it be attributed to the physiological effects of a substance or to another medical condition.

6. It is not a psychotic disorder

Finally, in order to be diagnosed with this syndrome, the diagnostic criteria for any other psychotic disorder must never have been met. However, it can lead to one of them.

epidemiology

The prevalence of attenuated psychotic symptoms syndrome is unknown to date. However, it is known that the symptoms described in this disorder are not uncommon in the general population.

In fact, the figures for these symptoms (specifically, hallucinatory experiences and delusional thinking), according to the DSM-5, range between 8 and 13%. At the level of gender distribution, there appears to be a slight preponderance of the syndrome in males.

Onset, course, and comorbidity

When does the disorder appear? Generally, its onset is in late adolescence or early adulthood. It may or may not be preceded by normal development.

It can also appear after some evidence of cognitive decline, negative symptoms of a psychotic disorder (eg, anhedonia), or impaired social development.

In certain cases, the syndrome can lead to a depressive or bipolar disorder with psychotic characteristics ; however, it more often leads to schizophrenia spectrum disorders.

Pros and cons of this new diagnostic proposal

The experts who defend this type of proposal point out the therapeutic and prognostic importance, as well as the benefit that this implies for the patient. However, there are also certain mental health professionals who highlight the risks and biases of this new category.

Thus, according to them, there would be certain risks in its creation, since at present we do not have sufficient scientific criteria for an adequate primary prevention of schizophrenia or the rest of the psychoses. In this way, according to Hueso (2011), people diagnosed with attenuated psychotic symptoms syndrome could be uselessly diagnosed, medicalized and stigmatized.

Future perspectives

There is much criticism that DSM-5 has received for the inclusion of so many new diagnoses. Perhaps it is one of the reasons why attenuated psychotic symptoms syndrome is not yet considered a diagnosis as such, it could become one in the future.

This proposal continues to feed the debate, open for many years, on the pathologization of daily life, emotions and behavior. Is human suffering always susceptible to being labeled as a mental disorder? We will see how this “new” syndrome evolves; the debate is served.