Attenuated psychosis syndrome shows clinical significance

Jan 9 2014

By Lucy Piper, Senior medwireNews Reporter

The community prevalence of attenuated psychosis syndrome is sufficient to make it a valid addition to the DSM-5, but only with revisions to the current criteria, findings from the BEAR Study show.

Attenuated psychosis syndrome was included in section III of the DSM-5 as “a condition for further study,” due to doubt regarding the community prevalence of attenuated psychotic symptoms (APS) and the level of APS-related distress leading to help-seeking.

The results from The Bern Epidemiological At-Risk (BEAR) Study, involving 1229 individuals aged 16 to 40 years, show a lifetime prevalence of APS of 12.9%, making these symptoms “not rare,” say researcher Frauke Schultze-Lutter (University of Bern, Switzerland) and colleagues.

The team acknowledges, however, that just 0.3% of individuals met the current criteria for attenuated psychosis syndrome. This low prevalence was mainly due to the fact that only 3.8% met the current criteria for frequency (at least weekly occurrence in the past month) and just 1.1% met the criteria for onset/worsening (onset or worsening of APS within the past year).

But given that attenuated psychosis syndrome was proposed as a self-contained syndrome and therefore requires no progression criteria, Schultze-Lutter and co-workers suggest revising the criteria to simply differentiate from schizotypal traits.

When attenuated psychosis syndrome was assessed using this revision and with the original symptom, frequency, and distress/disability criteria, the prevalence was 2.6%. Also, it was associated with other nonpsychotic mental disorders and impaired psychosocial functioning within the past year.

“This suggests that this revised syndrome possesses greater clinical utility than the original syndrome,” the authors write in Schizophrenia Bulletin.

Attenuated delusions were the predominant symptom, affecting 97% of patients, according to the revised attenuated psychosis syndrome criteria, followed by attenuated hallucinations, at 89%.

But despite the frequent distress and behavioral impact of such symptoms, none of the patients cited APS as a reason for seeking care. Among the 23% of patients who did seek help, the main reasons were depressed mood and anxiety.

“Therefore, the decision to omit the help-seeking requirement from the distress/disability criterion is strongly supported by our findings,” say the researchers.

They conclude that young adults who meet their revised criteria for attenuated psychosis syndrome may benefit from supportive measures, such as monitoring or even specific intervention, but add that follow-up is needed to determine whether or not APS are transient and therefore the benefits of clinical intervention.

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