Cited by 103Schizophrenia research and treatmentMental Health and PsychiatryBipolar Disorder and Treatment

Clinical Validity of DSM-5 Attenuated Psychosis Syndrome: Advances in Diagnosis, Prognosis, and Treatment

Open access
Salazar de Pablo, Gonzalo, Catalan, Ana, Fusar-Poli, Paolo·2020·JAMA Psychiatry

Abstract

Importance: Since the release of the DSM-5 diagnosis of attenuated psychosis syndrome (DSM-5-APS) in 2013, several research studies have investigated its clinical validity. Although critical and narrative reviews have reviewed these progresses, no systematic review has comprehensively summarized the available evidence regarding the clinical validity of DSM-5-APS. Objective: To provide current evidence on the clinical validity of DSM-5-APS, focusing on recent advances in diagnosis, prognosis, and treatment. Evidence Review: A multistep literature search using the Web of Science database, Cochrane Central Register of Reviews, Ovid/PsychINFO, conference proceedings, and trial registries from database inception to June 16, 2019, was conducted following PRISMA and MOOSE guidelines and PROSPERO protocol. Studies with original data investigating individuals diagnosed using DSM-5-APS or meeting comparable criteria were included. The results of the systematic review were summarized in tables and narratively synthesized against established evidence-based antecedent, concurrent, and prognostic validators. A quantitative meta-analysis was conducted to explore the cumulative risk of psychosis onset at 6, 12, 24, and 36 months in individuals diagnosed using DSM-5-APS criteria. Findings: The systematic review included 56 articles, which reported on 124 validators, including 15 antecedent, 55 concurrent, and 54 prognostic validators. The epidemiological prevalence of the general non-help-seeking young population meeting DSM-5-APS criteria was 0.3%; the prevalence of individuals meeting DSM-5-APS criteria was variable in clinical samples. The interrater reliability for DSM-5-APS criteria was comparable with that of other DSM-5 mental disorders and can be optimized by the use of specific psychometric instruments. DSM-5-APS criteria were associated with frequent depressive comorbid disorders, distress, suicidality, and functional impairment. The meta-analysis included 23 prospective cohort studies, including 2376 individuals. The meta-analytical risk of psychosis onset was 11% at 6 months, 15% at 12 months, 20% at 24 months, and 23% at 36 months. Research into predisposing and precipitating epidemiological factors, neurobiological correlates, and effective treatments for DSM-5-APS criteria has been limited. Conclusions and Relevance: Over recent years, DSM-5-APS criteria have received substantial concurrent and prognostic validation, mostly driven by research into the clinical high-risk state for psychosis. Precipitating and predisposing factors, neurobiological correlates, and effective treatments are undetermined to date.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1001/jamapsychiatry.2019.3561

Cites

104 of 104 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

8 of the 112 references couldn’t be matched to a known paper.

Research works printed but not linked: 7

  1. Cakmak S, Karaytug MO, Bal U, Tamam L, Tasdemir A. Retrospective evaluation of risk determinants in prodromal period with a group of schizophrenia patients. Cukurova Medical Journal. 2016;41(3):437-446.
  2. Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. Jama. 2000;Apr 19(15):2008-2012.
  3. Riecher-Rössler A, Aston J, Ventura J, et al. [The Basel Screening Instrument for Psychosis (BSIP): development, structure, reliability and validity]. Fortschr Neurol Psychiatr. 2008;76(4):207-216.
  4. Newcombe R. Two-sided confidence intervals for the single proportion: comparison of seven methods. Stat Med. 1998;17:857-872.
  5. Harbord R, Harris R, Sterne A. Updated tests for small-study effects inmeta- analyses. Stat Med. 2009;9(2):197-210.
  6. Woods S, Walsh B, McGlashan T. Diagnostic reliability and validity of the proposed DSM-5 attenuated psychosis syndrome. Early Intervention in Psychiatry. 2012;6:33-33.
  7. Woods S, Addington J, Bearden C, et al. Antidepressant Medication Use in Attenuated Psychosis Syndrome: Community Selection and Outcome. Early Intervention in Psychiatry. 2018;12:10-10.

Cited by

Sorted by citations

Authors
Salazar de Pablo, G., Catalan, A., & Fusar-Poli, P.
Affiliations
Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
Venue
JAMA Psychiatry
Published
2020-03-01
Volume
77
Issue
3
Pages
311
ISSN
2168-622X (ISSN-L)
OpenAlex
W2989821710
Cited by
103
References
112
Citations by year
2026: 4 · 2025: 10 · 2024: 8 · 2023: 13 · 2022: 19 · 2021: 31 · 2020: 17
FWCI
2.83
Type
journal article
Language
en
Open access
Licence
other-oa
Locations
  • JAMA Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Research Portal (King's College London) (acceptedVersion, other-oa)
Funders
  • Fundación Alicia Koplowitz
  • European Commission
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
Keywords
attenuated psychosis syndrome, DSM-5 diagnostic criteria, clinical validity, concurrent validation, prognostic validation, inter-rater reliability, comorbid depression, suicidality, functional disability, prevalence, psychosis prevention, early intervention, antipsychotic drugs, antipsychotic adverse effects, antipsychotic non-response, antipsychotic non-adherence, antipsychotic tolerability, antipsychotic safety, antipsychotic efficacy
MeSH terms
Humans, Prognosis, Psychotic Disorders, Reproducibility of Results, Diagnostic and Statistical Manual of Mental Disorders

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review