Ethical, Legal, and Clinical Considerations when Disclosing a High‐Risk Syndrome for Psychosis
Abstract
There are complex considerations when planning to disclose an attenuated psychosis syndrome (APS) diagnosis. In this review, we evaluate ethical, legal, and clinical perspectives as well as caveats related to full, non‐ and partial disclosure strategies, discuss societal implications, and provide clinical suggestions. Each of the disclosure strategies is associated with benefits as well as costs/considerations. Full disclosure promotes autonomy, allows for the clearest psychoeducation about additional risk factors, helps to clarify and/or correct previous diagnoses/treatments, facilitates early intervention and bolsters communication between providers but there are important considerations involving heritability, comorbidity, culture, and stigma. Non‐disclosure advances nonmaleficence by limiting stigma and stress (which may inadvertently exacerbate the condition), and confusion (related to the rapidly evolving diagnosis) in a sensitive developmental period but is complicated by varying patient preferences and the possibility that, as new treatments without adverse effects become available, the risk with false positives no longer justifies the accompanying loss of autonomy. Partial disclosure balances ethical considerations by focusing on symptoms instead of labels, but evidence that laypersons may interpret this information as a pseudo‐diagnosis and that symptoms alone also contribute to stigma limits the efficacy of this approach. In addition, there are notable societal considerations relating to disclosure involving conservatorship, the reach of insurance companies, and discrimination. We advocate a hybrid approach to disclosure and recommend future research aimed at understanding the effects of stigma on clinical course and a renewed focus on those help‐seeking cases that do not transition but remain clinically relevant.
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The negative consequences of risk or vulnerability labels, together with uncertainty about their prognostic value and the absence of treatment options, cast doubt on whether and how to inform patients about risk.
“The unwanted consequences of risk/vulnerability labels, in addition to the uncertainty about their prognostic value and the lack of treatment options, cast doubts on the opportunity of informing patients about the risk, and on the best way to do it 154 .”
From Ethical challenges in contemporary psychiatry: an overview and an appraisal of possible strategies and research needs (2024) · cites this paper as [154]
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- Authors
- Mittal, V. A., Dean, D. J., Mittal, J., & Saks, E. R.
- Affiliations
- University of Colorado Boulder (US)
- University of Southern California (US)
- Corresponding author
- Mittal, Vijay A.
- Venue
- Bioethics
- Publisher
- Wiley
- Published
- 2015-02-17
- Volume
- 29
- Issue
- 8
- Pages
- 543-556
- ISSN
- 0269-9702 (ISSN-L)
- 1467-8519
- OpenAlex
- W1885698623
- Cited by
- 57
- References
- 7
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 5 · 2023: 4 · 2022: 2 · 2021: 11 · 2020: 6 · 2019: 6 · 2018: 1 · 2017: 5 · 2016: 8 · 2015: 2
- FWCI
- 4.32
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Bioethics (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (R01MH094650, R21MH103231)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
- Keywords
- attenuated psychosis syndrome, diagnosis disclosure, non-disclosure, partial disclosure, full disclosure, stigma, patient autonomy, non-maleficence, heritability, comorbidities, cultural factors, insurance discrimination, conservatorship, early intervention, help-seeking
- MeSH terms
- Adolescent, Adolescent Behavior, Cultural Characteristics, Humans, Insurance, Health, Patient Education as Topic, Psychotic Disorders, Risk Factors, Self Concept, Stress, Psychological, Truth Disclosure, Comorbidity, Insurance Coverage, Personal Autonomy, Beneficence, Paternalism, Disclosure, Heredity, Adolescent Development, Patient Preference, Social Stigma, Social Discrimination
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