Attenuated psychotic symptoms syndrome: how it may affect child and adolescent psychiatry

The DSM-5 task force on schizophrenia and psychotic disorders have recently proposed to include attenuated psychotic symptoms syndrome as a disorder not currently listed in DSM-IV-TR, either in the main manual or in an Appendix for further research. One of the potential benefits of including this diagnosis in DSM-5 is to identify persons at high risk of developing psychotic disorders to prevent the appearance of these disorders or lead to disorders with a better prognosis. One of the challenges applying the criteria proposed to the pediatric population is the difficulty in defining “attenuated” in the same way and it is done with adults. The threshold for psychosis may be lower in children and, therefore, what is attenuated in adults may be fully present, although transient, in paediatric population. Other potential risks are a lower threshold for prescribing antipsychotics without clear evidence and whether the help-seeking behaviour criterion will be applied to the patients and/or the parents.