Scott W Woods1, Carrie E Bearden2, Fred W Sabb3, William S Stone4, John Torous5, Barbara A Cornblatt6, Diana O Perkins7, Kristin S Cadenhead8, Jean Addington9, Albert R Powers10, Daniel H Mathalon11, Monica E Calkins12, Daniel H Wolf12, Cheryl M Corcoran13, Leslie E Horton14, Vijay A Mittal15, Jason Schiffman16, Lauren M Ellman17, Gregory P Strauss18, Daniel Mamah19, Jimmy Choi20, Godfrey D Pearlson21, Jai L Shah22, Paolo Fusar-Poli23, Celso Arango24, Jesus Perez25, Nikolaos Koutsouleris26, Jijun Wang27, Jun Soo Kwon28, Barbara C Walsh29, Thomas H McGlashan29, Steven E Hyman30, Raquel E Gur12, Tyrone D Cannon10, John M Kane6, Alan Anticevic10. 1. Department of Psychiatry, Yale University, New Haven, CT, USA. Electronic address: scott.woods@yale.edu. 2. Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA; Department Psychology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA. 3. Lewis Center for Neuroimaging, University of Oregon, Eugene, USA. 4. Department of Psychiatry, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA; Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, China. 5. Department of Psychiatry, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA. 6. Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA. 7. Department of Psychiatry, University of North Carolina, Chapel Hill, USA. 8. Department of Psychiatry, University of California, San Diego, USA. 9. Department of Psychiatry, University of Calgary, Alberta, Canada. 10. Department of Psychiatry, Yale University, New Haven, CT, USA; Department of Psychology, Yale University, New Haven, CT, USA. 11. Department of Psychiatry, University of California, San Francisco, USA. 12. Department of Psychiatry, University of Pennsylvania, Philadelphia, USA. 13. Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA. 14. Department of Psychiatry, University of Pittsburgh, PA, USA. 15. Department of Psychology, Northwestern University, Evanston, IL, USA; Department of Psychology, Northwestern University, Chicago, IL, USA. 16. Department of Psychology, University of Maryland, Baltimore County, USA. 17. Department of Psychology, Temple University, Philadelphia, PA, USA. 18. Department of Psychology, University of Georgia, Athens, GA, USA. 19. Department of Psychiatry, Washington University in Saint Louis, MO, USA. 20. Olin Neuropsychiatry Research Center, Institute of Living, Hartford Hospital, CT, USA. 21. Department of Psychiatry, Yale University, New Haven, CT, USA; Olin Neuropsychiatry Research Center, Institute of Living, Hartford Hospital, CT, USA. 22. Department of Psychiatry, McGill University, Montreal, Canada. 23. Department of Psychosis Studies, King's College London, UK; Department of Behavioral Sciences, University of Pavia, Pavia, Italy. 24. Dept. of Child and Adolescent Psychiatry, Universidad Complutense de Madrid, Spain. 25. Department of Psychiatry, University of Cambridge, UK. 26. Department of Psychiatry, Ludwig Maximilian University of Munich, Germany. 27. Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, China. 28. Department of Psychiatry, Seoul National University College of Medicine, South Korea. 29. Department of Psychiatry, Yale University, New Haven, CT, USA. 30. Broad Institute of MIT and Harvard, Cambridge, MA, USA.
Abstract
BACKGROUND: Malhi et al. in this issue critique the clinical high risk (CHR) syndrome for psychosis. METHOD: Response to points of critique. RESULTS: We agree that inconsistency in CHR nomenclature should be minimized. We respectfully disagree on other points. In our view: a) individuals with CHR and their families need help, using existing interventions, even though we do not yet fully understand disease mechanisms; b) substantial progress has been made in identification of biomarkers; c) symptoms used to identify CHR are specific to psychotic illnesses; d) CHR diagnosis is not "extremely difficult"; e) the pattern of progression, although heterogenous, is discernible; f) "psychosis-like symptoms" are common but are not used to identify CHR; and g) on the point described as 'the real risk,' CHR diagnosis does not frequently cause harmful stigma. DISCUSSION: Malhi et al.'s arguments do not fairly characterize progress in the CHR field nor efforts to minimize stigma. That said, much work remains in areas of consistent nomenclature, mechanisms of disease, dissecting heterogeneity, and biomarkers. With regard to what the authors term the "real risk" of stigma associated with a CHR "label," however, our view is that avoiding words like "risk" and "psychosis" reinforces the stigma that both they and we mean to oppose. Moreover, patients and their families benefit from being given a term that describes what is happening to them.
BACKGROUND: Malhi et al. in this issue critique the clinical high risk (CHR) syndrome for psychosis. METHOD: Response to points of critique. RESULTS: We agree that inconsistency in CHR nomenclature should be minimized. We respectfully disagree on other points. In our view: a) individuals with CHR and their families need help, using existing interventions, even though we do not yet fully understand disease mechanisms; b) substantial progress has been made in identification of biomarkers; c) symptoms used to identify CHR are specific to psychotic illnesses; d) CHR diagnosis is not "extremely difficult"; e) the pattern of progression, although heterogenous, is discernible; f) "psychosis-like symptoms" are common but are not used to identify CHR; and g) on the point described as 'the real risk,' CHR diagnosis does not frequently cause harmful stigma. DISCUSSION: Malhi et al.'s arguments do not fairly characterize progress in the CHR field nor efforts to minimize stigma. That said, much work remains in areas of consistent nomenclature, mechanisms of disease, dissecting heterogeneity, and biomarkers. With regard to what the authors term the "real risk" of stigma associated with a CHR "label," however, our view is that avoiding words like "risk" and "psychosis" reinforces the stigma that both they and we mean to oppose. Moreover, patients and their families benefit from being given a term that describes what is happening to them.
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