Treatment Options for Sub-Threshold Psychosis

While there is no specific treatment for sub-threshold psychosis, the options are similar to those at ultra-high risk of developing clinical psychosis. A review of treatment options indicated that antipsychotics, antipsychotics used together with cognitive behavior therapy, cognitive therapy, intensive community care and family psychoeducation, and omega-3 polyunsaturated fatty acid supplements with intensive community care, all lowered the risk of developing psychosis.5 While the effectiveness of these treatments in the lower risk categories has not been tested or established, it would be reasonable to assume similar results. More testing would be required to justify this hypothesis, however.

The DSM-5 Debate

There has been debate regarding the inclusion of Attenuated Psychosis Syndrome (APS)6 as a new classification in the DSM-5, recommended by the American Psychiatric Association. The suggested diagnostic criteria for APS includes incidents of hallucinations, delusions, or confused speech occurring at least once a week for a month, where the symptoms are distressing enough that help is sought.7 The reasoning behind the drive towards inclusion is that those with sub-threshold symptoms are still suffering cognitive, psychological or behavioral impairments. They would benefit from the inclusion of APS in the DSM, and any subsequent treatment. Indeed, it has been noted that the earlier treatment is provided, the greater the chances of remission or recovery.6


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There are those opposing the classification of a continuum of psychosis, with the argument being that the inclusion would be time-consuming and premature, requiring considerable clinical research to warrant such change.8 Opponents ascertain that, since we don’t definitively know whether psychosis could exist on a continuum, it is dangerous to divert our attention towards determining this. However, as those on the higher functioning end of the autism spectrum will no doubt attest, knowing the cause and possible effects of symptoms has improved their quality of life and ability to function. It may well be that the quality of life for those with subclinical psychotic experiences would be improved through the early detection, monitoring, and treatment of symptoms.

Nicola Davies, PhD, is a psychologist and freelance writer who lives in Bedfordshire, UK. She has a love of learning and a passion for making scientific knowledge accessible to everyone. 

References

  1. National Alliance on Mental Illness, 2011, First Episode: Psychosis. From http://www.nami.org/psychosis/report.
  2. Binbay T, et al. Testing the Psychosis Continuum: Differential Impact of Genetic and Nongenetic Risk Factors and Comorbid Psychopathology Across the Entire Spectrum of Psychosis. Schizophrenia Bulletin. 2011; 38(5):992-1002.
  3. McGrath JJ, et al. Psychotic Experiences in the General Population: A Cross-National Analysis Based on 31 261 Respondents From 18 Countries.  JAMA Psychiatry. 2011: 72(7): 697-705.
  4. Abbs B, et al. The 3rd Schizophrenia International Research Society Conference, 14-18 APRIL 2012, Florence, Italy: Summaries of Oral Sessions. Schizophrenia Research. 2012;  doi: 10.1016/j.schres.2012.07.024.
  5. Preti A and Cella M. Randomized-controlled trials in people at ultra-high risk of psychosis: A review of treatment effectiveness. Schizophrenia Research. 2010; 123(1): 30–36.
  6. Kontaxakis V, et al. ‘Attenuated Psychosis Syndrome’ or ‘Subthreshold Prodromal State’? Psychiatry Investigation. 2013; 10(2): 203–204.
  7. Tsuang MT, et al. Attenuated psychosis syndrome in DSM-5. Schizophrenia Research. 2013; http://openjournals.net/files/Ref/HARVARD2009%20Reference%20guide.pdf.
  8. Lawrie, SM, et al. The ‘continuum of psychosis’: scientifically unproven and clinically impractical. The British Journal of Psychiatry (editorial). 2010; 197(6): 423-425.