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July 8, 2020

Attenuated Psychosis Syndrome or Pharmacologically Attenuated First-Episode Psychosis?An Undesirably Widespread Confounder

Author Affiliations
  • 1Section of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Perugia, Italy
  • 2Center for Translational, Phenomenological and Developmental Psychopathology, Perugia University Hospital, Perugia, Italy
  • 3Pathological Addiction, Child and Adolescent Neuropsychiatry Service, Department of Mental Health, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
  • 4Centro Medico “Genneruxi,” Cagliari, Italy
  • 5Center of Liaison Psychiatry and Psychosomatics, University Hospital, University of Cagliari, Cagliari, Italy
JAMA Psychiatry. Published online July 8, 2020. doi:10.1001/jamapsychiatry.2020.1634

Preempting the risk of transition of a subclinical liability into a full-blown disorder is a central tenet of preventive medicine. In psychiatry, although incipient psychosis may be difficult to detect, this strategic goal has inspired and given momentum to the breadth of prodromal/ultrahigh risk (UHR) research and its clinical translations. Such a research stream has in turn tangibly contributed to an overarching, prevention-oriented re-envisioning of the field of clinical psychiatry.1 Indeed, with the ultimate aim of reducing chronicity and attenuating the burden of its consequences, the timely identification of individuals at high risk of developing psychosis has become a catalyst for developmentally oriented understanding of illness trajectories, personalized risk prediction, and service innovation.2 In this perspective, the meta-analysis by Salazar de Pablo and colleagues3 provides an important, timely overview of the validity of DSM-5 attenuated psychosis syndrome (APS) as well as an interesting photograph of some major blind spots in the field.

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