Anticipating DSM-V: Should Psychosis Risk Become a Diagnostic Class?

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Abstract
In this issue, Woods et al1 report data analyses that support the validity of the criteria for identifying the prodrome stage of psychotic disorders. We have previously placed emphasis on this issue with a special theme.2–8 Questions related to the development of Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-V) now emerge. Should clinical practice move in the direction of early detection of risk status? Do research findings warrant interventions at the prodrome stage in general clinical practice? If the answers are yes, then DSM-V and International Classification of Diseases, Twelfth Revision, will be challenged to provide clinicians with a diagnostic category to support this shift in practice. This will be an essential step for providing education, encouraging clinical intervention, and supporting research on these clinical activities. The DSM-V workgroup responsible for psychotic disorders is considering creating a new diagnostic class for this purpose. Although I chair the DSM-V Psychoses Workgroup, this editorial represents personal views, not recommendations, of the Psychosis Workgroup or official decisions of the DSM-V Task Force. These views are informed, however, by discussions with workgroup members (http://www.psych.org/MainMenu/Research/DSMIV/DSMV.aspx), especially Ming Tsuang, and advisors Tom McGlashan and Scott Woods.