For the purpose of diagnosis, psychopathology can be assessed at different levels of temporal resolution. Thus, episodes of illness can vary over a period of months, for example an episode of anxiety being followed by an episode of psychosis. However, psychopathology can also be assessed at the level of fluctuating symptoms, varying from day to day. Finally, psychopathology can be assessed at the level of fluctuating mental states that vary from moment to moment in the flow of daily life.

 

The development of the DSM-5 represented an open series of debates concerning numerous changes proposed for the revision, some of which were eventually adopted. Among the major changes proposed, a most interesting one was Attenuated Psychosis Syndrome (APS). APS contained all the ingredients for good debate, since it involved clarification of terms, issues of development, early intervention, stigma, and potential overuse of medications. While the DSM, itself, is not a set of treatment guidelines, the diagnostic criteria can clearly play a role in terms of providing the impetus for treatment recommendations. Differing views throughout the world on the nature of “at risk” populations, the differentiation of psychotic behavior into better-defined syndromes, public debate on the potential risks associated with adopting this diagnosis into the main section of the DSM, and the data on conversion to psychotic and non-psychotic syndromes all focused attention on this syndrome throughout the seven year period of work on the DSM-5.

 

Our discussion will provide a revisit to the process that led to the placement of APS among conditions for further study, the pros and cons of that decision and its implications.