Counterpoint. Early intervention for psychosis risk syndromes: Minimizing risk and maximizing benefit

Schizophr Res. 2021 Jan;227:10-17. doi: 10.1016/j.schres.2020.04.020. Epub 2020 May 10.


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.

Keywords: Autonomy; Beneficence; Biomarkers; Clinical high risk (CHR); Psychosis; Stigma.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Humans
  • Psychotic Disorders* / diagnosis
  • Psychotic Disorders* / therapy
  • Social Stigma
  • Syndrome