Should a risk syndrome for first episode psychosis be included in the DSM-5?

The purpose of this paper is to review recent discussion about the possibility of including a new category in the next version of the DSM (DSM-5) for the 'at risk mental state' or the 'psychosis risk syndrome'.

A number of issues have been addressed by commentators in the field, including the issue of early intervention versus the risk of false positives; stigma and discrimination; the use of antipsychotic medication in at-risk individuals; how to manage clinical need; whether the Risk Syndrome is a valid clinical entity; the reliability of assessment of the Risk Syndrome; and where to place the Risk Syndrome in the DSM-5.

There are several issues about which advocates of the different positions (for or against inclusion of the Risk Syndrome category or advocating inclusion of an alternative category) are in agreement. These include that people who meet the 'at risk' criteria are symptomatic and in need of clinical care, that they have a greatly increased risk of developing a psychotic disorder within a brief time frame, and that they need treatment for current problems and to prevent transition to psychotic disorder. However, a source of disagreement between the positions is the relative importance that they afford each of these factors.