A principle-based framework for disclosing a psychosis risk diagnosis

Area of Science:

• Psychiatry
• Bioethics
• Clinical Psychology

Background:

• Identifying individuals at high risk for psychosis, termed At-Risk Mental State (ARMS), aims to prevent or delay onset.
• Disclosure of ARMS status is controversial due to potential harms like stigma and discrimination, especially given low psychosis conversion rates (approx. 25% at 3 years).
• Lack of evidence for effective interventions for ARMS patients further complicates the risk-benefit analysis of disclosure.

Purpose of the Study:

• To develop a unified, principle-based disclosure strategy for clinicians working with ARMS patients.
• To address the ethical justification of disclosing ARMS status, which is often omitted in clinical guidelines.

Main Methods:

• A principle-based ethical analysis of the values and normative significance of ARMS disclosure.
• Comparison of the proposed disclosure framework with existing approaches.
• Consideration of the limitations of the proposed strategy.

Main Results:

• The ethical analysis supports full disclosure of the ARMS label in most clinical situations.
• Enhancing patient understanding is identified as a primary ethical justification for disclosure.

Conclusions:

• A unified disclosure strategy is proposed, favoring full disclosure to enhance patient understanding.
• The strategy aims to guide clinicians in navigating the ethical complexities of ARMS disclosure.
• Further discussion and refinement of the framework are necessary, acknowledging its limitations.