The Psychosis-Risk Syndrome: Handbook for Diagnosis and Follow-up

The handbook The Psychosis-Risk Syndrome is a summary of over a decade of research and clinical practice at PRIME (Psychosis Risk Identification, Management, and Education), the Yale University psychosis-risk clinic. The focus of the book is the psychosis-risk syndrome that precedes the onset of schizophrenia and the utilization of the Structured Interview for Psychosis-Risk Syndromes (SIPS) assessment to assist clinicians in determining risk. The authors contend that early detection and intervention in the first episode and the psychosis-risk phase reduce the severity of the disorder and delay its onset.

According to the authors, one step toward prevention is the ability to identify and define the period leading up to a first psychotic break. The SIPS, developed by McGlashan and his colleagues and utilized at their psychosis-risk (prodromal) clinic, rates symptom and syndrome severity and generates diagnoses. It provides the clinician with a tool to determine whether the patient is psychotic or is at risk of developing psychosis in the future.

The handbook is separated into three parts. The first part provides an overview of risk syndromes and psychosis and then focuses on the development of the SIPS assessment. The SIPS is an objective measure that captures multiple domains and provides the clinician with parameters to monitor the potential development of psychosis. The authors use the first part to describe the SIPS (including its validity, reliability, and diagnostic criteria) and lay the groundwork for its use.

The second part of the handbook provides the reader with a brief overview of PRIME and then discusses utilization of the SIPS in practice. The reader can find a copy of the SIPS in an appendix of the handbook, which avoids disrupting the flow of the handbook. Numerous deidentified case presentations bring the process of administering the SIPS to life. The third part of the handbook focuses on the PRIME clinic and provides a brief overview of its organizational structure and practical implications.

The psychosis-risk syndrome is one of the most controversial debates in DSM-5 development. In a recent article, Frances (1) discussed the consequences of identifying individuals at risk of psychosis. For example, there is concern about inappropriately exposing individuals to antipsychotic medications that negatively affect health. According to Frances, psychiatry does not have the tools to identify individuals before they become psychotic. In addition, findings from the North American Prodrome Longitudinal Study indicate that the majority of individuals identified as at risk of developing psychosis do not actually do so (2).

Despite the controversy, I would recommend The Psychosis-Risk Syndrome to clinicians because it raises awareness of psychosis risk and the need to monitor patients for potential psychosis. The inclusion of the SIPS is thought provoking; however, Frances (1) pointed out the difficulty in transferring knowledge from research to practice. It is not clear whether the SIPS is ready for mainstream clinical settings, although the authors should be applauded for their work, particularly during this pivotal time in the field of psychiatry.