Department of Psychiatry, Yale University, New Haven, CT, USA.
Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA; Department Psychology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA.
Schizophr Res. 2021 Jan;227:10-17. doi: 10.1016/j.schres.2020.04.020. Epub 2020 May 10.
Malhi et al. in this issue critique the clinical high risk (CHR) syndrome for psychosis.
Response to points of critique.
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.
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.
马利等人在本期中对精神病的临床高风险（CHR）综合征提出了批评。
对批评意见的回应。
我们同意，应尽量减少 CHR 命名法的不一致性。在其他方面，我们持不同意见。在我们看来：a）有 CHR 的个体及其家属需要帮助，可以使用现有的干预措施，尽管我们尚未完全了解疾病机制；b）在识别生物标志物方面已取得重大进展；c）用于识别 CHR 的症状是特定于精神病的；d）CHR 诊断并非“极其困难”；e）尽管进展模式存在异质性，但可以识别；f）“类似精神病的症状”很常见，但不用于识别 CHR；g）关于所谓的“真正的风险”，CHR 诊断不会经常引起有害的污名。
马利等人的论点并没有公正地描述 CHR 领域的进展，也没有努力减轻污名。话虽如此，但在命名法的一致性、疾病机制、剖析异质性和生物标志物等方面仍有许多工作要做。关于作者所说的与 CHR“标签”相关的污名的“真正风险”，然而，我们的观点是，避免使用“风险”和“精神病”等词会加剧他们和我们都想反对的污名。此外，患者及其家属受益于使用描述他们所经历的事情的术语。
