False-positives and Clinical Heterogeneity among Youth at Clinical High-risk for Psychosis: Clinical and Ethical Implications for Assessment and Treatment
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2018-06-15
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Zachary B. Millman, False-positives and Clinical Heterogeneity among Youth at Clinical High-risk for Psychosis: Clinical and Ethical Implications for Assessment and Treatment, Journal of Ethics in Mental Health, vol. 9, 2014-2016.
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Abstract
Early detection and prevention of psychosis among those showing early, attenuated manifestations
has become an international initiative. Multiple ethical and clinical challenges, however, complicate
these efforts. We discuss contextual considerations in the identification of psychosis-risk, the
complicating role of comorbidities in clinical decision-making, and limitations to the extant
psychosocial intervention literature. Factors such as clients’ life experiences, cultural background,
and co-occurring psychopathology may all influence whether putative attenuated psychotic signs are
considered risk factors for psychosis. Once a high-risk label is ascribed, these and other
considerations influence the degree to which available interventions are appropriate for presenting
concerns. We suggest that brief screening instruments may promote more accurate identification of
psychosis-risk; we also contend that a modular, needs-based treatment model may begin to address
the ethical and clinical concerns associated with providing early intervention to people identified as
at-risk, even if psychosis is not the ultimate clinical outcome.