Many individuals may experience functional impairments. Modest-to-moderate impair— ment in social and role functioning may persist even with abatement of symptoms. A sub- stantial portion of individuals with the diagnosis will improve over time; many continue to have mild symptoms and impairment, and many others will have a full recovery.
Brief psychotic disorder. When symptoms of attenuated psychosis syndrome initially manifest, they may resemble symptoms of brief psychotic disorder. However, in attenu- ated psychosis syndrome, the symptoms do not cross the psychosis threshold and reality testing/insight remains intact.
Schizotypal personality disorder. Schizotypal personality disorder, although having symptomatic features that are similar to those of attenuated psychosis syndrome, is a rel- atively stable trait disorder not meeting the state-dependent aspects (Criterion C) of atten- uated psychosis syndrome. In addition, a broader array of symptoms is required for schizotypal personality disorder, although in the early stages of presentation it may re- semble attenuated psychosis syndrome.
Depressive or bipolar disorders. Reality distortions that are temporally limited to an episode of a major depressive disorder or bipolar disorder and are descriptively more characteristic of those disorders do not meet Criterion E for attenuated psychosis syn- drome. For example, feelings of low self—esteem or attributions of low regard from others in the context of major depressive disorder would not qualify for comorbid attenuated psychosis syndrome.
Anxiety disorders. Reality distortions that are temporally limited to an episode of an anxiety disorder and are descriptively more characteristic of an anxiety disorder do not meet Criterion E for attenuated psychosis syndrome. For example, a feeling of being the focus of undesired attention in the context of social anXiety disorder would not qualify for comorbid attenuated psychosis syndrome.
Bipolar || disorder. Reality distortions that are temporally limited to an episode of ma- nia or hypomania and are descriptively more characteristic of bipolar disorder do not meet
Criterion E for attenuated psychosis syndrome. For example, inflated self—esteem in the context of pressured speech and reduced need for sleep would not qualify for comorbid at- tenuated psychosis syndrome.
Borderline personality disorder. Reality distortions that are concomitant with border- line personality disorder and are descriptively more characteristic of it do not meet Crite- rion E for attenuated psychosis syndrome. For example, a sense of being unable to experience feelings in the context of an intense fear of real or imagined abandonment and recurrent self—mutilation would not qualify for comorbid attenuated psychosis syndrome.
Adjustment reaction of adolescence. Mild, transient symptoms typical of normal de- velopment and consistent with the degree of stress experienced do not qualify for attenu- ated psychosis syndrome.
Extreme end of perceptual aberration and magical thinking in the non-ill population.
This diagnostic possibility should be strongly entertained when reality distortions are not associated with distress and functional impairment and need for care.
Substance/medication-induced psychotic disorder. Substance use is common among individuals whose symptoms meet attenuated psychosis syndrome criteria. When other- wise qualifying characteristic symptoms are strongly temporally related to substance use episodes, Criterion E for attenuated psychosis syndrome may not be met, and a diagnosis
Attention-deficit/hyperactivity disorder. A history of attentional impairment does not exclude a Current attenuated psychosis syndrome diagnosis. Earlier attentional impair- ment may be a prodromal condition or comorbid attention-deficit/hyperactivity disorder.