Subthreshold psychiatry

Are we in need of including in our diagnostic systems a new category of subthreshold psychiatry? Studies have shown that we are faced in our daily clinical practice with many patients who do not fulfil the criteria of either ICD-10 or DSM-IV (at best they may be included under ‘atypical’, ‘unspecified’ or ‘not elsewhere classified’). Subthreshold cases or prodromal psychotic or non-psychotic clinical cases are encountered frequently in clinical practice, especially primary care (Knappe et al, 2008), but because of some ethical and nosological issues their needs are unmet. Pharmacological interventions for such conditions are denied in some countries, especially with managed care, where maximisation of profit and minimisation of cost are often the main objectives. It has been reported that the early treatment of many disorders ensures a better outcome and better assimilation in society and reduces residual manifestations of disease. Recent data suggest that the impairment and disability caused by subsyndromal disorders are almost equal to those caused by syndromal ones. We need more scientific data and research studies to evaluate the course, outcome and value of treating such disorders.