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Two-year follow-up of a Chinese sample at clinical high risk for psychosis: timeline of symptoms, help-seeking and conversion

  • T. H. Zhang (a1), H. J. Li (a2) (a3), K. A. Woodberry (a3), L. H. Xu (a1), Y. Y. Tang (a1), Q. Guo (a1), H. R. Cui (a1), X. H. Liu (a1), A. Chow (a4), C. B. Li (a1), K. D. Jiang (a1), Z. P. Xiao (a1), L. J. Seidman (a3) and J. J. Wang (a1) (a5)...



Chinese psychiatrists have gradually started to focus on those who are deemed to be at ‘clinical high-risk (CHR)’ for psychosis; however, it is still unknown how often those individuals identified as CHR from a different country background than previously studied would transition to psychosis. The objectives of this study are to examine baseline characteristics and the timing of symptom onset, help-seeking, or transition to psychosis over a 2-year period in China.


The presence of CHR was determined with the Structured Interview for Prodromal Syndromes (SIPS) at the participants' first visit to the mental health services. A total of 86 (of 117) CHR participants completed the clinical follow-up of at least 2 years (73.5%). Conversion was determined using the criteria of presence of psychotic symptoms (in SIPS). Analyses examined baseline demographic and clinical predictors of psychosis and trajectory of symptoms over time. Survival analysis (Kaplan–Meier) methods along with Log-rank tests were performed to illustrate the relationship of baseline data to either conversion or non-conversion over time. Cox regression was performed to identify baseline predictors of conversion by the 2-year follow-up.


In total 25 (29.1%) of 86 completers transitioned to a psychotic disorder over the course of follow-up. Among the CHR sample, the mean time between attenuated symptom onset and professional help-seeking was about 4 months on average, and converters developed fully psychotic symptoms about 12 months after symptom onset. Compared with those CHR participants whose risk syndromes remitted over the course of the study, converters had significantly longer delays (p = 0.029) for their first visit to a professional in search of help. At baseline assessment, the conversion subgroup was younger, had poorer functioning, higher total SIPS positive symptom scores, longer duration of untreated prodromal symptoms, and were more often given psychosis-related diagnoses and subsequently prescribed antipsychotics in the clinic.


Chinese CHR identified primarily by a novel clinical screening approach had a 2-year transition rate comparable with those of specialised help-seeking samples world-wide. Early clinical intervention with this functionally deteriorating clinical population who are suffering from attenuated psychotic symptoms, is a next step in applying the CHR construct in China.


Corresponding author

*Address for correspondence: J. J. Wang, Shanghai Key Laboratory of Psychotic Disorders (No.13dz2260500), Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Bio-X Institutes, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, Shanghai 200030, PR China. (Email: L. J. Seidman, Harvard Medical School Department of Psychiatry, Beth Israel Deaconess Medical Center, 75 Fenwood Rd, Boston, Massachusetts 02115, USA. (Email:


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Aas, IH (2010). Global assessment of functioning (GAF): properties and frontier of current knowledge. Annals of General Psychiatry 9, 20.
Addington, J, Cadenhead, KS, Cannon, TD, Cornblatt, B, McGlashan, TH, Perkins, DO, Seidman, LJ, Tsuang, M, Walker, EF, Woods, SW, Heinssen, R (2007). North American Prodrome Longitudinal Study: a collaborative multisite approach to prodromal schizophrenia research. Schizophrenia Bulletin 33, 665672.
Addington, J, Cornblatt, BA, Cadenhead, KS, Cannon, TD, McGlashan, TH, Perkins, DO, Seidman, LJ, Tsuang, MT, Walker, EF, Woods, SW, Heinssen, R (2011). At clinical high risk for psychosis: outcome for nonconverters. The American Journal of Psychiatry 168, 800805.
Addington, J, Liu, L, Buchy, L, Cadenhead, KS, Cannon, TD, Cornblatt, BA, Perkins, DO, Seidman, LJ, Tsuang, MT, Walker, EF, Woods, SW, Bearden, CE, Mathalon, DH, McGlashan, TH (2015). North American Prodrome Longitudinal Study (NAPLS 2): the prodromal symptoms. The Journal of Nervous and Mental Disease 203, 328335.
Broome, MR, Woolley, JB, Johns, LC, Valmaggia, LR, Tabraham, P, Gafoor, R, Bramon, E, McGuire, PK (2005). Outreach and support in south London (OASIS): implementation of a clinical service for prodromal psychosis and the at risk mental state. European Psychiatry 20, 372378.
Cannon, TD, Cadenhead, K, Cornblatt, B, Woods, SW, Addington, J, Walker, E, Seidman, LJ, Perkins, D, Tsuang, M, McGlashan, T, Heinssen, R (2008). Prediction of psychosis in youth at high clinical risk: a multisite longitudinal study in North America. Archives of General Psychiatry 65, 2837.
Fusar-Poli, P, Bonoldi, I, Yung, AR, Borgwardt, S, Kempton, MJ, Valmaggia, L, Barale, F, Caverzasi, E, McGuire, P (2012). Predicting psychosis: meta-analysis of transition outcomes in individuals at high clinical risk. Archives of General Psychiatry 69, 220229.
Larsen, TK, Friis, S, Haahr, U, Joa, I, Johannessen, JO, Melle, I, Opjordsmoen, S, Simonsen, E, Vaglum, P (2001). Early detection and intervention in first-episode schizophrenia: a critical review. Acta Psychiatrica Scandinavica 103, 323334.
Lemos-Giraldez, S, Vallina-Fernandez, O, Fernandez-Iglesias, P, Vallejo-Seco, G, Fonseca-Pedrero, E, Paino-Pineiro, M, Sierra-Baigrie, S, Garcia-Pelayo, P, Pedrejon-Molino, C, Alonso-Bada, S, Gutierrez-Perez, A, Ortega-Ferrandez, JA (2009). Symptomatic and functional outcome in youth at ultra-high risk for psychosis: a longitudinal study. Schizophrenia Research 115, 121129.
Loewy, RL, Bearden, CE, Johnson, JK, Raine, A, Cannon, TD (2005). The prodromal questionnaire (PQ): preliminary validation of a self-report screening measure for prodromal and psychotic syndromes. Schizophrenia Research 79, 117125.
McGlashan, T, Walsh, B, Woods, S (2010). The Psychosis-Risk Syndrome: Handbook for Diagnosis and Follow-up. Oxford University Press: New York.
Melle, I, Larsen, TK, Haahr, U, Friis, S, Johannessen, JO, Opjordsmoen, S, Simonsen, E, Rund, BR, Vaglum, P, McGlashan, T (2004). Reducing the duration of untreated first-episode psychosis: effects on clinical presentation. Archives of General Psychiatry 61, 143150.
Miller, TJ, McGlashan, TH, Rosen, JL, Somjee, L, Markovich, PJ, Stein, K, Woods, SW (2002). Prospective diagnosis of the initial prodrome for schizophrenia based on the Structured Interview for Prodromal Syndromes: preliminary evidence of interrater reliability and predictive validity. The American Journal of Psychiatry 159, 863865.
Miller, TJ, McGlashan, TH, Rosen, JL, Cadenhead, K, Cannon, T, Ventura, J, McFarlane, W, Perkins, DO, Pearlson, GD, Woods, SW (2003). Prodromal assessment with the structured interview for prodromal syndromes and the scale of prodromal symptoms: predictive validity, interrater reliability, and training to reliability. Schizophrenia Bulletin 29, 703715.
Milne, BJ, Caspi, A, Crump, R, Poulton, R, Rutter, M, Sears, MR, Moffitt, TE (2009). The validity of the family history screen for assessing family history of mental disorders. American Journal of Medical Genetics. Part B, Neuropsychiatric Genetics 150B, 4149.
Nelson, B, Yuen, HP, Wood, SJ, Lin, A, Spiliotacopoulos, D, Bruxner, A, Broussard, C, Simmons, M, Foley, DL, Brewer, WJ, Francey, SM, Amminger, GP, Thompson, A, McGorry, PD, Yung, AR (2013). Long-term follow-up of a group at ultra high risk (“prodromal”) for psychosis: the PACE 400 study. JAMA Psychiatry 70, 793802.
Perkins, DO, Gu, H, Boteva, K, Lieberman, JA (2005). Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: a critical review and meta-analysis. The American Journal of Psychiatry 162, 17851804.
Rajji, TK, Mulsant, BH (2008). Nature and course of cognitive function in late-life schizophrenia: a systematic review. Schizophrenia Research 102, 122140.
Raven, M, Stuart, GW, Jureidini, J (2012). ‘Prodromal’ diagnosis of psychosis: ethical problems in research and clinical practice. The Australian and New Zealand Journal of Psychiatry 46, 6465.
Roy, MA, Walsh, D, Kendler, KS (1996). Accuracies and inaccuracies of the family history method: a multivariate approach. Acta Psychiatrica Scandinavica 93, 224234.
Schultze-Lutter, F, Ruhrmann, S, Berning, J, Maier, W, Klosterkotter, J (2010). Basic symptoms and ultrahigh risk criteria: symptom development in the initial prodromal state. Schizophrenia Bulletin 36, 182191.
Simon, AE, Umbricht, D (2010). High remission rates from an initial ultra-high risk state for psychosis. Schizophrenia Research 116, 168172.
Solis, M (2014). Prevention: before the break. Nature 508, S12S13.
Thompson, A, Nelson, B, Yung, A (2011). Predictive validity of clinical variables in the “at risk” for psychosis population: international comparison with results from the North American Prodrome Longitudinal Study. Schizophrenia Research 126, 5157.
van der Gaag, M, Smit, F, Bechdolf, A, French, P, Linszen, DH, Yung, AR, McGorry, P, Cuijpers, P (2013). Preventing a first episode of psychosis: meta-analysis of randomized controlled prevention trials of 12 month and longer-term follow-ups. Schizophrenia Research 149, 5662.
van der Werf, M, Hanssen, M, Kohler, S, Verkaaik, M, Verhey, FR, van Winkel, R, van Os, J, Allardyce, J (2014). Systematic review and collaborative recalculation of 133,693 incident cases of schizophrenia. Psychological Medicine 44, 916.
Velthorst, E, Nieman, DH, Becker, HE, van de Fliert, R, Dingemans, PM, Klaassen, R, de Haan, L, van Amelsvoort, T, Linszen, DH (2009). Baseline differences in clinical symptomatology between ultra high risk subjects with and without a transition to psychosis. Schizophrenia Research 109, 6065.
Woods, SW, Walsh, BC, Addington, J, Cadenhead, KS, Cannon, TD, Cornblatt, BA, Heinssen, R, Perkins, DO, Seidman, LJ, Tarbox, SI, Tsuang, MT, Walker, EF, McGlashan, TH (2014). Current status specifiers for patients at clinical high risk for psychosis. Schizophrenia Research 158, 6975.
Yung, AR, Phillips, LJ, Yuen, HP, McGorry, PD (2004). Risk factors for psychosis in an ultra high-risk group: psychopathology and clinical features. Schizophrenia Research 67, 131142.
Yung, AR, Yuen, HP, McGorry, PD, Phillips, LJ, Kelly, D, Dell'Olio, M, Francey, SM, Cosgrave, EM, Killackey, E, Stanford, C, Godfrey, K, Buckby, J (2005). Mapping the onset of psychosis: the comprehensive assessment of at-risk mental states. The Australian and New Zealand Journal of Psychiatry 39, 964971.
Yung, AR, Nelson, B, Stanford, C, Simmons, MB, Cosgrave, EM, Killackey, E, Phillips, LJ, Bechdolf, A, Buckby, J, McGorry, PD (2008). Validation of “prodromal” criteria to detect individuals at ultra high risk of psychosis: 2 year follow-up. Schizophrenia Research 105, 1017.
Zhang, T, Li, H, Woodberry, KA, Seidman, LJ, Zheng, L, Zhao, S, Tang, Y, Guo, Q, Lu, X, Zhuo, K, Qian, Z, Chow, A, Li, C, Jiang, K, Xiao, Z, Wang, J (2014). Prodromal psychosis detection in a counseling center population in China: an epidemiological and clinical study. Schizophrenia Research 152, 391399.
Zheng, L, Wang, J, Zhang, T, Li, H, Li, C, Jiang, K (2012). The Chinese version of the SIPS/SOPS: a pilot study of reliability and validity. Chinese Mental Health Journal 26, 571576.
Ziermans, TB, Schothorst, PF, Sprong, M, van Engeland, H (2011). Transition and remission in adolescents at ultra-high risk for psychosis. Schizophrenia Research 126, 5864.


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Two-year follow-up of a Chinese sample at clinical high risk for psychosis: timeline of symptoms, help-seeking and conversion

  • T. H. Zhang (a1), H. J. Li (a2) (a3), K. A. Woodberry (a3), L. H. Xu (a1), Y. Y. Tang (a1), Q. Guo (a1), H. R. Cui (a1), X. H. Liu (a1), A. Chow (a4), C. B. Li (a1), K. D. Jiang (a1), Z. P. Xiao (a1), L. J. Seidman (a3) and J. J. Wang (a1) (a5)...


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