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

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 psycho...

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Bibliographic Details
Published in:Epidemiology and psychiatric sciences 2017-06, Vol.26 (3), p.287-298
Main Authors: Zhang, T. H., Li, H. J., Woodberry, K. A., Xu, L. H., Tang, Y. Y., Guo, Q., Cui, H. R., Liu, X. H., Chow, A., Li, C. B., Jiang, K. D., Xiao, Z. P., Seidman, L. J., Wang, J. J.
Format: Article
Language:English
Subjects:
Adult
Ambulatory Care
China
Conversion
Demographics
Disease Progression
Female
Follow-Up Studies
Health risks
Help seeking behavior
Humans
Original
Original Articles
Prodromal Symptoms
Psychiatry
Psychosis
Psychotic Disorders - diagnosis
Psychotic Disorders - ethnology
Psychotic Disorders - physiopathology
Rank tests
Risk Factors
Schizophrenia - diagnosis
Schizophrenia - physiopathology
Survival Analysis
Time Factors
Young Adult
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Summary: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.
ISSN:2045-7960
2045-7979
DOI:10.1017/S2045796016000184