title: Two-year follow-up of a Chinese sample at clinical high risk for psychosis: timeline of symptoms, help-seeking and conversion.
abstract: 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.
authors.affiliation: Shanghai Key Laboratory of Psychotic Disorders (No.13dz2260500),Shanghai Mental Health Center,Shanghai Jiaotong University School of Medicine,Shanghai 200030,PR China.
authors.forename: T H
authors.initials: TH
authors.lastname: Zhang
authors.affiliation: Department of Psychology,Florida A & M University,Tallahassee,Florida 32307,USA.
authors.forename: H J
authors.initials: HJ
authors.lastname: Li
authors.affiliation: Harvard Medical School Department of Psychiatry,Beth Israel Deaconess Medical Center,75 Fenwood Rd,Boston,Massachusetts 02115,USA.
authors.forename: K A
authors.initials: KA
authors.lastname: Woodberry
authors.affiliation: Shanghai Key Laboratory of Psychotic Disorders (No.13dz2260500),Shanghai Mental Health Center,Shanghai Jiaotong University School of Medicine,Shanghai 200030,PR China.
authors.forename: L H
authors.initials: LH
authors.lastname: Xu
authors.affiliation: Shanghai Key Laboratory of Psychotic Disorders (No.13dz2260500),Shanghai Mental Health Center,Shanghai Jiaotong University School of Medicine,Shanghai 200030,PR China.
authors.forename: Y Y
authors.initials: YY
authors.lastname: Tang
authors.affiliation: Shanghai Key Laboratory of Psychotic Disorders (No.13dz2260500),Shanghai Mental Health Center,Shanghai Jiaotong University School of Medicine,Shanghai 200030,PR China.
authors.forename: Q
authors.initials: Q
authors.lastname: Guo
authors.affiliation: Shanghai Key Laboratory of Psychotic Disorders (No.13dz2260500),Shanghai Mental Health Center,Shanghai Jiaotong University School of Medicine,Shanghai 200030,PR China.
authors.forename: H R
authors.initials: HR
authors.lastname: Cui
authors.affiliation: Shanghai Key Laboratory of Psychotic Disorders (No.13dz2260500),Shanghai Mental Health Center,Shanghai Jiaotong University School of Medicine,Shanghai 200030,PR China.
authors.forename: X H
authors.initials: XH
authors.lastname: Liu
authors.affiliation: Department of Psychological Medicine,Changi General Hospital,Singapore.
authors.forename: A
authors.initials: A
authors.lastname: Chow
authors.affiliation: Shanghai Key Laboratory of Psychotic Disorders (No.13dz2260500),Shanghai Mental Health Center,Shanghai Jiaotong University School of Medicine,Shanghai 200030,PR China.
authors.forename: C B
authors.initials: CB
authors.lastname: Li
authors.affiliation: Shanghai Key Laboratory of Psychotic Disorders (No.13dz2260500),Shanghai Mental Health Center,Shanghai Jiaotong University School of Medicine,Shanghai 200030,PR China.
authors.forename: K D
authors.initials: KD
authors.lastname: Jiang
authors.affiliation: Shanghai Key Laboratory of Psychotic Disorders (No.13dz2260500),Shanghai Mental Health Center,Shanghai Jiaotong University School of Medicine,Shanghai 200030,PR China.
authors.forename: Z P
authors.initials: ZP
authors.lastname: Xiao
authors.affiliation: Harvard Medical School Department of Psychiatry,Beth Israel Deaconess Medical Center,75 Fenwood Rd,Boston,Massachusetts 02115,USA.
authors.forename: L J
authors.initials: LJ
authors.lastname: Seidman
authors.affiliation: Shanghai Key Laboratory of Psychotic Disorders (No.13dz2260500),Shanghai Mental Health Center,Shanghai Jiaotong University School of Medicine,Shanghai 200030,PR China.
authors.forename: J J
authors.initials: JJ
authors.lastname: Wang
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D002681:China; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D000066505:Help-Seeking Behavior; D006801:Humans; D062706:Prodromal Symptoms; D011618:Psychotic Disorders / Q000175:diagnosis / Q000208:ethnology / Q000503:physiopathology*; D012307:Risk Factors; D012559:Schizophrenia / Q000175:diagnosis / Q000503:physiopathology*; D016019:Survival Analysis; D013997:Time Factors; D055815:Young Adult
keywords: Outpatient psychiatry; psychosis; risk factors; schizophrenia