A comparison of conversion rates, clinical profiles and predictors of outcomes in two independent samples of individuals at clinical high risk for psychosis in China

Abstract

Objective: In a previous epidemiological study, we reported on the ascertainment and outcomes of "clinical high risk" (CHR) individuals at the Shanghai Mental Health Center (SMHC, "2011 cohort"). The current study compares demographic and clinical characteristics, including conversion rates, of this sample with a subsequently recruited, independent CHR sample and with published data from western samples.

Method: A new sample of 100 CHR subjects ("2013 cohort") was selected based on screening and semi-structured interviews. Both studies used the Structured Interview for Prodromal Syndromes (SIPS) for CHR assessment and conducted a naturalistic two-year follow-up. The two cohorts were compared on conversion rates, demographic and clinical characteristics, psychosis risk symptoms, and risk factors for psychotic conversion.

Results: Ninety one (91%) of the 2013 cohort subjects completed the clinical two-year follow-up and 25 (27.5% of the 91) converted to a psychotic disorder over the follow-up period. A comparison of conversions to full psychosis between the 2013 and the 2011 cohorts showed no significant difference in time to conversion (Pairwise comparison: χ2=0.3, p=0.562). Both cohort studies showed that CHR subjects with more severe clinical symptoms at baseline and decline in functioning were more likely to convert to psychosis.

Conclusions: Conversion rates in this new, independent Chinese sample are similar to those reported in non-Chinese samples and to the 2011 cohort. Future research is needed to examine whether the implementation of early intervention for CHR/prodromal symptoms reduces the risk of psychosis and decreases the conversion rate.

Keywords: Clinical high risk; Conversion rates; Prodromal psychosis.

Conflict of interest statement

Competing financial interests

The authors report no biomedical financial interests or potential conflicts of interest.

Copyright © 2017 Elsevier B.V. All rights reserved.

Figures

Fig. 1

Kaplan–Meyer survival curves for conversions to psychosis between 2011-cohort and 2013-cohort. Note: Converters classified with certainty and non-converters were “censored”.

Fig. 2

Summarized profile of risk factors for psychosis onset from CHR sample in the 2011- and 2013-cohorts. Note: P symptoms: positive symptoms; P1: unusual thought content/delusional symptom; D symptoms: disorganized symptoms. The overlap between the ovals represents the consistency of identified predictive factors between the two cohorts.