Abstract
BackgroundTo investigate a 3-stage screening procedure and explore the clinical features of subjects at Clinical High Risk (CHR) for psychosis in a representative sample of Chinese college students.MethodsAn epidemiological survey of the prevalence of the CHR syndrome in Chinese college students that was selected by stratified random sampling from Shanghai, Nanjing and Nanchang cities was done following a 3-stage procedure. Participants were initially screened with the Prodromal Questionnaire-brief version (PQ-B), and whose distress score of PQ-B exceeded 24 would be invited to a telephone assessment using the subscale for positive symptoms of the Scale of Prodromal Symptoms (SOPS)/Structured Interview for Prodromal Syndromes (SIPS). Lastly, participants who scored 3 or higher in any item of the subscale would be administered with the SIPS interview conducted by trained researchers to confirm the diagnosis of CHR syndrome.ResultsTwenty-three thousand sixty-three college students completed the survey during September 2017 to October 2018. Seventy-two students were diagnosed as CHR subjects, and the detection rate in the total sample was 0.3%. The peak age range for the first diagnosis of CHR was 17 to 20 years. Thirteen and forty-six were set as the cutoff points of PQ-B total score and distress score to balance the greatest sensitivity and specificity. Binary logistic regression revealed that 8 items in PQ-B showed significant distinction for detecting CHR subjects.ConclusionsThe 3-stage screening method can be utilized in the detection of CHR subjects for psychosis in the general population, during which delusional ideas, perceptual abnormalities and suspiciousness deserve great attention.
Highlights
To investigate a 3-stage screening procedure and explore the clinical features of subjects at Clinical High Risk (CHR) for psychosis in a representative sample of Chinese college students
CHR subjects refer to individuals who are identified as having nonspecific symptoms and attenuated or intermittent psychotic symptoms, schizotypal personality traits or having asymptomatic genetic risks, but do not meet criteria for a syndromal psychosis, and thereby they are considered to be at increased risk for developing psychotic disorders [4, 8]
Fusar-Poli et al [9] reported that 20–35% CHR subjects developed syndromal psychotic disorder in 2 years through a meta-analysis, and Zhang et al [10] discovered that the transition rate in the first 2 years was 26.4% in a Chinese help-seeking sample, both of which indicated that the risk of developing psychosis in CHR subjects deserved serious attention
Summary
To investigate a 3-stage screening procedure and explore the clinical features of subjects at Clinical High Risk (CHR) for psychosis in a representative sample of Chinese college students. As a series of studies of first-episode psychosis suggests that longer duration of untreated psychosis significantly correlates with worse treatment response and prognosis [5], global researchers and clinicians have reached a consensus that early detection and prevention is central to contain the development and burden of psychosis. They started to investigate whether there is an earlier period in the development of psychosis that can be detected before the break, and gave birth to the concept of ultra-high risk (UHR) or clinical high risk (CHR) for psychosis [6, 7]. Since the instruments listed above are based on the clinician’s assessments through clinical interviews, several self-report scales have been established to simplify the screening of CHR individuals, such as Prodromal Questionnaire-Brief version (PQ-B) [16], Prodromal Questionnaire-16 items (PQ-16) [17], Prime Screen [18] and Early Psychosis Screener (EPS) [19, 20]
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