Attenuated Psychosis Syndromes Among Youth and Young Adults in China: Early Identification and Intervention

  • Tianhong Zhang
  • Daniel I. Shapiro
  • Jijun Wang


Attenuated psychosis syndromes (APS) is defined as a high-risk state with an increased probability of developing a frank psychosis. It is crucial to investigate psychosis risk states in Chinese youth, including APS, in order to better understand characteristic features like psychotic-spectrum symptoms and the complexity of an individual’s real-life experience. In 2012, the “Shanghai At Risk for Psychosis (SHARP)” program was launched at the Shanghai Mental Health Center (SMHC), the largest outpatient mental health clinic in China. Here, we present both epidemiological data from this program and offer an APS case to illustrate the complexity and some common features of APS in China.


Ultrahigh risk Clinical high risk Prodromal psychosis Cultural complexity Chinese elements Outcome 


  1. Addington, J., Cadenhead, K. S., Cannon, T. D., Cornblatt, B., McGlashan, T. H., Perkins, D. O., … Heinssen, R. (2007). North American Prodrome Longitudinal Study: A collaborative multisite approach to prodromal schizophrenia research. Schizophrenia Bulletin, 33(3), 665–672.PubMedPubMedCentralGoogle Scholar
  2. Addington, J., Cornblatt, B. A., Cadenhead, K. S., Cannon, T. D., McGlashan, T. H., Perkins, D. O., … Heinssen, R. (2011). At clinical high risk for psychosis: Outcome for nonconverters. American Journal of Psychiatry, 168(8), 800–805.PubMedGoogle Scholar
  3. Addington, J., Epstein, I., Liu, L., French, P., Boydell, K. M., & Zipursky, R. B. (2011). A randomized controlled trial of cognitive behavioral therapy for individuals at clinical high risk of psychosis. Schizophrenia Research, 125(1), 54–61.PubMedGoogle Scholar
  4. Allen, P., Chaddock, C. A., Howes, O. D., Egerton, A., Seal, M. L., Fusar-Poli, P., … McGuire, P. K. (2012). Abnormal relationship between medial temporal lobe and subcortical dopamine function in people with an ultra high risk for psychosis. Schizophrenia Bulletin, 38(5), 1040–1049.PubMedGoogle Scholar
  5. Amminger, G. P., Schafer, M. R., Papageorgiou, K., Klier, C. M., Cotton, S. M., Harrigan, S. M., … Berger, G. E. (2010). Long-chain omega-3 fatty acids for indicated prevention of psychotic disorders: A randomized, placebo-controlled trial. Archives of General Psychiatry, 67(2), 146–154.PubMedGoogle Scholar
  6. Bechdolf, A., Wagner, M., Ruhrmann, S., Harrigan, S., Putzfeld, V., Pukrop, R., … Klosterkotter, J. (2012). Preventing progression to first-episode psychosis in early initial prodromal states. British Journal of Psychiatry, 200(1), 22–29.PubMedGoogle Scholar
  7. Cannon, T. D., Cadenhead, K., Cornblatt, B., Woods, S. W., Addington, J., Walker, E., … Heinssen, R. (2008). Prediction of psychosis in youth at high clinical risk: A multisite longitudinal study in North America. Archives of General Psychiatry, 65(1), 28–37.PubMedPubMedCentralGoogle Scholar
  8. Cannon, T. D., Yu, C., Addington, J., Bearden, C. E., Cadenhead, K. S., Cornblatt, B. A., … Kattan, M. W. (2016). An individualized risk calculator for research in prodromal psychosis. American Journal of Psychiatry, 173(10), 980–988.PubMedGoogle Scholar
  9. Faraone, S. V., Chen, W. J., Goldstein, J. M., & Tsuang, M. T. (1994). Gender differences in age at onset of schizophrenia. The British Journal of Psychiatry, 164(5), 625–629.PubMedGoogle Scholar
  10. Fusar-Poli, P., Byrne, M., Valmaggia, L., Day, F., Tabraham, P., Johns, L., & McGuire, P. (2010). Social dysfunction predicts two years clinical outcome in people at ultra high risk for psychosis. Journal of Psychiatry Research, 44(5), 294–301.Google Scholar
  11. Fusar-Poli, P., Byrne, M., Badger, S., Valmaggia, L. R., & McGuire, P. K. (2012). Outreach and support in South London (OASIS), 2001–2011: Ten years of early diagnosis and treatment for young individuals at high clinical risk for psychosis. European Psychiatry, 28(5), 315–326.PubMedGoogle Scholar
  12. Hafner, H., Maurer, K., Loffler, W., & Riecher-Rossler, A. (1993). The influence of age and sex on the onset and early course of schizophrenia. British Journal of Psychiatry, 162, 80–86.PubMedGoogle Scholar
  13. Kline, E., Thompson, E., Schimunek, C., Reeves, G., Bussell, K., Pitts, S. C., & Schiffman, J. (2013). Parent-adolescent agreement on psychosis risk symptoms. Schizophrenia Research, 147(1), 147–152.PubMedGoogle Scholar
  14. Klosterkotter, J., Hellmich, M., Steinmeyer, E. M., & Schultze-Lutter, F. (2001). Diagnosing schizophrenia in the initial prodromal phase. Archives of General Psychiatry, 58(2), 158–164.PubMedGoogle Scholar
  15. Koutsouleris, N., Davatzikos, C., Bottlender, R., Patschurek-Kliche, K., Scheuerecker, J., Decker, P., … Meisenzahl, E. M. (2012). Early recognition and disease prediction in the at-risk mental states for psychosis using neurocognitive pattern classification. Schizophreia Bulletin, 38(6), 1200–1215.Google Scholar
  16. Loewy, R. L., Bearden, C. E., Johnson, J. K., Raine, A., & Cannon, T. D. (2005). The prodromal questionnaire (PQ): Preliminary validation of a self-report screening measure for prodromal and psychotic syndromes. Schizophrenia Research, 79(1), 117–125.PubMedGoogle Scholar
  17. Miller, T. J., McGlashan, T. H., Woods, S. W., Stein, K., Driesen, N., Corcoran, C. M., … Davidson, L. (1999). Symptom assessment in schizophrenic prodromal states. Psychiatric Quarterly, 70(4), 273–287.PubMedGoogle Scholar
  18. Miller, T. J., McGlashan, T. H., Rosen, J. L., Somjee, L., Markovich, P. J., Stein, K., & Woods, S. W. (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. American Journal of Psychiatry, 159(5), 863–865.PubMedGoogle Scholar
  19. Miller, T. J., McGlashan, T. H., Rosen, J. L., Cadenhead, K., Cannon, T., Ventura, J., … Woods, S. W. (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(4), 703–715.PubMedGoogle Scholar
  20. Morrison, A. P., Stewart, S. L., French, P., Bentall, R. P., Birchwood, M., Byrne, R., … Dunn, G. (2011). Early detection and intervention evaluation for people at high-risk of psychosis-2 (EDIE-2): Trial rationale, design and baseline characteristics. Early Intervention in Psychiatry, 5(1), 24–32.PubMedGoogle Scholar
  21. Nelson, B., Yuen, K., & Yung, A. R. (2011). Ultra high risk (UHR) for psychosis criteria: Are there different levels of risk for transition to psychosis? Schizophrenia Research, 125(1), 62–68.PubMedGoogle Scholar
  22. Rauchensteiner, S., Kawohl, W., Ozgurdal, S., Littmann, E., Gudlowski, Y., Witthaus, H., … Juckel, G. (2011). Test-performance after cognitive training in persons at risk mental state of schizophrenia and patients with schizophrenia. Psychiatry Research, 185(3), 334–339.PubMedGoogle Scholar
  23. 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(1), 182–191.PubMedGoogle Scholar
  24. Shim, G., Kang, D. H., Choi, J. S., Jung, M. H., Kwon, S. J., Jang, G. E., & Kwon, J. S. (2008). Prospective outcome of early intervention for individuals at ultra-high-risk for psychosis. Early Intervention in Psychiatry, 2(4), 277–284.PubMedGoogle Scholar
  25. Simon, A. E., & Umbricht, D. (2010). High remission rates from an initial ultra-high risk state for psychosis. Schizophrenia Research, 116(2–3), 168–172.PubMedGoogle Scholar
  26. Simon, A. E., Velthorst, E., Nieman, D. H., Linszen, D., Umbricht, D., & de Haan, L. (2012). Ultra high-risk state for psychosis and non-transition: A systematic review. Schizophrenia Research, 132(1), 8–17.Google Scholar
  27. Walker, E. F., Cornblatt, B. A., Addington, J., Cadenhead, K. S., Cannon, T. D., McGlashan, T. H., … Heinssen, R. (2009). The relation of antipsychotic and antidepressant medication with baseline symptoms and symptom progression: A naturalistic study of the North American Prodrome Longitudinal Sample. Schizophrenia Research, 115(1), 50–57.PubMedPubMedCentralGoogle Scholar
  28. Wang, L., Shi, J., Chen, F., Yao, Y., Zhan, C., Yin, X., … Zhao, X. (2015). Family perception and 6-month symptomatic and functioning outcomes in young adolescents at clinical high risk for psychosis in a general population in China. PLoS One, 10(9), e0138361.PubMedPubMedCentralGoogle Scholar
  29. Xu, L., Zhang, T., & Wang, J. (2015). Psychosis risk syndrome is not prodromal psychosis. Shanghai Archives of Psychiatry, 27(1), 42–44.PubMedPubMedCentralGoogle Scholar
  30. Yung, A. R., Phillips, L. J., McGorry, P. D., McFarlane, C. A., Francey, S., Harrigan, S., … Jackson, H. J. (1998). Prediction of psychosis. A step towards indicated prevention of schizophrenia. British Journal of Psychiatry Supplement, 172(33), 14–20.Google Scholar
  31. Yung, A. R., Yuen, H. P., McGorry, P. D., Phillips, L. J., Kelly, D., Dell’Olio, M., … Buckby, J. (2005). Mapping the onset of psychosis: The Comprehensive Assessment of At-Risk Mental States. Australian and New Zealand Journal of Psychiatry, 39(11–12), 964–971.PubMedGoogle Scholar
  32. Yung, A. R., Buckby, J. A., Cosgrave, E. M., Killackey, E. J., Baker, K., Cotton, S. M., & McGorry, P. D. (2007). Association between psychotic experiences and depression in a clinical sample over 6 months. Schizophrenia Research, 91(1–3), 246–253.PubMedGoogle Scholar
  33. Yung, A. R., McGorry, P. D., Francey, S. M., Nelson, B., Baker, K., Phillips, L. J., … Amminger, G. P. (2007). PACE: A specialised service for young people at risk of psychotic disorders. Medical Journal of Australia, 187(7 Suppl), S43–S46.PubMedGoogle Scholar
  34. Yung, A. R., Yuen, H. P., Berger, G., Francey, S., Hung, T. C., Nelson, B., … McGorry, P. (2007). Declining transition rate in ultra high risk (prodromal) services: Dilution or reduction of risk? Schizophrenia Bulletin, 33(3), 673–681.PubMedPubMedCentralGoogle Scholar
  35. Zhang, T., Li, H., Woodberry, K. A., Seidman, L. J., Zheng, L., Li, H., … Wang, J. (2014). Prodromal psychosis detection in a counseling center population in China: An epidemiological and clinical study. Schizophrenia Research, 152(2–3), 391–399.PubMedGoogle Scholar
  36. Zhang, T., Li, H., Stone, W. S., Woodberry, K. A., Seidman, L. J., Tang, Y., … Wang, J. (2015). Neuropsychological impairment in prodromal, first-episode, and chronic psychosis: Assessing RBANS performance. PLoS One, 10(5), e0125784.PubMedPubMedCentralGoogle Scholar
  37. Zhang, T., Li, H., Woodberry, K. A., Seidman, L. J., Chow, A., Xiao, Z., & Wang, J. (2015). Interaction of social role functioning and coping in people with recent-onset attenuated psychotic symptoms: A case study of three Chinese women at clinical high risk for psychosis. Neuropsychiatry Disease and Treatment, 11, 1647–1654.Google Scholar
  38. Zhang, T., Yi, Z., Li, H., Cui, H., Tang, Y., Lu, X., … Wang, J. (2016). Faux pas recognition performance in a help-seeking population at clinical high risk of psychosis. European Archives of Psychiatry and Clinical Neuroscience, 266(1), 71–78.PubMedGoogle Scholar
  39. 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(8), 571–576.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Tianhong Zhang
    • 1
  • Daniel I. Shapiro
    • 2
  • Jijun Wang
    • 1
  1. 1.Shanghai Mental Health Center, Shanghai Key Laboratory of Psychotic DisordersShanghai Jiaotong University School of MedicineShanghaiPeople’s Republic of China
  2. 2.Department of PsychiatryEarly Psychosis Programs, University of California-DavisSacramentoUSA

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