This observational study sample was taken from the Shanghai Psychotherapy and Psychological Counseling Center (SPCC) at SMHC, which is China’s largest outpatient medication-management and psychotherapy providing mental health clinic. Participants were a consecutive series from the psychological counseling service setting according to the hospital register form. Exclusion criteria were: (i) severe somatic diseases, such as pneumonia, cancer, or heart failure (ii) mental retardation or (iii) dementia. Inclusion criteria were: (i) age of 14–45 years (ii) individuals younger than 18 years who were accompanied by either their parent or legal guardian (iii) capacity to provide informed consent and (iv) completed at least 6 years of primary education. ![]() The sampling approach, interviews, and follow-up methods have been published extensively elsewhere 6, 7. Those younger than 18 years of age provided assent and were signed up for the study by their parents, who provided consent. All participants provided written informed consent. In total, 511 participants with CHR (CHRs) were consecutively recruited based on a face-to-face interview during follow-up every 6 months without any extra intervention programs. All participants gave written informed consent at the recruitment stage of the study. The study was conducted following the tenets of the Helsinki Declaration and approved by the Research Ethics Committee of the SMHC in 2011. The current study was conducted at the Shanghai Mental Health Centre (SMHC). This large-scale follow-up study was designed to evaluate the potential of first-time experience of TCDs and/or PAs to predict psychosis. Because of these potentials, we hypothesized that the isolated PAs are less specific early symptoms than TCDs in predicting conversion to full psychosis. Currently, misconceptions exist in the public attitude and psychiatric practice toward hallucinations because there is no evidence to challenge the conventional opinion that confuses hallucinations with psychosis. However, none of the previous studies 4, 5 reported PAs as a valuable predictive factor in psychosis risk calculations. Unlike TCDs, which appear insidiously, PAs are more easily identified both by professionals and non-professional, and are often deemed as “insanity” resulting in extreme fear, misery, and stigma for those experiencing a hallucinatory state for the first time. Perceptual abnormalities (PAs), including auditory hallucinations, and thought content disorders (TCDs), including delusions, are the two most common symptoms that occur during the course of psychosis 1 in the early psychosis stage, these symptoms are identified as clinical high risk (CHR) 2, 3. Compared with TCDs, the isolated PAs are not strongly associated with increased susceptibility to psychosis. About 89% TCDs contents were related with their experienced PAs. CHRs with isolated PAs had shown a higher level of dysphoric mood at baseline compared with those with TCDs. Survival analysis revealed a higher conversion rate in CHRs with TCDs compared with those with PAs only. At the follow-up endpoint, 39 (19.9%) CHRs in the “TCDs-only” group, 2 (8.3%) in the “PAs-only” group, 45 (17.0%) in the “TCDs-and-PAs” group, and 1 (3.8%) in the “None” group converted to psychosis. ![]() CHRs were divided into four groups according to the presence of PAs and/or TCDs. ![]() A total of 511 CHRs were recruited, of whom 443 (86.7%) completed the clinical follow-up of at least 6 months and up to 2 years. Conversion to psychosis was the major focus of this follow-up study. In an ongoing prospective follow-up study of individuals at a clinical high risk (CHR) of psychosis, we evaluated the potential of first-time experience of PAs and/or thought content disorders (TCDs) to predict psychosis. However, it remains unclear whether symptoms of sub-clinical PAs also play a key role in predicting psychosis. Perceptual abnormalities (PAs) such as auditory hallucinations are one of the most common symptoms of psychotic patients.
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