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The onset and offset of psychosis – and what happens in between

A commentary on ‘Reappraising the long-term course and outcome of psychotic disorders: the AESOP-10 Study’ by Morgan et al. (2014)

Published online by Cambridge University Press:  06 June 2014

J. J. McGrath ,
J. Miettunen ,
E. Jääskeläinen  and
F. Dark
J. J. McGrath*
Affiliation:
Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia Queensland Brain Institute, University of Queensland, St Lucia, QLD, Australia
J. Miettunen
Affiliation:
Department of Psychiatry, University of Oulu and Oulu University Hospital, Oulu, Finland Institute of Health Sciences, University of Oulu, Oulu, Finland Medical Research Centre, University of Oulu and Oulu University Hospital, Oulu, Finland
E. Jääskeläinen
Affiliation:
Department of Psychiatry, University of Oulu and Oulu University Hospital, Oulu, Finland Medical Research Centre, University of Oulu and Oulu University Hospital, Oulu, Finland
F. Dark
Affiliation:
Rehabilitation Academic Clinical Unit, Metro South Mental Health Services, McGregor, QLD, Australia
*
* Address for correspondence: J. J. McGrath, Queensland Brain Institute, University of Queensland, St Lucia, QLD 4072, Australia. (Email: [email protected])
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Abstract

As one would expect for a heterogeneous syndrome like schizophrenia, at the individual level the course of symptoms and disability vary widely. Mindful that the definition of recovery/remission varies widely between studies, a recent systematic review and meta-analysis reported that the proportion of those with schizophrenia who recover on both symptom and functional outcome is modest (approximately 14%). A 10-year follow-up of the English multicentre AESOP incidence study provides more ‘fine-grained’ insights into the time course of symptom fluctuation for schizophrenia and other psychotic disorders. We highlight selected findings from the new study and speculate on the role of different outcome domains for future study (e.g. symptom, occupational/functional, cognition, physical health, patient-nominated outcomes). Because recovery is a multifaceted process, we need to develop a panel of practical and operationalizable criteria for remission and recovery.

Keywords

Epidemiologyfirst-episode psychosisrecoveryremissionschizophrenia
Type
Commentary
Information
Psychological Medicine , Volume 44 , Issue 13 , October 2014 , pp. 2705 - 2711
Copyright
Copyright © Cambridge University Press 2014 

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References

Aleman, A, Kahn, RS, Selten, JP (2003). Sex differences in the risk of schizophrenia: evidence from meta-analysis. Archives of General Psychiatry 60, 565–571.CrossRefGoogle ScholarPubMed
Andreasen, NC, Carpenter, WT Jr, Kane, JM, Lasser, RA, Marder, SR, Weinberger, DR (2005). Remission in schizophrenia: proposed criteria and rationale for consensus. American Journal of Psychiatry 162, 441–449.CrossRefGoogle ScholarPubMed
Barak, Y, Bleich, A, Aizenberg, D (2010). Psychosocial remission in schizophrenia: developing a clinician-rated scale. Comprehensive Psychiatry 51, 94–98.Google Scholar
Beary, M, Hodgson, R, Wildgust, HJ (2012). A critical review of major mortality risk factors for all-cause mortality in first-episode schizophrenia: clinical and research implications. Journal of Psychopharmacology 26, 52–61.Google Scholar
Ben-Zeev, D, Brenner, CJ, Begale, M, Duffecy, J, Mohr, DC, Mueser, KT (2014). Feasibility, acceptability, and preliminary efficacy of a smartphone intervention for schizophrenia. Schizophrenia Bulletin. Published online 19 03 2014 . doi:10.1093/schbul/sbu033.Google Scholar
Bergen, SE, O'Dushlaine, CT, Lee, PH, Fanous, AH, Ruderfer, DM, Ripke, S, International Schizophrenia Consortium, Swedish Schizophrenia Consortium, Sullivan, PF, Smoller, JW, Purcell, SM, Corvin, A (2014). Genetic modifiers and subtypes in schizophrenia: investigations of age at onset, severity, sex and family history. Schizophrenia Research 154, 48–53.Google Scholar
Bushe, CJ, Taylor, M, Haukka, J (2010). Mortality in schizophrenia: a measurable clinical endpoint. Journal of Psychopharmacology 24, 17–25.CrossRefGoogle ScholarPubMed
Cantor-Graae, E, Selten, JP (2005). Schizophrenia and migration: a meta-analysis and review. American Journal of Psychiatry 162, 12–24.Google Scholar
Cohen, A, Patel, V, Thara, R, Gureje, O (2008). Questioning an axiom: better prognosis for schizophrenia in the developing world? Schizophrenia Bulletin 34, 229–244.Google Scholar
Emsley, R, Chiliza, B, Asmal, L, Lehloenya, K (2011). The concepts of remission and recovery in schizophrenia. Current Opinions in Psychiatry 24, 114–121.Google Scholar
Faerden, A, Nesvag, R, Marder, SR (2008). Definitions of the term ‘recovered’ in schizophrenia and other disorders. Psychopathology 41, 271–278.CrossRefGoogle ScholarPubMed
Fearon, P, Kirkbride, JB, Morgan, C, Dazzan, P, Morgan, K, Lloyd, T, Hutchinson, G, Tarrant, J, Fung, WL, Holloway, J, Mallett, R, Harrison, G, Leff, J, Jones, PB, Murray, RM (2006). Incidence of schizophrenia and other psychoses in ethnic minority groups: results from the MRC AESOP Study. Psychological Medicine 36, 1541–1550.Google Scholar
Ferrari, AJ, Saha, S, McGrath, JJ, Norman, R, Baxter, AJ, Vos, T, Whiteford, HA (2012). Health states for schizophrenia and bipolar disorder within the Global Burden of Disease 2010 Study. Population Health Metrics 10, 16.Google Scholar
Fries, JF (2005). Frailty, heart disease, and stroke: the Compression of Morbidity paradigm. American Journal of Preventive Medicine 29, 164–168.CrossRefGoogle ScholarPubMed
Haro, JM, Novick, D, Bertsch, J, Karagianis, J, Dossenbach, M, Jones, PB (2011). Cross-national clinical and functional remission rates: Worldwide Schizophrenia Outpatient Health Outcomes (W-SOHO) study. British Journal of Psychiatry 199, 194–201.CrossRefGoogle ScholarPubMed
Harrison, G, Hopper, K, Craig, T, Laska, E, Siegel, C, Wanderling, J, Dube, KC, Ganev, K, Giel, R, an der Heiden, W, Holmberg, SK, Janca, A, Lee, PW, Leon, CA, Malhotra, S, Marsella, AJ, Nakane, Y, Sartorius, N, Shen, Y, Skoda, C, Thara, R, Tsirkin, SJ, Varma, VK, Walsh, D, Wiersma, D (2001). Recovery from psychotic illness: a 15- and 25-year international follow-up study. British Journal of Psychiatry 178, 506–517.Google Scholar
Harvey, PD (2014). Disability in schizophrenia: contributing factors and validated assessments. Journal of Clinical Psychiatry 75 (Suppl. 1), 15–20.Google Scholar
Harvey, PD, Bellack, AS (2009). Toward a terminology for functional recovery in schizophrenia: is functional remission a viable concept? Schizophrenia Bulletin 35, 300–306.Google Scholar
Harvey, PD, Heaton, RK, Carpenter, WT Jr, Green, MF, Gold, JM, Schoenbaum, M (2012). Functional impairment in people with schizophrenia: focus on employability and eligibility for disability compensation. Schizophrenia Research 140, 1–8.Google Scholar
Hegarty, JD, Baldessarini, RJ, Tohen, M, Waternaux, C, Oepen, G (1994). One hundred years of schizophrenia: a meta-analysis of the outcome literature. American Journal of Psychiatry 151, 1409–1416.Google Scholar
International First Episode Vocational Recovery (iFEVR) Group (2010). Meaningful lives: supporting young people with psychosis in education, training and employment: an international consensus statement. Early Intervention Psychiatry 4, 323–326.Google Scholar
Jaaskelainen, E, Juola, P, Hirvonen, N, McGrath, JJ, Saha, S, Isohanni, M, Veijola, J, Miettunen, J (2013). A systematic review and meta-analysis of recovery in schizophrenia. Schizophrenia Bulletin 39, 1296–1306.CrossRefGoogle ScholarPubMed
Jablensky, A, Sartorius, N, Ernberg, G, Anker, M, Korten, A, Cooper, JE, Day, R, Bertelsen, A (1992). Schizophrenia: manifestations, incidence and course in different cultures. A World Health Organization ten-country study. Psychological Medicine Monograph Supplement 20, 1–97.CrossRefGoogle ScholarPubMed
Jauhar, S, McKenna, PJ, Radua, J, Fung, E, Salvador, R, Laws, KR (2014). Cognitive–behavioural therapy for the symptoms of schizophrenia: systematic review and meta-analysis with examination of potential bias. British Journal of Psychiatry 204, 20–29.Google Scholar
Karow, A, Moritz, S, Lambert, M, Schottle, D, Naber, D (2012). Remitted but still impaired? Symptomatic versus functional remission in patients with schizophrenia. European Psychiatry 27, 401–405.Google Scholar
Khandaker, GM, Barnett, JH, White, IR, Jones, PB (2011). A quantitative meta-analysis of population-based studies of premorbid intelligence and schizophrenia. Schizophrenia Research 132, 220–227.Google Scholar
Kirkbride, JB, Fearon, P, Morgan, C, Dazzan, P, Morgan, K, Tarrant, J, Lloyd, T, Holloway, J, Hutchinson, G, Leff, JP, Mallett, RM, Harrison, GL, Murray, RM, Jones, PB (2006). Heterogeneity in incidence rates of schizophrenia and other psychotic syndromes: findings from the 3-center AeSOP study. Archives of General Psychiatry 63, 250–258.CrossRefGoogle ScholarPubMed
Kohane, IS, Drazen, JM, Campion, EW (2012). A glimpse of the next 100 years in medicine. New England Journal of Medicine 367, 2538–2539.Google Scholar
Lang, FU, Kosters, M, Lang, S, Becker, T, Jager, M (2013). Psychopathological long-term outcome of schizophrenia – a review. Acta Psychiatrica Scandinavica 127, 173–182.Google Scholar
Leucht, S, Lasser, R (2006). The concepts of remission and recovery in schizophrenia. Pharmacopsychiatry 39, 161–170.Google Scholar
Liberman, RP, Kopelowicz, A (2005). Recovery from schizophrenia: a concept in search of research. Psychiatric Services 56, 735–742.Google Scholar
Marder, SR (2011). Lessons from MATRICS. Schizophrenia Bulletin 37, 233–234.CrossRefGoogle ScholarPubMed
McGrath, J (2008). Dissecting the heterogeneity of schizophrenia outcomes. Schizophrenia Bulletin 34, 247–248.Google Scholar
McGrath, J, Saha, S, Chant, D, Welham, J (2008). Schizophrenia: a concise overview of incidence, prevalence, and mortality. Epidemiologic Reviews 30, 67–76.Google Scholar
McGrath, J, Saha, S, Welham, J, El Saadi, O, MacCauley, C, Chant, D (2004). A systematic review of the incidence of schizophrenia: the distribution of rates and the influence of sex, urbanicity, migrant status and methodology. BMC Medicine 2, 13.Google Scholar
McGrath, JJ (2007). The surprisingly rich contours of schizophrenia epidemiology. Archives of General Psychiatry 64, 14–16.Google Scholar
Medalia, A, Saperstein, AM (2013). Does cognitive remediation for schizophrenia improve functional outcomes? Current Opinions in Psychiatry 26, 151–157.Google Scholar
Menezes, NM, Arenovich, T, Zipursky, RB (2006). A systematic review of longitudinal outcome studies of first-episode psychosis. Psychological Medicine 36, 1349–1362.CrossRefGoogle ScholarPubMed
Morgan, C, Kirkbride, J, Hutchinson, G, Craig, T, Morgan, K, Dazzan, P, Boydell, J, Doody, GA, Jones, PB, Murray, RM, Leff, J, Fearon, P (2008). Cumulative social disadvantage, ethnicity and first-episode psychosis: a case–control study. Psychological Medicine 38, 1701–1715.Google Scholar
Morgan, C, Lappin, J, Heslin, M, Donoghue, K, Lomas, B, Reininghaus, U, Onyejiaka, A, Croudace, T, Jones, PB, Murray, RM, Fearon, P, Doody, GA, Dazzan, P (2014). Reappraising the long-term course and outcome of psychotic disorders: the AESOP-10 Study. Psychological Medicine. Published online: 26 02 2014 . doi:10.1017/S0033291714000282.Google ScholarPubMed
Morgan, VA, Jablensky, AV (2010). From inventory to benchmark: quality of psychiatric case registers in research. British Journal of Psychiatry 197, 8–10.Google Scholar
Mowry, BJ, Gratten, J (2013). The emerging spectrum of allelic variation in schizophrenia: current evidence and strategies for the identification and functional characterization of common and rare variants. Molecular Psychiatry 18, 38–52.Google Scholar
Murray, CJ, Vos, T, Lozano, R, Naghavi, M, Flaxman, AD, Michaud, C, Ezzati, M, Shibuya, K, Salomon, JA, Abdalla, S, Aboyans, V, Abraham, J, Ackerman, I, Aggarwal, R, Ahn, SY, Ali, MK, Alvarado, M, Anderson, HR, Anderson, LM, Andrews, KG, Atkinson, C, Baddour, LM, Bahalim, AN, Barker-Collo, S, Barrero, LH, Bartels, DH, Basanez, MG, Baxter, A, Bell, ML, Benjamin, EJ, Bennett, D, Bernabe, E, Bhalla, K, Bhandari, B, Bikbov, B, Bin Abdulhak, A, Birbeck, G, Black, JA, Blencowe, H, Blore, JD, Blyth, F, Bolliger, I, Bonaventure, A, Boufous, S, Bourne, R, Boussinesq, M, Braithwaite, T, Brayne, C, Bridgett, L, Brooker, S, Brooks, P, Brugha, TS, Bryan-Hancock, C, Bucello, C, Buchbinder, R, Buckle, G, Budke, CM, Burch, M, Burney, P, Burstein, R, Calabria, B, Campbell, B, Canter, CE, Carabin, H, Carapetis, J, Carmona, L, Cella, C, Charlson, F, Chen, H, Cheng, AT, Chou, D, Chugh, SS, Coffeng, LE, Colan, SD, Colquhoun, S, Colson, KE, Condon, J, Connor, MD, Cooper, LT, Corriere, M, Cortinovis, M, de Vaccaro, KC, Couser, W, Cowie, BC, Criqui, MH, Cross, M, Dabhadkar, KC, Dahiya, M, Dahodwala, N, Damsere-Derry, J, Danaei, G, Davis, A, De Leo, D, Degenhardt, L, Dellavalle, R, Delossantos, A, Denenberg, J, Derrett, S, Des Jarlais, DC, Dharmaratne, SD, Dherani, M, Diaz-Torne, C, Dolk, H, Dorsey, ER, Driscoll, T, Duber, H, Ebel, B, Edmond, K, Elbaz, A, Ali, SE, Erskine, H, Erwin, PJ, Espindola, P, Ewoigbokhan, SE, Farzadfar, F, Feigin, V, Felson, DT, Ferrari, A, Ferri, CP, Fevre, EM, Finucane, MM, Flaxman, S, Flood, L, Foreman, K, Forouzanfar, MH, Fowkes, FG, Fransen, M, Freeman, MK, Gabbe, BJ, Gabriel, SE, Gakidou, E, Ganatra, HA, Garcia, B, Gaspari, F, Gillum, RF, Gmel, G, Gonzalez-Medina, D, Gosselin, R, Grainger, R, Grant, B, Groeger, J, Guillemin, F, Gunnell, D, Gupta, R, Haagsma, J, Hagan, H, Halasa, YA, Hall, W, Haring, D, Haro, JM, Harrison, JE, Havmoeller, R, Hay, RJ, Higashi, H, Hill, C, Hoen, B, Hoffman, H, Hotez, PJ, Hoy, D, Huang, JJ, Ibeanusi, SE, Jacobsen, KH, James, SL, Jarvis, D, Jasrasaria, R, Jayaraman, S, Johns, N, Jonas, JB, Karthikeyan, G, Kassebaum, N, Kawakami, N, Keren, A, Khoo, JP, King, CH, Knowlton, LM, Kobusingye, O, Koranteng, A, Krishnamurthi, R, Laden, F, Lalloo, R, Laslett, LL, Lathlean, T, Leasher, JL, Lee, YY, Leigh, J, Levinson, D, Lim, SS, Limb, E, Lin, JK, Lipnick, M, Lipshultz, SE, Liu, W, Loane, M, Ohno, SL, Lyons, R, Mabweijano, J, MacIntyre, MF, Malekzadeh, R, Mallinger, L, Manivannan, S, Marcenes, W, March, L, Margolis, DJ, Marks, GB, Marks, R, Matsumori, A, Matzopoulos, R, Mayosi, BM, McAnulty, JH, McDermott, MM, McGill, N, McGrath, J, Medina-Mora, ME, Meltzer, M, Mensah, GA, Merriman, TR, Meyer, AC, Miglioli, V, Miller, M, Miller, TR, Mitchell, PB, Mock, C, Mocumbi, AO, Moffitt, TE, Mokdad, AA, Monasta, L, Montico, M, Moradi-Lakeh, M, Moran, A, Morawska, L, Mori, R, Murdoch, ME, Mwaniki, MK, Naidoo, K, Nair, MN, Naldi, L, Narayan, KM, Nelson, PK, Nelson, RG, Nevitt, MC, Newton, CR, Nolte, S, Norman, P, Norman, R, O'Donnell, M, O'Hanlon, S, Olives, C, Omer, SB, Ortblad, K, Osborne, R, Ozgediz, D, Page, A, Pahari, B, Pandian, JD, Rivero, AP, Patten, SB, Pearce, N, Padilla, RP, Perez-Ruiz, F, Perico, N, Pesudovs, K, Phillips, D, Phillips, MR, Pierce, K, Pion, S, Polanczyk, GV, Polinder, S, Pope, CA 3rd, Popova, S, Porrini, E, Pourmalek, F, Prince, M, Pullan, RL, Ramaiah, KD, Ranganathan, D, Razavi, H, Regan, M, Rehm, JT, Rein, DB, Remuzzi, G, Richardson, K, Rivara, FP, Roberts, T, Robinson, C, De Leon, FR, Ronfani, L, Room, R, Rosenfeld, LC, Rushton, L, Sacco, RL, Saha, S, Sampson, U, Sanchez-Riera, L, Sanman, E, Schwebel, DC, Scott, JG, Segui-Gomez, M, Shahraz, S, Shepard, DS, Shin, H, Shivakoti, R, Singh, D, Singh, GM, Singh, JA, Singleton, J, Sleet, DA, Sliwa, K, Smith, E, Smith, JL, Stapelberg, NJ, Steer, A, Steiner, T, Stolk, WA, Stovner, LJ, Sudfeld, C, Syed, S, Tamburlini, G, Tavakkoli, M, Taylor, HR, Taylor, JA, Taylor, WJ, Thomas, B, Thomson, WM, Thurston, GD, Tleyjeh, IM, Tonelli, M, Towbin, JA, Truelsen, T, Tsilimbaris, MK, Ubeda, C, Undurraga, EA, van der Werf, MJ, van Os, J, Vavilala, MS, Venketasubramanian, N, Wang, M, Wang, W, Watt, K, Weatherall, DJ, Weinstock, MA, Weintraub, R, Weisskopf, MG, Weissman, MM, White, RA, Whiteford, H, Wiebe, N, Wiersma, ST, Wilkinson, JD, Williams, HC, Williams, SR, Witt, E, Wolfe, F, Woolf, AD, Wulf, S, Yeh, PH, Zaidi, AK, Zheng, ZJ, Zonies, D, Lopez, AD, AlMazroa, MA, Memish, ZA (2012). Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380, 2197–2223.Google Scholar
Saha, S, Chant, D, McGrath, J (2007). A systematic review of mortality in schizophrenia: is the differential mortality gap worsening over time? Archives of General Psychiatry 64, 1123–1131.Google Scholar
Salomon, JA, Vos, T, Hogan, DR, Gagnon, M, Naghavi, M, Mokdad, A, Begum, N, Shah, R, Karyana, M, Kosen, S, Farje, MR, Moncada, G, Dutta, A, Sazawal, S, Dyer, A, Seiler, J, Aboyans, V, Baker, L, Baxter, A, Benjamin, EJ, Bhalla, K, Bin Abdulhak, A, Blyth, F, Bourne, R, Braithwaite, T, Brooks, P, Brugha, TS, Bryan-Hancock, C, Buchbinder, R, Burney, P, Calabria, B, Chen, H, Chugh, SS, Cooley, R, Criqui, MH, Cross, M, Dabhadkar, KC, Dahodwala, N, Davis, A, Degenhardt, L, Diaz-Torne, C, Dorsey, ER, Driscoll, T, Edmond, K, Elbaz, A, Ezzati, M, Feigin, V, Ferri, CP, Flaxman, AD, Flood, L, Fransen, M, Fuse, K, Gabbe, BJ, Gillum, RF, Haagsma, J, Harrison, JE, Havmoeller, R, Hay, RJ, Hel-Baqui, A, Hoek, HW, Hoffman, H, Hogeland, E, Hoy, D, Jarvis, D, Karthikeyan, G, Knowlton, LM, Lathlean, T, Leasher, JL, Lim, SS, Lipshultz, SE, Lopez, AD, Lozano, R, Lyons, R, Malekzadeh, R, Marcenes, W, March, L, Margolis, DJ, McGill, N, McGrath, J, Mensah, GA, Meyer, AC, Michaud, C, Moran, A, Mori, R, Murdoch, ME, Naldi, L, Newton, CR, Norman, R, Omer, SB, Osborne, R, Pearce, N, Perez-Ruiz, F, Perico, N, Pesudovs, K, Phillips, D, Pourmalek, F, Prince, M, Rehm, JT, Remuzzi, G, Richardson, K, Room, R, Saha, S, Sampson, U, Sanchez-Riera, L, Segui-Gomez, M, Shahraz, S, Shibuya, K, Singh, D, Sliwa, K, Smith, E, Soerjomataram, I, Steiner, T, Stolk, WA, Stovner, LJ, Sudfeld, C, Taylor, HR, Tleyjeh, IM, van der Werf, MJ, Watson, WL, Weatherall, DJ, Weintraub, R, Weisskopf, MG, Whiteford, H, Wilkinson, JD, Woolf, AD, Zheng, ZJ, Murray, CJ, Jonas, JB (2012). Common values in assessing health outcomes from disease and injury: disability weights measurement study for the Global Burden of Disease Study 2010. Lancet 380, 2129–2143.Google Scholar
van Os, J, Burns, T, Cavallaro, R, Leucht, S, Peuskens, J, Helldin, L, Bernardo, M, Arango, C, Fleischhacker, W, Lachaux, B, Kane, JM (2006). Standardized remission criteria in schizophrenia. Acta Psychiatrica Scandinavica 113, 91–95.Google Scholar
Velligan, DI, Fredrick, M, Mintz, J, Li, X, Rubin, M, Dube, S, Deshpande, SN, Trivedi, JK, Gautam, S, Avasthi, A, Kern, RS, Marder, SR (2013). The reliability and validity of the MATRICS Functional Assessment Battery. Schizophrenia Bulletin. Published online 9 11 2013 . doi:10.1093/schbul/sbt148.Google Scholar
Wunderink, L, Nieboer, RM, Wiersma, D, Sytema, S, Nienhuis, FJ (2013). Recovery in remitted first-episode psychosis at 7 years of follow-up of an early dose reduction/discontinuation or maintenance treatment strategy: long-term follow-up of a 2-year randomized clinical trial. JAMA Psychiatry 70, 913–920.Google Scholar
Wykes, T, Reeder, C, Huddy, V, Taylor, R, Wood, H, Ghirasim, N, Kontis, D, Landau, S (2012). Developing models of how cognitive improvements change functioning: mediation, moderation and moderated mediation. Schizophrenia Research 138, 88–93.CrossRefGoogle ScholarPubMed
Yang, LH, Phillips, MR, Li, X, Yu, G, Zhang, J, Shi, Q, Song, Z, Ding, Z, Pang, S, Susser, E (2013). Employment outcome for people with schizophrenia in rural v. urban China: population-based study. British Journal of Psychiatry 203, 272–279.Google Scholar
Yung, AR, McGorry, PD (1996). The prodromal phase of first-episode psychosis: past and current conceptualizations. Schizophrenia Bulletin 22, 353–370.Google Scholar