Poor social and interpersonal functioning prior to diagnosis predicts poor outcome for people with first episode psychosis

摘要

Premorbid functioning is an important factor in first episode psychosis (FEPj. Some people who develop schizophrenia do not have severe problems with either social or academic functioning prior to the onset of the psychosis, however the majority do. The Premorbid Adjustment Scale (PAS) developed by Canon-Spoor divides the premorbid phase into childhood, early and late adolescence, and adulthood, and it takes the duration of untreated psychosis into consideration.In the study by Addington and Addington 194 patients with FEP were assessed using the PAS and cluster analysis was used to detect patterns of premorbid functioning. Twenty nine per cent of the sample had stable-good premorbid functioning indicating that they had no marked problems in social or school functioning at all, even though they developed psychosis later in life. A group of people with deteriorating premorbid adjustment was identified and this group had more symptoms at 1 year (positive and negative symptoms) and 2 year follow up (negative symptoms) compared with the stable-good premorbid functioning group.In a Scandinavian study we found that PAS could be meaningfully divided into two domains-social and academic. Within each domain we identified similar patterns as described by Addington and Addington. Those with a stable premorbid social course compared with a deteriorating one had a shorter duration of untreated psychosis, were older, had more friends, and fewer negative symptoms. Good childhood academic function correlated with more education, more meaningful activities, and better working memory.Taken together, these studies emphasise the importance of measuring premorbid adjustment for the planning of rehabilitation services. They also make it clear that we need more research on the underlying biopsychosocial causes of schizophrenia. Seen from the premorbid point of view, the syndrome of psychosis is not only heterogeneous regarding symptom formation at baseline and outcome, but also on its precursors.