Distinct patterns of premorbid social functioning in first-episode psychosis: Relationship to initial presentation

Abstract

Objective:

To explore different longitudinal patterns of social functioning before onset of psychotic illness and how they relate to clinical presentation, substance use and acute treatment response.

Methods:

Inclusion criteria: Drug-naïve first-episode psychosis, 18-50 yo, criteria for Schizophrenia or Other Psychotic Disorders (DSM-IV), excluding Psychotic Disorder due to a General Medical Condition and Substance-Induced Psychotic Disorder.

Exclusion criteria:

Mental Retardation, neurological disease, brain injury or drug dependence.

Measures:

Premorbid Adjustment Scale (PAS), Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms (SANS).

Statistical analysis:

Ward cluster analyses were carried out to differentiate three longitudinal patterns of social premorbid adjustment from childhood to late adolescence: stable good (N=75), stable bad (N=44) and deteriorating (N=35). Chi-square and ANOVA tests were used.

Results:

154 subjects (64.5% male, mean age 26.81, SD=6.98) participated in the study.

At baseline the socially stable good group had more positive symptoms, SAPS 13.85 (3.99), than the stable bad group, SAPS 11.82 (3.93) (p=0.023).

At six weeks post-treatment the socially deteriorating group had more negative symptoms, SANS 8 (4.89), than the stable good, SANS 3.85 (4.11), and the stable bad, SANS 5.23 (5.45) (p=0.000).

The stable good group had the highest rates of substance use, followed by the deteriorating group.

Conclusions:

A good premorbid social life was related to higher substance use and more positive symptoms at presentation. A social deteriorating pattern was associated with more negative symptoms at baseline and six weeks post-treatment. These differences would argue for different pathogeneses of psychosis.