Diagnostic specificity of poor premorbid adjustment: Comparison of schizophrenia, schizoaffective disorder, and mood disorder with psychotic features

Abstract

Individuals with schizophrenia have significant deficits in premorbid social and academic adjustment compared to individuals with non-psychotic diagnoses. However, it is unclear how severity and developmental trajectory of premorbid maladjustment compare across psychotic disorders. This study examined the association between premorbid functioning (in childhood, early adolescence, and late adolescence) and psychotic disorder diagnosis in a first-episode sample of 105 individuals: schizophrenia (n=68), schizoaffective disorder (n=22), and mood disorder with psychotic features (n=15). Social and academic maladjustment was assessed using the Cannon-Spoor Premorbid Adjustment Scale. Worse social functioning in late adolescence was associated with higher odds of schizophrenia compared to odds of either schizoaffective disorder or mood disorder with psychotic features, independently of child and early adolescent maladjustment. Greater social dysfunction in childhood was associated with higher odds of schizoaffective disorder compared to odds of schizophrenia. Premorbid decline in academic adjustment was observed for all groups, but did not predict diagnosis at any stage of development. Results suggest that social functioning is disrupted in the premorbid phase of both schizophrenia and schizoaffective disorder, but remains fairly stable in mood disorders with psychotic features. Disparities in the onset and time course of social dysfunction suggest important developmental differences between schizophrenia and schizoaffective disorder.

Heterogeneity of functional outcomes in patients with bipolar disorder: a cluster‐analytic approach

“…Future studies should consider the combination of subjective and objective measures to capture a more comprehensive picture of the patient outcomes . Moreover, the study of other characteristics that may be influencing functional outcomes such as premorbid social and academic adjustment , contextual factors and personality traits , social cognition and proxies of cognitive reserve would be of interest.…”

Factors Moderating the Relationship Between Childhood Trauma and Premorbid Adjustment in First-Episode Schizophrenia

“…an individual’s functioning across social and academic domains from childhood through to early adulthood prior to the onset of psychosis) has long been a focus of interest in schizophrenia research [2]. Deficits in premorbid adjustment are reported consistently as a precursor to schizophrenia [3], and as such provide supportive evidence for the neurodevelopmental model [4–5]. For example, poor social adjustment during childhood has been proposed as an early manifestation of impairment of developmental trajectories that evolve into deficits in social cognition and later into schizophrenia [6].…”

Social Functioning and Age Across Affective and Nonaffective Psychoses

“…While some have suggested that social functioning is similarly poor between individuals with non-affective or with affective psychosis (e.g., Bellack et al, 1989; Simonsen et al, 2010), others have reported that those with affective psychosis have significantly better social functioning (e.g., Tarbox et al, 2012). Given that older ages are associated with greater social dysfunction in both SZ (Gould et al, 2012; Mueser et al, 2010) and bipolar disorder with and without psychotic features (Depp et al, 2007; Mueser et al, 2010), one possible reason for discrepant findings is differing age ranges of participants across investigations.…”