Premorbid adjustment profiles in psychosis and the role of familial factors.

Abstract

Disease heterogeneity in patients with psychotic disorder may be explained by distinct profiles of premorbid adjustment. The current study explored premorbid adjustment profiles in patients with psychotic disorders, associations with cognitive and clinical characteristics after disease onset, and the role of familial factors. A total of 666 patients with psychosis (predominantly schizophrenia), 673 siblings, 575 parents, and 585 controls were included in this study. Cluster analyses were performed on the patients' scores of the Premorbid Adjustment Scale (PAS), using information on domains (social, academic) and age epochs (childhood, early adolescence, late adolescence). Resulting profiles were compared with characteristics in patients and their unaffected relatives. Six clusters, labeled normal, social intermediate, academic decline, overall decline, overall intermediate, and overall impaired adjustment, were identified in patients. Patients in different clusters differed from each other on cognitive, clinical, and functional characteristics after disease onset. Heterogeneity in the patient population may be explained in part by the adjustment profile prior to disease onset. This is in line with theories that propose different etiologies in the development of psychosis. Patient profiles were expressed in unaffected siblings, suggesting a role for familial factors.

Premorbid academic and social functioning in patients with schizophrenia and its associations with negative symptoms and cognition

“…Unaffected relatives also differed from healthy controls, although to a lesser extent than patients, by showing a poorer early adjustment only for the academic domain and independently of the age period, as well as a slightly greater frequency of poor early adjustment. These findings, in line with those of other studies exploring early adjustment in patients' relatives (4)(5)(6)(7)(8)64), support the hypothesis that poor early adjustment may represent a marker of vulnerability to schizophrenia.…”

“…In line with the neurodevelopmental hypothesis of schizophrenia, a poor premorbid adjustment has been widely reported in individuals affected by the disorder (1)(2)(3). Moreover, an impairment of functioning in early epochs of life has been described in unaffected relatives of patients with schizophrenia as compared to healthy controls (4)(5)(6)(7)(8).…”

Premorbid adjustment trajectories in schizophrenia and bipolar disorder: A transdiagnostic cluster analysis

“…Those with a declining social course had fewer friends and greater negative symptoms after disease onset, and those with worse childhood academic adjustment achieved less education and had poorer working memory. Quee et al (2014) identified six clusters based on social and academic PMA, ranging from "normal" to "overall impaired." Horton et al (2015) found three clusters of PMA trajectories in a sample of first-episode patients.…”

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

“…Another important question is whether childhood trauma acts on its own or whether other risk factors moderate or mediate its effect on premorbid adjustment. Other risk factors include, amongst others, obstetric complications [18], neurological soft signs, substance abuse [18] and a family history of the illness [19]. …”