Social Functioning in Urban, Predominantly African American, Socially Disadvantaged Patients With First-Episode Nonaffective Psychosis

Abstract

Background-Social functioning impairments develop and accumulate even prior to initial treatment-seeking for first-episode psychosis. This study, the first to examine social functioning in low-income, urban, predominantly African American first-episode patients: (1) assesses the internal consistency of Social Functioning Scale (SFS) subscales in this relatively unique sample; (2) identifies demographic and clinical variables that may be predictive of poor social functioning in this particular population; and (3) assesses changes in SFS scores in a subsample re-assessed six months after initial hospitalization.Methods-109 participants (age, 23.1±4.7 years; 76.1% male; 89.9% African American) hospitalized for a first episode of nonaffective psychosis in an urban, public-sector setting were administered the SFS along with other clinical research instruments. 34 (31.2%) returned for a followup clinical research assessment six months after baseline assessment. Associations between the variables of interest were analyzed utilizing independent samples Student's t-tests and Pearson correlations.Results-Associations were observed between social functioning domains and negative symptoms (r=−.21-−.32, p<.05), depressive symptoms (r=−.20-−.23, p<.05), and general psychopathology symptoms (r=−.23-−.24, p<.05). No significant differences were found in SFS subscale scores between baseline and six-month follow-up.Conclusions-Deficits in social functioning are meaningfully related to several domains of symptoms, and such deficits may be relatively stable in the early course of psychotic disorders. Such findings may inform development of psychosocial interventions targeting social functioning in firstepisode patients.

The impact of premorbid adjustment, neurocognition, and depression on social and role functioning in patients in an early psychosis treatment program

“…The absence of a negative symptoms measure or a more comprehensive instrument to assess psychotic symptoms is a fourth limitation. Though positive psychotic symptoms are not thought to be as predictive of functional improvement compared to other variables measured here, there is substantial evidence that negative symptoms are more strongly linked to functioning than positive symptoms in EP samples (Gorna et al, 2008;Goulding et al, 2010;Milev et al, 2005;Monte et al, 2008). PREP R recently introduced the Brief Psychiatric Rating Scale (Lukoff et al, 1986) to the clinical battery, in part, to address this limitation in future studies.…”

“…Depression often predates psychotic symptoms and can be an early signal of declining social functioning (Häfner et al, 1999;Cornblatt et al, 2003). Significant social functioning-depression associations have been observed in several EP studies (Chudleigh et al, 2011;Gorna et al, 2008;Goulding et al, 2010). In one study, scores on a depression scale predicted social functioning up to six years after initial screenings in 74 EP subjects (Gorna et al, 2008).…”

“…Several studies have assessed change in functioning in EP outside of specialized treatment programs (Austin et al, 2013;Goulding et al, 2010), whereas others have compared changes in functioning between samples receiving EP specific interventions with those receiving treatment as usual (Baksheev et al, 2012;Petersen et al, 2005).…”