Premorbid adjustment as predictor of outcome in schizophrenia: results of a prospective study (original) (raw)
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Premorbid adjustment in schizophrenia and schizoaffective disorder
Psychiatry research, 2009
There is evidence that premorbid adjustment can differentiate schizophrenia from schizoaffective disorder. We recruited 41 patients with schizophrenia and 24 patients with schizoaffective disorder without substance abuse 6 months before the assessment. Diagnoses were based on the Structured Clinical Interview for DSM-IV. Psychotic symptoms were rated with the Positive and Negative Syndrome Scale, the Calgary Depression Scale was used to assess depressive symptoms, and the Global Assessment of Functioning Scale was used to rate global psychosocial functioning. Premorbid adjustment was evaluated with the Premorbid Adjustment Scale. Patients with schizophrenia showed worse premorbid adjustment compared with the patients with schizoaffective disorder. The areas of "peer relationships" and "scholastic performance" showed deficits in schizophrenia. Significant associations were found between premorbid adjustment life periods and symptom severity in both groups. Differences found between groups may be related to an earlier illness onset in the schizophrenic group. Premorbid adjustment may be a useful clinical feature to differentiate schizoaffective disorder from schizophrenia.
The role of premorbid adjustment in schizophrenia: Focus on cognitive remediation outcome
Neuropsychological Rehabilitation, 2018
Premorbid adjustment has been associated with several outcomes in schizophrenia and has been proposed as an index of cognitive reserve. This study aims to comprehensively analyse the relation between premorbid adjustment and clinical, neurocognitive, socio-cognitive and functional assessments, as well as to investigate the effect of premorbid adjustment on cognitive improvements after a cognitive remediation therapy protocol. Seventy-nine clinically stabilised outpatients with schizophrenia underwent a combined intervention consisting of cognitive remediation therapy added to standard rehabilitation therapy. All patients were assessed at baseline for psychopathology, premorbid adjustment, intellectual level, cognition and functioning. Cognitive evaluations were also repeated after the intervention. At baseline, significant correlations were observed between premorbid adjustment and working memory. The global cognitive improvement after treatment was significantly predicted by age and premorbid adjustment. This study confirms the association between premorbid adjustment and cognitive impairment and is the first to highlight the possible role of premorbid adjustment on the capacity to recover from cognitive deficits through a cognitive remediation therapy protocol. The data suggest that cognitive remediation may be particularly effective for people in the early course and that the assessment of premorbid adjustment could be of value to design individualised interventions.
Schizophrenia Research, 2013
Background: The dimensionality of premorbid adjustment (PA) has been a debated issue, with attempts to determine whether PA is a unitary construct or composed of several independent domains characterized by a differential deterioration pattern and specific outcome correlates. Aims: This study examines the factorial structure of PA, as well as, the course and correlates of its domains. Method: Retrospective study of 84 adult patients experiencing first-episode psychosis (FEP) (n = 33) and individuals with schizophrenia (SCH) (n = 51). All patients were evaluated with a comprehensive battery of instruments including clinical, functioning and neuropsychological variables. A principal component analysis accompanied by a varimax rotation method was used to examine the factor structure of the PAS-S scale. Paired t tests and Wilcoxon rank tests were used to assess the changes in PAS domains over time. Bivariate correlation analyses were performed to analyse the relationship between PAS factors and clinical, social and cognitive variables. Results: PA was better explained by three factors (71.65% of the variance): Academic PA, Social PA and Socio-sexual PA. The academic domain showed higher scores of PA from childhood. Social and clinical variables were more strongly related to Social PA and Socio-sexual PA domains, and the Academic PA domain was exclusively associated with cognitive variables. Conclusion: This study supports previous evidence, emphasizing the validity of dividing PA into its sub-components. A differential deterioration pattern and specific correlates were observed in each PA domains, suggesting that impairments in each PA domain might predispose individuals to develop different expressions of psychotic dimensions.
Premorbid Adjustment in Schizophrenia - Implications for Psychosocial and Ventricular Pathology
Schizophrenia Research, 1994
Premorbid adjustment in schizophrenia is thought important (1) as a predictor of current pathology and course, and (2) as a psychosocial expression of brain pathology preceding psychosis. Its valid and reliable measurement, however, pose a major challenge. To address this issue we interviewed 12 chronic male schizophrenic veterans and their first degree relatives, plus 12 age and social class of origin matched normal controls and their relatives, using the Cannon-Spoor et al. Premorbid Adjustment Scale (PAS), for which we developed our own semi-structured interview. Objective data from school records were also obtained. Schizophrenic's PAS scores were significantly poorer, irrespective of whether PAS scores were based on information from subjects, first degree relatives or from 'combined sources'. PAS scores were worse at all developmental epochs, with a marked divergence beginning in late adolescence. Worse premorbid adjustment in schizophrenia was also highly correlated with current clinical state, more current negative symptoms, less independent living and longer duration of hospitalization. Additionally, worse premorbid adjustment in schizophrenia was associated with larger Magnetic Resonance (MR) Ventricular Brain Ratio (VBR) in an exploratory analysis using a subset of these patients. Premorbid adjustment, rigorously measured, is poorer in schizophrenics than in normal controls and correlates with psychosocial and ventricular pathology in schizophrenia.
Schizophrenia Bulletin, 2004
Impaired premorbid functioning prior to the onset of acute psychosis has frequently been noted in schizophrenia. This study examined retrospectively the premorbid status of patients in their first episode of psychosis in order to determine relationships with baseline symptoms, treatment response, and medication side effects. One hundred eleven schizophrenic and schizoaffective patients participating in a large prospective study of first episode schizophrenia were evaluated with the Premorbid Adjustment Scale (PAS). Premorbid functioning in males became progressively worse over time. Deficit state patients exhibited worse premorbid functioning. A third of patients exhibited sustained poor premorbid functioning. At various developmental stages, lower "sociability and withdrawal" scores correlated with increased time to treatment response, more severe negative symptoms, increased drug-induced parkinsonism, and deterioration of premorbid functioning. Various mean PAS scores predicted susceptibility to tardive dyskinesia. Our findings suggest that prior to acute psychosis onset there are certain behavioral precursors reflected in premorbid functioning that may predict subsequent illness manifestations. Measures of premorbid functioning indicate that disease pathogenesis is manifest, albeit more subtly, prior to presentation of first psychotic symptoms.
Schizophrenia research, 2012
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 hig...
Workshop on Factors Related to Premorbid Adjustment
Schizophrenia Bulletin, 1978
Participants at a 2-day NIMH workshop on Factors Related to Premorbid Adjustment agreed that research in the area has contributed substantially to the prediction of outcome in schizophrenia. But there was also consensus that continued use of the term "premorbid adjustment" might prove a barrier to further progress. Scales of premorbid adjustment, it was felt, had made a valuable contribution and ought now be replaced by an expanded scale of social functioning. By broadening their conceptual sights from a concentration on precursors of pathology to a consideration of schizophrenia within a larger developmental framework, the assembled researchers believed that understanding of the disorder would ultimately be enhanced.
Schizophrenia
Premorbid social and academic adjustment are important predictors of cognitive and functional performance in schizophrenia. Whether this relationship is also present in individuals at ultra-high risk (UHR) for psychosis is the focus of the present study. Using baseline data from a randomised clinical trial (N = 146) this study investigated associations between premorbid adjustment and neuro- and social cognition and functioning in UHR individuals aged 18–40 years. Patients were evaluated with the Premorbid Adjustment Scale (PAS) comprising a social and an academic domain. Using validated measures neurocognition was assessed in the domains of processing speed, executive function, attention, verbal learning and memory, visual learning and memory, and working memory along with estimated IQ. Social cognitive domains assessed were theory of mind, emotion recognition, and attributional bias. Functional assessment comprised the domains of social- and role functioning, functional capacity, ...
Iranian journal of psychiatry, 2010
Poor premorbid adjustment has been reported to be a predictor of more severe psychotic symptoms and poor quality of life in such psychotic disorders as schizophrenia. However, most studies were performed on chronic schizophrenic patients, and proposed the likelihood of recall biases and the effect of chronicity. The aim of this study was to investigate these factors in a sample of first episode psychotic patients, as a part of Roozbeh first episode psychosis project (RooF). Premorbid adjustment was assessed using Premorbid Adjustment Scale (PAS) in 48 patients with the first psychotic episode who were admitted to Roozbeh Psychiatric Hospital. The severity of symptoms was measured using Positive and Negative Scale (PANSS) in three subgroups of positive, negative and general subscales. Quality of life was measured using WHO QOL , and Global Assessment of Functioning (GAF) was also measured. The mean age was 24 years. Poor Premorbid adjustment in late adolescence was significantly asso...