Abstract
The study aimed to explore premorbid academic and social functioning in patients with schizophrenia, and its associations with the severity of negative symptoms and neurocognitive impairment. Premorbid adjustment (PA) in patients with schizophrenia was compared to early adjustment in unaffected first-degree relatives and healthy controls. Its associations with psychopathology, cognition, and real-life functioning were investigated. The associations of PA with primary negative symptoms and their two factors were explored. We found an impairment of academic and social PA in patients (P ≤ 0.000001) and an impairment of academic aspects of early adjustment in relatives (P ≤ 0.01). Patients with poor PA showed greater severity of negative symptoms (limited to avolition after excluding the effect of depression/parkinsonism), working memory, social cognition, and real-life functioning (P ≤ 0.01 to ≤0.000001). Worse academic and social PA were associated with greater severity of psychopathology, cognitive impairment, and real-life functioning impairment (P ≤ 0.000001). Regression analyses showed that worse PA in the academic domain was mainly associated to the impairment of working memory, whereas worse PA in the social domain to avolition (P ≤ 0.000001). Our findings suggest that poor early adjustment may represent a marker of vulnerability to schizophrenia and highlight the need for preventive/early interventions based on psychosocial and/or cognitive programs.
Highlights
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]
Group comparisons on demographic variables showed a higher frequency of male gender among patients (69.4%) with respect to both relatives and controls (42.9% and 48.4%, respectively; P ≤ 0.000001), an older age in relatives (55.0 Æ 13.7 years) with respect to patients and controls (40.2 Æ 10.7 and 40.5 Æ 12.5 years, respectively; P ≤ 0.00002), due to the fact that parents were included in the group of relatives, and a higher education level in controls (13.0 Æ 4.0 years) than in patients and relatives (11.6 Æ 3.4 and 11.3 Æ 4.0 years, respectively; P ≤ 0.00002)
In subsequent comparisons among the three groups, gender and age were used as covariates, whereas education was not, as reported in the Methods section
Summary
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]. A worse premorbid adjustment in patients with schizophrenia is associated with severity of negative symptoms, neurocognitive impairment, and poor functional outcome [8,9,10,11,12,13]. To further characterize these associations, several studies explored them by taking into account the distinction of premorbid functioning in two separate subdomains (i.e. the academic and the social one) and/or in different patterns of progression over time Some studies reported an association of negative symptoms with specific patterns of progression of premorbid adjustment over time, mainly the ‘stable-poor’ and/or the ‘deteriorating’ one [10, 15, 26]; a lack of specificity has been reported [27]
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