Premorbid Adjustment In Schizophrenia Research Articles

Disability and premorbid adjustment in schizophrenia: A retrospective analysis.

Schizophrenia is highly disabling. Though efforts at genetic mapping to identify those at risk of the illness have been promising but same cannot be said about predicting its associated disability before illness-onset (i.e., during premorbid phase). It is envisaged that Schizophrenia-related disability may be ameliorated if premorbid clinical markers are adequately predictive enough to identify those at risk and worked upon them. This study aimed to determine whether there is a relationship between schizophrenia-related disability and premorbid adjustment. This cross-sectional study was conducted at the out-patient clinic of the Neuropsychiatric Hospital, Aro, Abeokuta, Ogun State, Nigeria. Three hundred patients with the diagnosis of schizophrenia and within the age range of 18-64 years were eligible for the study. Mean age of the participants was 41.9 ± 10.05 years with a slight female dominance (50.7%). Spearman's correlation revealed a direct correlation between disability and premorbid adjustment, albeit rather weak (r s = 0.130, p = 0.025). Pre-diagnostic factors such as premorbid functioning may play a role in the subsequent functioning of an individual post-diagnosis. Other research efforts may focus on yet-to-be identified premorbid factors that may be targets of prevention to reduce disability in schizophrenia. This research serves as a pioneer work on disability and premorbid adjustment and has provided a template for the early identification of those at risk of schizophrenia by providing an intervention opportunity at the premorbid stage.

Latent Profiles of Premorbid Adjustment in Schizophrenia and Their Correlation with Measures of Recovery.

Premorbid adjustment (PA) has classically been defined as psychosocial functioning in the areas of education, occupation, social and interpersonal relationships prior to evidence of characteristic positive symptomatology. It is a concept which possesses ample evidence regarding its predictive nature for the course of Schizophrenia. The study aimed to analyze the latent profiles of premorbid adjustment and their relationship with symptomatology, functionality, subjective recovery, stigma resistance and years of untreated psychosis. Latent class analysis (LCA) was used to elaborate a solution of three premorbid adjustment profiles in a sample of 217 patients diagnosed with Schizophrenia from Public Mental Health Centers in the city of Arica, Chile. The results show that premorbid adjustment was significantly correlated with recovery indicators and that latent profiles of better premorbid adjustment predict better outcomes in subjective recovery and stigma resistance. The results show that premorbid adjustment not only has implications for the severity of the disorder, but that psychosocial functioning prior to psychosis affects the patient’s subjectivity, the representation of the disorder and the recovery process.

Premorbid Adjustment in Predicting Symptom Severity and Social Cognitive Deficits in Schizophrenia

Schizophrenia patients have deficits in premorbid adjustment (PMA) and social cognition (SC); both deficits are associated with symptom severity, neuro-cognitive deficits, and prognosis. This study aimed to determine symptom severity and two domains of SC deficit by assessing specific areas of PMA in schizophrenia patients. This cross-sectional study included 60 male and 60 female patients with paranoid schizophrenia aged 20 to 35 years from two psychiatric inpatient departments of Chhattisgarh state of India. They were assessed using the Scale for Assessment of Positive Symptoms, Scale for Assessment of Negative Symptoms, Premorbid Adjustment Scale, Recognition of Facial Expression Task, and Picture Arrangement Test. Deficits in premorbid sociability and in scholastic performance were the best predictors of severity of positive symptoms, social knowledge, and negative emotion recognition deficit in schizophrenia patients. Given the important role of SC and PMA, assessing premorbid functioning can help in deciding early and appropriate intervention for schizophrenia.

Gender Difference in Premorbid Adjustment in Schizophrenia- A Comparative Study

Gender Difference in Premorbid Adjustment in Schizophrenia- A Comparative Study

The role of premorbid adjustment in schizophrenia: Focus on cognitive remediation outcome

ABSTRACTPremorbid 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.

The impact of premorbid functioning on outcome indices in a large sample of Italian patients with schizophrenia

IntroductionAn impairment of premorbid adjustment (PA) has been regarded among poor prognostic indicators of schizophrenia. Some discrepancies in the literature suggest the usefulness of further characterizations of its impact on different aspects of the disease.AimsThe present study aimed to investigate the association of poor PA with psychopathology, neurocognition and real-life functioning in patients with schizophrenia recruited within the multicenter study of the Italian network for research on psychoses. functioning during childhood and adolescence (early adjustment) was assessed also in a group of healthy controls (HC) and one of unaffected relatives of patients (UR).MethodsGroup comparisons were performed between patients with poor and those with good PA. Differences in frequency of poor early adjustment were investigated among patients, HC and UR.ResultsPatients with poor PA, as compared to those with good PA, showed earlier age of onset, more severe negative symptoms and disorganization, greater impairment on all cognitive domains with the exception of attention/vigilance and worse real-life functioning in the considered areas (interpersonal relationships, community activities and work abilities). The pattern of poor early adjustment was more frequent in patients with respect to UR and HC and, to a less degree, in UR with respect to HC.ConclusionsOur findings confirm that poor PA in schizophrenia is associated with poorer illness outcome, and offer a further characterization of PA impact on different psychopathological and cognitive domains. They also suggest that poor early adjustment is a candidate endophenotype of schizophrenia, occurring in patients and their unaffected relatives.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Differences in developmental changes in academic and social premorbid adjustment between males and females with schizophrenia

The assessment of premorbid adjustment in schizophrenia has received considerable attention because of models suggesting that schizophrenia is a neurodevelopmental disorder characterized by abnormalities in functioning prior to onset of the disorder. Some studies suggest that premorbid adjustment is best viewed as a multidimensional construct where different areas of functioning might be differentially impacted by the illness and sex. The current study examined these matters using of Premorbid Adjustment Scale (PAS) in a sample of 421 individuals with schizophrenia. Confirmatory factory analyses conducted for three developmental periods (childhood, early adolescence, late adolescence) and for males and females separately, indicated that the PAS consists of academic and social factors that are invariant across developmental period and sex. However, differences in severity of academic and social premorbid impairment were present between males and females across developmental periods. Findings suggest important differences between males and females in the course of premorbid deterioration prior to onset of schizophrenia.

Using latent class growth analysis to form trajectories of premorbid adjustment in schizophrenia.

Premorbid adjustment varies widely among individuals with schizophrenia and has been shown to bear significantly on prodrome and onset characteristics, and on cognition, symptoms, and functioning after onset. The current analysis focused on the Premorbid Adjustment Scale, a retrospective measure assessing social and academic function at several time points from early childhood to illness onset. In an effort to explore discrete developmental subtypes, we applied latent class growth analysis to data from the Premorbid Adjustment Scale in our sample of individuals with schizophrenia (N = 208), finding three latent trajectory classes. The first of these classes showed consistently adequate-to-good social and academic functioning before onset; the second showed initially good function and deterioration with time until onset; the third showed poor functioning in childhood that deteriorated further during the years up to diagnosis. The classes differed significantly in terms of age of onset, processing speed, and functioning after onset. There were no significant differences in symptomatology. Our findings illustrate a potentially powerful methodological approach to the problem of heterogeneity in schizophrenia research, and add weight to the notion that aspects of premorbid history may be useful for subtyping schizophrenia patients. The potential implications of this subtyping strategy, including those pertaining to potential genetics studies, are discussed.

Premorbid functioning of patients with first-episode nonaffective psychosis: A comparison of deterioration in academic and social performance, and clinical correlates of Premorbid Adjustment Scale scores

BackgroundMotivated by a previous study among male veterans [Allen, D.N., Frantom, L.V., Strauss, G.P., van Kammen, D.P., 2005. Differential patterns of premorbid academic and social deterioration in patients with schizophrenia. Schizophr. Res. 75, 389–397], the present analysis examined: (1) patterns of premorbid academic and social functioning during childhood, early adolescence, and late adolescence, and (2) associations between these premorbid functioning dimensions and a number of clinical variables. MethodsData on premorbid functioning were collected using the Premorbid Adjustment Scale (PAS) in 95 hospitalized first-episode patients. Analyses were similar to those conducted by Allen and colleagues (2005). ResultsDeterioration was evident in both academic and social functioning from childhood to early adolescence, along with a pronounced/accelerated deterioration in academic functioning from early adolescence to late adolescence, occurring in both male and female patients. Age at onset of prodromal symptoms was predicted by childhood/early adolescent/late adolescent academic functioning scores, and age at onset of psychotic symptoms was significantly associated only with childhood academic functioning. Severity of negative symptoms was predicted by childhood and late adolescent social functioning scores, and severity of general psychopathology symptoms was predicted by late adolescent academic functioning, as well as childhood and late adolescent social functioning scores. ConclusionsConsistent with prior findings, deterioration in premorbid functioning appears to be more pronounced in the academic than social dimension of the PAS. Some PAS scores are predictive of ages at onset of prodrome/psychosis and severity of psychotic symptoms. Ongoing research on premorbid adjustment in schizophrenia may have implications for future prevention goals.

Serum lipid levels in schizophrenia and bipolar disorder relapse

The assessment of premorbid adjustment in schizophrenia has received considerable attention because of models suggesting that schizophrenia is a neurodevelopmental disorder characterized by abnormalities in functioning prior to onset of the disorder. Some studies suggest that premorbid adjustment is best viewed as a multidimensional construct where different areas of functioning might be differentially impacted by the illness and sex. The current study examined these matters using of Premorbid Adjustment Scale (PAS) in a sample of 421 individuals with schizophrenia. Confirmatory factory analyses conducted for three developmental periods (childhood, early adolescence, late adolescence) and for males and females separately, indicated that the PAS consists of academic and social factors that are invariant across developmental period and sex. However, differences in severity of academic and social premorbid impairment were present between males and females across developmental periods. Findings suggest important differences between males and females in the course of premorbid deterioration prior to onset of schizophrenia.

Ajuste premórbido pobre vinculado al deterioro en habilidades de teoría de la mente: estudio en pacientes esquizofrénicos estabilizados

Previous studies suggest that there is a deficit in theory of mind (ToM) in stabilised schizophrenic patients. More specifically, it has been claimed that poor premorbid adjustment covaries with the abnormalities in ToM skills detected in such patients. It has also been suggested that this deficit could be a trait marker for schizophrenic disorders. The aim of this study was to examine the performance in mentalistic skills in 36 stabilised schizophrenic patients in comparison to a standard control group. We also sought to examine the relation between ToM skills and premorbid adjustment in our target sample. Premorbid adjustment was evaluated using the modified Cannon-Spoor premorbid adjustment scale, and ToM measurements were obtained by means of first- and second-order verbal experimental tasks. Schizophrenic patients presented statistically significant poorer performances in first- and second-order ToM tasks, although no differences were observed between these patients and the control sample as regards overall cognitive acuity. Poor premorbid adjustment in areas of social functioning in the patients was also associated with statistically significant poorer performance in both ToM tasks. Deficient premorbid adjustment in schizophrenia may be linked to a ToM deficit that can be assessed with simple tasks.

Premorbid adjustment and previous personality in schizophrenic patients

Psychosocial adjustment and premorbid personality are two factors that are frequently studied in order to elucidate the etiopathogenesis of schizophrenia. Premorbid adjustment alterations and personality disorders (principally those of the schizophrenia spectrum) have been considered vulnerability elements or have been linked with the early manifestations of a disease that is still underdeveloped (hypothesis of neurodevelopment). In this paper we review the literature. We also studied the relationship between premorbid adjustment (PAS scale) and previous personality disorders (SCID-II) in a sample of 40 patients with schizophrenia (DSM-III-R, DSM-IV, CIE-10), and statistically correlated them. The results show that premorbid adjustment correlates with avoidant, schizotypal and schizoid personality disorders: the more personality pathology found, the poorer is the premorbid psychosocial adjustment. Premorbid adjustment positively correlates with histrionic personality traits. The pathological traits of schizotypal and schizoid personalities account for up to 77% of the variance of the total premorbid adjustment in schizophrenic patients. Conclusion: The degrees of premorbid adjustment in schizophrenia are related to the different premorbid personality disorders of schizophrenic patients, which are mainly those most genetically related with schizophrenia, that is, the spectrum of the schizophrenia.

Premorbid adjustment in first episode schizophrenia and schizoaffective disorders: a comparison of social and academic domains

Recent evidence suggests that premorbid adjustment in schizophrenia and related disorders can be separated into social and academic domains. In this paper, we examine the correlates of and prognostic significance of social and academic premorbid adjustment in a sample of 113 patients. Premorbid adjustment, symptoms and cognitive functioning were assessed at presentation for treatment and symptoms were re-assessed after a year of treatment. Females and those with a diagnosis of schizoaffective disorder were found to have better premorbid adjustment in the academic domain, but not in the social domain. Neurocognitive functioning was more consistently related to academic than social adjustment. Better social and academic premorbid adjustment was correlated with lower negative symptoms after 1 year of treatment, but neither was a significant predictor of positive symptoms. Social and academic premorbid adjustments show different relations to gender, specific diagnosis and neurocognitive functioning in schizophrenia and related disorders.

Influence of depressive symptoms and premorbid adjustment on factor structure of phenomenology of schizophrenia: a study from India

This study investigated the nature of factor structure of schizophrenia syndromes using a sample of 151 patients with schizophrenia according to DSM-IV. The patients were assessed on the Scale for the Assessment of Positive Symptoms (SAPS), the Scale for the Assessment of Negative Symptoms (SANS), Hamilton Depression Rating Scale (HDRS) and the Phillips Rating Scale of Premorbid Adjustment in schizophrenia. Three factors— negative syndrome, reality-distortion syndrome and disorganized syndrome were extracted when only SAPS and SANS were analysed. Addition of the Phillips Rating Scale scores to SAPS and SANS ratings in the factorial equation led to splitting of the negative syndrome though reality-distortion and disorganized syndromes remained stable. Factor analysis of the HDRS scores with SAPS and SANS ratings resulted in the HDRS loading highly on reality-distortion syndrome and splitting of negative syndrome. Factor analysis of all the variables taken together resulted in delineation of four factors. The study suggests a link between depression and reality distortion. Apathy and anhedonia seem to be linked to premorbid adjustment.

Confirmation of a two-factor model of premorbid adjustment in males with schizophrenia.

Because schizophrenia is considered to be a neurodevelopmental disorder, premorbid adjustment is of particular interest. Premorbid adjustment is probably not a unitary construct but rather is expressed across a number of developmental domains. The current investigation examined the validity of a two-factor model that differentiated premorbid adjustment across social and academic domains and evaluated relationships between these premorbid adjustment domains and other variables of interest. Participants with schizophrenia (n = 141) underwent evaluation of premorbid adjustment (using the Premorbid Adjustment Scale), intellectual functioning, and psychiatric symptoms. Using confirmatory factor analysis, a two-factor model of premorbid adjustment was identified that included an academic domain and a social domain. The social domain was associated with symptom variables, while the academic domain was associated with measures of intelligence. Results provide evidence for at least two domains of premorbid adjustment in schizophrenia. Distinguishing between these two premorbid domains may be theoretically important because of potential differences in incidence rates and deterioration courses; some individuals with schizophrenia may exhibit adequate academic adjustment but poor social adjustment, while others may exhibit the opposite pattern.

Primary Enduring Negative Symptoms, Basic Symptoms and Premorbid Adjustment in Schizophrenia

Primary Enduring Negative Symptoms, Basic Symptoms and Premorbid Adjustment in Schizophrenia

Premorbid adjustment in schizophrenia: iImplications for psychosocial and ventricular pathology

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.

EP and neuropsychological correlates of premorbid adjustment in schizophrenia

EP and neuropsychological correlates of premorbid adjustment in schizophrenia

Relationship between CT findings, pregnancy and birth complications and premorbid adjustment in schizophrenia : Carlos v.K. Hübner, Knut Kohlmeyer and Wagner F. Gattaz Central Institute of Mental Health, J5 P.O. Box 5970, D-6800 Mannheim, FRG

Relationship between CT findings, pregnancy and birth complications and premorbid adjustment in schizophrenia : Carlos v.K. Hübner, Knut Kohlmeyer and Wagner F. Gattaz Central Institute of Mental Health, J5 P.O. Box 5970, D-6800 Mannheim, FRG

Social disability in Schizophrenia: The controlled prospective Burgh�lzli study

The assessment of premorbid adjustment in schizophrenia has gained increasing interest in psychiatric research. Numerous studies have provided evidence on the predictive power of premorbid adjustment in the course and outcome of schizophrenic psychoses, but only little systematic research has been done on this topic comparing schizophrenics and healthy persons. In this study we have analyzed the premorbid life situation and social adjustment of 69 first onset schizophrenics in contrast to 60 healthy subjects. The comparisons between these samples showed significant differences for nearly all areas assessed, indicating a premorbid disablement of the schizophrenics both for quantitative and qualitative aspects of social functioning. Compared to that of healthy people, the size of the schizophrenics' social network is markedly reduced and often characterized by a strong link to their family of origin. In general, the schizophrenics fail to establish close relationships or engage in social contact. Moreover, they tend to withdraw from existing relationships, especially heterosexual ones. Even when the schizophrenics appear quite normal on formal criteria (such as partnership or employment situation), further analyses often reveal problems, e.g., conflicts at work or reticence with partners. The results of this study clearly demonstrate the necessity of assessing not only formal criteria but also behavioral patterns and emotions of the persons concerned.