Premorbid functioning : correlations with social functioning and clinical symptoms in first-episode psychosis, using baseline data from the JCEP 4-year RCT study

Abstract

The current study analysed baseline data from the Jockey Club Early Psychosis (JCEP) 4-year RCT study (still underway). The aims were to (1) examine whether the correlations between premorbid functioning and the outcome variables of social functioning and clinical symptoms were significant in baseline measurements of the JCEP study, and (2) pave the way for the examination of the persistence of these correlations at 4 year follow-up, after the completion of the JCEP study.

360 first-episode adult-onset psychosis patients with schizophrenia-spectrum disorders were recruited from all inpatient and outpatient psychiatric units in Hong Kong since 2009. Premorbid functioning was measured by the Premorbid Adjustment Scale (PAS). Social functioning was measured by the Role Functioning Scale (RFS) and Social and Occupational Functioning Assessment Scale (SOFAS). Clinical symptoms were measured using the Positive and Negative Syndrome Scale (PANSS), Scale for Assessment of Negative Symptoms (SANS), and Scale for Assessment of Positive Symptoms (SAPS).

Premorbid adjustment was significantly correlated with social functioning and negative symptoms; patients with poorer premorbid adjustment had worse social functioning and more severe negative symptoms. Positive symptoms were not significantly correlated with premorbid adjustment. There were no gender differences in premorbid adjustment. The majority of patients had a pattern of good premorbid adjustment (adequate to good levels of premorbid adjustment across all age-specific time periods). There were no significant differences in the outcome variables between the premorbid adjustment patterns. The current study findings have important clinical implications, in terms of advising the use of more effective and personalized interventions and treatment regimens on patients. In addition, the examination of premorbid adjustment facilitates early detection and identification of high risk psychosis individuals, which may help to reduce the duration of untreated psychosis.