Premorbid adjustment associates with cognitive and functional deficits in individuals at ultra-high risk of psychosis

Cognitive Correlates of Functional Disruption at Psychosis Onset: Unique Relevance of Visual Cognition

Background: Cognitive impairment is a common feature of schizophrenia spectrum disorders and has been associated with functional disruption preceding the onset of psychosis. Understanding how cognitive deficits interact with clinical symptoms and functioning in early psychosis remains challenging. In this study, we aim to investigate whether a distinct "cognitive signature" characterizes functional disruption at the onset of psychosis. Material and Methods: Clinical, cognitive, and functional data were collected from 101 first episode psychosis patients at their first hospitalization. Stepwise regression models were used to identify predictors of global functioning and symptom severity at the time of onset, as well as diagnostic outcomes at discharge. Path analysis was used to explore the relationship among symptom severity, cognition, and functional outcomes. Results: Deficits in visual memory were selectively predictive of lower functioning and higher global symptom severity at the time of psychosis onset. Reduced visual-spatial abilities were also associated with unemployment at the time preceding hospitalization and predicted a non-affective schizophrenia spectrum diagnosis at discharge. Path analysis found that visual memory fully mediated the relationship between negative symptoms and level of functioning. Conclusions: Impairment in visual cognition seems to be uniquely associated with functional impairment and global symptom severity at the onset of psychosis and to mediate the relationship between negative symptoms and functioning. The results might indicate a primary relevance of visual cognitive aspects in marking functional disruption and symptom exacerbation at psychosis onset. This might have implications for early detection and inform treatment plans.

Life-course perspective on the causal mechanism of social functioning in schizophrenia spectrum disorder

BACKGROUND

Due to prior emphasis on clinical recovery in Schizophrenia Spectrum Disorder (SSD), improving social functioning (SF) was oftentimes neglected, with ⩽15% of patients achieving social recovery. Priorly, we and others have shown that life-course factors, including childhood adversities, play a role in the occurrence and severity of postmorbid SF impairments, highlighting the need to understand these factors for effective interventions.

AIM

This study investigates the mechanisms influencing SF in SSD and examines the causal roles of childhood trauma, premorbid adjustment, perceived stigma, self-esteem, and quality of life.

METHODS

This longitudinal study utilized data of 1,057 SSD patients, with measures at baseline, 3 and 6-year follow-up, from the Genetic Risk and Outcome of Psychosis cohort, to unravel the causal mechanism underlying SF utilizing Structural Equation Modeling. Determinants were assessed using validated retrospective and self-report questionnaires. Model development and testing involved a multistage process, encompassing relationships exploration, fit evaluation and model comparison.

RESULTS

We developed a probable causal model. Impaired premorbid adjustment emerged as a crucial factor, exerting negative influence on long-term SF, with a direct effect of β = -.252, p < .001 on SF at 3-year follow-up and β = -.056, p = .073 at 6-year follow-up. Childhood trauma exhibited a negative direct effect on SF at 3-year follow-up (β = -.087, p = .039), while demonstrating a substantial carry-over, indirect effect. Elevated perceived stigma negatively affected SF at 3-year follow-up (β = -.112, p = .008). The model explained 9.9% of SF variation at the 3-year follow-up and 54.3% at the 6-year follow-up.

CONCLUSIONS

While validation is necessary, we found a foundational basis for causal interpretation. Premorbid adjustment, childhood trauma, and perceived stigma are essential life-course factors shaping postmorbid SF in SSD. We recommend interventions covering both prevention and treatment for individuals with established symptoms-addressing childhood trauma, premorbid adjustment, and perceived stigma-to enhance long-term social outcomes and offer actionable insights for clinicians.

Predictors of Psychosocial Functioning Among Long-stay Schizophrenia Patients in a Malaysian Mental Institution

Background

A considerable number of schizophrenia patients still require long-term hospital care despite psychiatric deinstitutionalisation, especially in developing nations. Prolonged hospitalisation is associated with greater impairment in psychosocial functioning. This study aimed to determine the level of psychosocial functioning and its predictors among long-stay schizophrenia patients in a Malaysian mental institution.

Methods

This cross-sectional study included 138 patients selected through universal sampling. Data on socio-demographics, illness characteristics such as psychopathology and illness severity [measured using the Brief Psychiatric Rating Scale (BPRS)], and cognitive function [assessed using the Montreal Cognitive Assessment (MoCA)] were collected. The Personal and Social Performance (PSP) scale was used to evaluate psychosocial functioning. Pearson correlation coefficients and multiple linear regression analyses were applied to identify the correlates and predictors of psychosocial functioning.

Results

This study found that 47.8% and 16.7% of the patients had moderate and severe cognitive impairments, respectively. The mean PSP score was 69.68 (standard deviation (SD) = 15.48). Female gender, previous unemployment and more severe cognitive impairments were significantly associated with poorer psychosocial functioning. Meanwhile, negative symptoms and age of onset were negatively correlated with psychosocial functioning. By contrast, the duration of illness was positively correlated with psychosocial functioning. The regression model indicated that being female (β = -7.32, p < 0.001), previously unemployed (β = -3.67, p < 0.047), having negative symptoms (β = -4.18, p < 0.001), experiencing a longer illness duration (β = -0.60, p = 0.004), and the presence of severe cognitive impairment (β = -9.80, p < 0.001) significantly predicted poorer psychosocial functioning.

Conclusion

Long-stay schizophrenia patients experience substantial difficulties in psychosocial functioning. Factors such as gender, last employment status, negative symptoms, illness duration, and cognitive function affect psychosocial functioning.

Risk and protective factors for recovery at 3-year follow-up after first-episode psychosis onset: a multivariate outcome approach

PURPOSE

Recovery in people with first-episode psychosis (FEP) remains a major issue. When risk factors are studied in relation to the disorder, potential protective factors should also be considered since they can modulate this relationship. This study is aimed at exploring which premorbid and baseline characteristics are associated with a good and poor global recovery in patients with FEP at 3-year follow-up.

METHODS

We categorized patients' outcome by using a Latent Class Analysis (LCA) considering a multimodal set of symptomatic and functional outcomes. A Mixed effects Models Repeated Measures analysis of variance (MMRM) was used to highlight group differences over time on symptomatic and functional outcomes assessed during the 3-year follow-up.

RESULTS

A total of 325 patients with FEP aged between 18 and 35 years were included. Two groups were identified. A total of 187 patients (57.5%) did not achieve recovery, and 138 patients (42.5%) achieved recovery. Recovered patients had generally a better premorbid and baseline profile in comparison with non-recovered patients (as among which shorter duration of untreated psychosis (DUP), higher degree of insight, better functional level and lower illness severity at baseline). The trajectories for the psychopathological and functional outcomes over 36 months differed between the non-recovered and the recovered group of patients.

CONCLUSIONS

Our results pointed to some variables associated with recovery, acting as potential protective factors. These should be considered for early intervention programs to promote psychological resilience specifically in those with a worse prognosis in order to mitigate the effects of the variables that make them more vulnerable to poorer outcome.

Premorbid functioning in adolescence associates with comorbid disorders in individuals at ultra-high risk for psychosis: A brief report

AIM

This study examines associations between premorbid adjustment and comorbid disorders in individuals at ultra-high risk (UHR) for psychosis.

METHODS

Premorbid social and academic adjustment data were collected from 146 UHR individuals using the Premorbid Adjustment Scale. Comorbid disorders were determined by the Structural Clinical Interview for DSM-IV.

RESULTS

Logistic regressions showed lower premorbid social adjustment associated with personality disorders. Lower premorbid academic adjustment associated with affective disorders. More specifically, poor premorbid social adjustment in early and late adolescence associated with personality disorders. Lower premorbid social adjustment in late adolescence and lower premorbid academic adjustment in early adolescence associated with affective disorders.

CONCLUSION

Partly corroborating evidence from schizophrenia samples, our findings suggest that poor premorbid adjustment relate to distinct comorbid disorders in UHR individuals. If replicated, it indicates that premorbid adjustment deficits may be a key area for targeted interventions improving the clinical prognosis of UHR individuals.