Workshop on factors related to premorbid adjustment

Frequency and predictive values of first rank symptoms at baseline among 362 young adult patients with first-episode schizophrenia Results from the Danish OPUS study

AIM

To investigate the frequency of the Schneiderian First Rank Symptoms (FRSs) in a representative group of patients with first-episode schizophrenia and to analyse the predictive value of these symptoms in relation to psychopathology, work situation, depression, dependency and admission after 2 years of treatment.

METHOD

547 patients were included in the Danish OPUS trial. A subgroup of these, namely the 388 patients who fulfilled the diagnostic criteria for schizophrenia (ICD-10), was included in this study. Data from SCAN interviews were used to describe the frequency of the different first rank symptoms and to compare the characteristics of the patients with and without FRSs.

RESULTS

FRSs were very common among these patients with first-episode schizophrenia. Only 16% reported no FRSs at all. Almost half of the patients had experienced commenting or discussing voices, and more than 40% had experienced loud thoughts. More patients with than without FRSs had some kind of substance abuse. FRSs at baseline did not predict the level of scores in the psychotic, negative or disorganized dimension after 2 years. Having FRSs at baseline was related to a significantly lower number of days of admission during the two-year period, but was not associated with antipsychotic medication or depression after 2 years.

CONCLUSION

FRSs are very common among first-episode psychosis patients, but their predictive value seems to be limited with respect to outcome measures like psychopathology, work or substance abuse. However, FRSs did predict a lower mean of days of admission.

Gender differences in young adults with first-episode schizophrenia spectrum disorders at baseline in the Danish OPUS study

Gender differences in age at first onset, duration of untreated psychosis, psychopathology, social functioning, and self-esteem were investigated in a group of 578 young adults with a first-episode schizophrenia spectrum disorder. The mean age at first-onset of symptoms, age at first contact, and duration of untreated psychosis were similar for men and women. Men had more severe negative symptoms, poorer premorbid functioning, and poorer social networks, whereas women had more severe hallucinations. More men than women were substance abusers, were unemployed, and lived alone. Women had poorer self-esteem than men, in spite of better scores in functioning. Premorbid social adjustment was significantly related to the level of negative symptoms and number of friends. Conclusion is that men and women with first-episode psychosis showed different psychopathological characteristics and different social functioning, which cannot be explained by older age of onset for women. Women make more suicide attempts and experience lower self-esteem in spite of better social functioning.

Premorbid adjustment of schizophrenic criminal offenders

The premorbid psychosocial adjustment of 28 schizophrenic criminal offenders, 23 non-criminal-offender schizophrenics (ICD-9) and 14 nonpsychotic criminals was compared by means of the Premorbid Adjustment Scale (PAS). The schizophrenic groups did not differ regarding age, marital status, diagnostic subgroup or length of illness. PAS scores showed highly significant differences between the schizophrenic groups and the controls on every subscale and on average scores. Yet, aside from 2 items (sociability/withdrawal in adulthood and education), no differences could be found between offender and non-offender schizophrenics. Furthermore, the PAS scores showed a markedly better premorbid psychosocial adjustment in schizophrenics with offending behaviour (and convictions) before the onset of the psychosis than in schizophrenics without previous convictions, who committed one rather severe crime that was closely connected to psychosis itself.