Department of Psychiatry, University of Campania L. Vanvitelli, Naples, Italy.
Section of Psychiatry, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
Acta Psychiatr Scand. 2018 Sep;138(3):253-266. doi: 10.1111/acps.12938. Epub 2018 Jul 8.
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.
本研究旨在探讨精神分裂症患者的病前学业和社会功能，并分析其与阴性症状严重程度和神经认知损伤的相关性。
我们将精神分裂症患者的病前适应（PA）与未受影响的一级亲属和健康对照组进行比较，并探讨其与精神病理学、认知和现实生活功能的相关性。还探讨了 PA 与原发性阴性症状及其两个因子的相关性。
我们发现患者的学业和社会 PA 受损（P ≤ 0.000001），亲属的早期适应的学业方面受损（P ≤ 0.01）。PA 较差的患者表现出更严重的阴性症状（排除抑郁/帕金森病影响后仅限于意志缺乏）、工作记忆、社会认知和现实生活功能受损（P ≤ 0.01 至 ≤0.000001）。较差的学业和社会 PA 与更严重的精神病理学、认知损伤和现实生活功能损伤相关（P ≤ 0.000001）。回归分析显示，学业领域的 PA 较差主要与工作记忆的损伤相关，而社会领域的 PA 较差与意志缺乏相关（P ≤ 0.000001）。
我们的研究结果表明，早期适应不良可能是精神分裂症易感性的标志，并强调了基于心理社会和/或认知方案的预防/早期干预的必要性。
