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Premorbid social adjustment and association with attenuated psychotic symptoms in clinical high-risk and help-seeking youth

  • S. I. Tarbox-Berry (a1), D. O. Perkins (a2), S. W. Woods (a1) and J. Addington (a3)

Abstract

Background

Attenuated positive symptom syndrome (APSS), characterized by ‘putatively prodromal’ attenuated psychotic-like pathology, indicates increased risk for psychosis. Poor premorbid social adjustment predicts severity of APSS symptoms and predicts subsequent psychosis in APSS-diagnosed individuals, suggesting application for improving detection of ‘true’ prodromal youth who will transition to psychosis. However, these predictive associations have not been tested in controls and therefore may be independent of the APSS diagnosis, negating utility for improving prediction in APSS-diagnosed individuals.

Method

Association between premorbid social maladjustment and severity of positive, negative, disorganized, and general APSS symptoms was tested in 156 individuals diagnosed with APSS and 76 help-seeking (non-APSS) controls enrolled in the Enhancing the Prospective Prediction of Psychosis (PREDICT) study using prediction analysis.

Results

Premorbid social maladjustment was associated with social anhedonia, reduced expression of emotion, restricted ideational richness, and deficits in occupational functioning, independent of the APSS diagnosis. Associations between social maladjustment and suspiciousness, unusual thought content, avolition, dysphoric mood, and impaired tolerance to normal stress were uniquely present in participants meeting APSS criteria. Social maladjustment was associated with odd behavior/appearance and diminished experience of emotions and self only in participants who did not meet APSS criteria.

Conclusions

Predictive associations between poor premorbid social adjustment and attenuated psychotic-like pathology were identified, a subset of which were indicative of high risk for psychosis. This study offers a method for improving risk identification while ruling out low-risk individuals.

Copyright

Corresponding author

*Address for correspondence: S. I. Tarbox-Berry, Ph.D., PRIME Research Clinic, Yale University School of Medicine, Connecticut Mental Health Center, 34 Park Street, B-38, New Haven, CT 06519, USA. (Email: sarah.tarbox@yale.edu)

References

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Addington, J, Addington, D (2005). Patterns of premorbid functioning in first episode psychosis: relationship to 2-year outcome. Acta Psychiatrica Scandinavica 112, 4046.
Addington, J, Cornblatt, BA, Cadenhead, KS, Cannon, TD, McGlashan, TH, Perkins, DO, Seidman, LJ, Tsuang, MT, Walker, EF, Woods, SW, Heinssen, R (2011). At clinical high risk for psychosis: outcome for nonconverters. American Journal of Psychiatry 168, 800805.
Addington, J, Liu, L, Buchy, L, Cadenhead, KS, Cannon, TD, Cornblatt, BA, Perkins, DO, Seidman, LJ, Tsuang, MT, Walker, EF, Woods, SW, Bearden, CE, Mathalon, DH, McGlashan, TH (2015). North American Prodrome Longitudinal Study (NAPLS 2): the prodromal symptoms. Journal of Nervous and Mental Disease 203, 328335.
Addington, J, Liu, L, Perkins, DO, Carrion, RE, Keefe, RSE, Woods, SW (2017). The role of cognition and social functioning as predictors in the transition to psychosis for youth with attenuated psychotic symptoms. Schizophrenia Bulletin 43, 5763.
Addington, J, Piskulic, D, Perkins, D, Woods, SW, Liu, L, Penn, DL (2012). Affect recognition in people at clinical high risk of psychosis. Schizophrenia Research 140, 8792.
Alderman, T, Addington, J, Bearden, C, Cannon, TD, Cornblatt, BA, McGlashan, TH, Perkins, DO, Seidman, LJ, Tsuang, MT, Walker, EF, Woods, SW, Cadenhead, KS (2015). Negative symptoms and impaired social functioning predict later psychosis in Latino youth at clinical high risk in the North American prodromal longitudinal studies consortium. Early Intervention in Psychiatry 9, 467475.
Bailer, J, Brauer, W, Rey, ER (1996). Premorbid adjustment as predictor of outcome in schizophrenia: results of a prospective study. Acta Psychiatrica Scandinavica 93, 368377.
Brill, N, Reichenberg, A, Weiser, M, Rabinowicz, J (2008). Validity of the premorbid adjustment scale. Schizophrenia Bulletin 34, 981983.
Brucato, G, Masucci, MD, Arndt, LY, Ben-David, S, Colibazzi, T, Corcoran, CM, Crumbley, AH, Crump, FM, Gill, KE, Kimhy, D, Lister, A, Schobel, SA, Yang, LH, Lieberman, JA, Girgis, RR (2017). Baseline demographics, clinical features and predictors of conversion among 200 individuals in a longitudinal prospective psychosis-risk cohort. Psychological Medicine 47, 19231935.
Cannon, TD, Cadenhead, K, Cornblatt, B, Woods, SW, Addington, J, Walker, E, Seidman, LJ, Perkins, D, Tsuang, M, McGlashan, T, Heinssen, R (2008). Prediction of psychosis in youth at high clinical risk: a multisite longitudinal study in North America. Archives of General Psychiatry 65, 2837.
Cannon, TD, Yu, C, Addington, J, Bearden, CE, Cadenhead, KS, Cornblatt, BA, Heinssen, R, Jeffries, CD, Mathalon, DH, McGlashan, TH, Perkins, DO, Seidman, LJ, Tsuang, MT, Walker, EF, Woods, SW, Kattan, MW (2016). An individualized risk calculator for research in prodromal psychosis. American Journal of Psychiatry 173, 980988.
Cannon-Spoor, H, Potkin, S, Wyatt, R (1982). Measurement of premorbid adjustment in chronic schizophrenia. Schizophrenia Bulletin 8, 470484.
Carrion, RE, Cornblatt, BA, Burton, CZ, Tso, IF, Auther, AM, Adelsheim, S, Calkins, R, Carter, CS, Niendam, T, Sale, TG, Taylor, SF, McFarlane, WR (2016). Personalized prediction of psychosis: external validation of the NAPLS-2 psychosis risk calculator with the EDIPPP project. American Journal of Psychiatry 173, 989996.
Cornblatt, BA, Carrion, RE, Addington, J, Seidman, L, Walker, EF, Cannon, TD, Cadenhead, KS, McGlashan, TH, Perkins, DO, Tsuang, MT, Woods, SW, Heinssen, R, Lencz, T (2012). Risk factors for psychosis: impaired social and role functioning. Schizophrenia Bulletin 38, 12471257.
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (1995). Structured Clinical Interview for DSM-IV Axis I Disorders, Patient Edition, January 1995 FINAL, (SCID-I/P Version 2.0) . Biometrics Research Department, New York State Psychiatric Institute: New York.
Fusar-Poli, P, Borgwardt, S, Bechdolf, A, Addington, J, Riecher-Rossler, A, Schultze-Lutter, F, Keshavan, M, Wood, S, Ruhrmann, S, Seidman, LJ, Valmaggia, L, Cannon, T, Velthorst, E, De Haan, L, Cornblatt, B, Bonoldi, I, Birchwood, M, McGlashan, T, Carpenter, W, McGorry, P, Klosterkotter, J, McGuire, P, Yung, A (2013). The psychosis high-risk state: a comprehensive state-of-the-art review. JAMA Psychiatry 70, 107120.
Fusar-Poli, P, Cappucciati, M, Rutigliano, G, Schultze-Lutter, F, Bonoldi, I, Borgwardt, S, Riecher-Rossler, A, Addington, J, Perkins, D, Woods, SW, McGlashan, TH, Lee, J, Klosterkotter, J, Yung, AR, McGuire, P (2015). At risk or not at risk? A meta-analysis of the prognostic accuracy of psychometric interviews for psychosis prediction. World Psychiatry 14, 322332.
Goulding, SM, Holtzman, CW, Trotman, HD, Ryan, AT, Macdonald, AN, Shapiro, DI, Brasfield, JL, Walker, EF (2013). The prodrome and clinical risk for psychotic disorders. Child and Adolescent Psychiatric Clinics of North America 22, 557567.
Haas, GL, Sweeney, JA (1992). Premorbid and onset features of first-episode schizophrenia. Schizophrenia Bulletin 16, 373386.
Hafner, H, Maurer, K, Loffler, W, an der Heiden, W, Hambrecht, M, Schultze-Lutter, F (2003). Modeling the early course of schizophrenia. Schizophrenia Bulletin 29, 325340.
Hawkins, KA, McGlashan, TH, Quinlan, D, Miller, TJ, Perkins, DO, Zipursky, RB, Addington, J, Woods, SW (2004). Factorial structure of the scale of prodromal symptoms. Schizophrenia Research 68, 339347.
Horton, LE, Tarbox, SI, Olino, TM, Haas, GL (2015). Trajectories of premorbid childhood and adolescent functioning in schizophrenia-spectrum psychoses: a first-episode study. Psychiatry Res 227, 339346.
Ingraham, LJ (1995). Family-genetic research and schizotypal personality. In Schizotypal Personality (ed. Raine, A., Lencz, T. and Mednick, S. A.), pp. 1942. Cambridge University Press: Cambridge.
Katsanis, J, Iacono, W, Beiser, M (1990). Anhedonia and perceptual aberration in first-episode psychotic patients and their relatives. Journal of Abnormal Psychology 99, 202206.
Kimhy, D, Gill, KE, Brucato, G, Vakhrusheva, J, Arndt, L, Gross, JJ, Girgis, RR (2016). The impact of emotion awareness and regulation on social functioning in individuals at clinical high risk for psychosis. Psychological Medicine 46, 29072918.
Kraepelin, E (1919). Dementia Praecox and Paraphrenia. Robert E. Krieger Publishing Co. Inc.: Huntington, NY, USA.
Kwapil, TR (1998). Social anhedonia as a predictor of the development of schizophrenia-spectrum disorders. Journal of Abnormal Psychology 107, 558565.
Lencz, T, Smith, CW, Auther, A, Correll, CU, Cornblatt, B (2004). Nonspecific and attenuated negative symptoms in patients at clinical high-risk for schizophrenia. Schizophrenia Research 68, 3748.
Lyngberg, K, Buchy, L, Liu, L, Perkins, D, Woods, S, Addington, J (2015). Patterns of premorbid functioning in individuals at clinical high risk of psychosis. Schizophrenia Research 169, 209213.
McGlashan, T, Walsh, B, Woods, SW (2010). The Psychosis-Risk Syndrome: Handbook for Diagnosis and Follow-Up. Oxford University Press: USA.
Miller, TJ, McGlashan, TH, Rosen, JL, Cadenhead, K, Cannon, T, Ventura, J, McFarlane, W, Perkins, DO, Pearlson, GD, Woods, SW (2003a). Prodromal assessment with the structured interview for prodromal syndromes and the scale of prodromal symptoms: predictive validity, interrater reliability, and training to reliability. Schizophrenia Bulletin 29, 703715.
Miller, TJ, McGlashan, TH, Rosen, JL, Somjee, L, Markovitch, P, Stein, K, Woods, SW (2002). Prospective diagnosis of the prodrome for schizophrenia: preliminary evidence of interrater reliability and predictive validity using operational criteria and a structured interview. American Journal of Psychiatry 159, 863865.
Miller, TJ, Zipursky, RB, Perkins, D, Addington, J, Woods, SW, Hawkins, KA, Hoffman, R, Preda, A, Epstein, I, Addington, D, Lindborg, S, Marquez, E, Tohen, M, Breier, A, McGlashan, TH (2003b). The PRIME North America randomized double-blind clinical trial of olanzapine versus placebo in patients at risk of being prodromally symptomatic for psychosis. II. Baseline characteristics of the ‘prodromal’ sample. Schizophrenia Research 61, 1930.
Mueser, KT, Bellack, AS (1998). Social skills and social functioning in schizophrenia. In Handbook of Social Functioning in Schizophrenia (ed. Mueser, K. T. and Tarrier, N.), pp. 7996. Allyn & Bacon: Needham Heights, MA, USA.
Ruhrmann, S, Schultze-Lutter, F, Salokangas, RKR, Heinimaa, M, Linszen, D, Dingemans, P, Birchwood, M, Patterson, P, Juckel, G, Heinz, A, Morrison, A, Lewis, S, Graf von Reventlow, H, Klosterkotter, J (2010). Prediction of psychosis in adolescents and young adults at high risk: results from the prospective European prediction of psychosis study. Archives of General Psychiatry 67, 241251.
Strauss, JS, Carpenter, WT (1972). The prediction of outcome in schizophrenia: I. Characteristics of outcome. Archives of General Psychiatry 27, 739746.
Tarbox, SI, Addington, J, Cadenhead, K, Cannon, TD, Cornblatt, B, Perkins, D, Seidman, LJ, Tsuang, MT, Walker, E, Heinssen, R, McGlashan, T, Woods, SW (2013). Premorbid functional development and conversion to psychosis in clinical high-risk youth. Development and Psychopathology 25, 11731188.
Tarbox, SI, Pogue-Geile, MF (2008). Development of social functioning in preschizophrenia children and adolescents: a systematic review. Psychological Bulletin 34, 561583.
Tarbox, SI, Pogue-Geile, MF (2011). A multivariate perspective on schizotypy and familial association with schizophrenia: a review. Clinical Psychology Review 31, 11691182.
Woods, SW, Addington, J, Cadenhead, KS, Cannon, TD, Cornblatt, BA, Heinssen, R, Perkins, DO, Seidman, LJ, Tsuang, MT, Walker, EF, McGlashan, TH (2009). Validity of the prodromal risk syndrome for first psychosis: findings from the North American Prodrome Longitudinal Study. Schizophrenia Bulletin 35, 894908.
Yung, AR, Phillips, LJ, Yuen, HP, Francey, SM, McFarlane, CA, Hallgren, M, McGorry, PD (2003). Psychosis prediction: 12-month follow up of a high-risk (‘prodromal’) group. Schizophrenia Research 60, 2132.

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