Premorbid adjustment (PA) abnormalities in psychotic disorders are associated with an earlier age at onset (AAO) and unfavorable clinical outcomes, including treatment resistance. Prior family studies suggest that familial liability, likely reflecting increased genetic risk, and socioeconomic status (SES) contribute to premorbid maladjustment. However, their joint effect possibly indicating gene–environment interaction has not been evaluated.

We examined whether family history of psychosis (FHP) and parental SES may predict PA and AAO in unrelated cases with first-episode psychosis (n = 108) and schizophrenia (n = 104). Premorbid academic and social functioning domains during childhood and early adolescence were retrospectively assessed. Regression analyses were performed to investigate main effects of FHP and parental SES, as well as their interaction. The relationships between PA, AAO, and response to antipsychotic medication were also explored.

Positive FHP associated with academic PA difficulties and importantly interacted with parental SES to moderate social PA during childhood (interaction p = 0.024). Positive FHP and parental SES did not predict differences in AAO. Nevertheless, an earlier AAO was observed among cases with worse social PA in childhood (β = −0.20; p = 0.005) and early adolescence (β = −0.19; p = 0.007). Further, confirming evidence emerged for an association between deficient childhood social PA and poor treatment response (p = 0.04).

Familial risk for psychosis may interact with parental socioeconomic position influencing social PA in childhood. In addition, this study supports the link between social PA deviations, early psychosis onset, and treatment resistance, which highlights premorbid social functioning as a promising clinical indicator.

Meeting patients’ needs is of great importance for ensuring quality of life and reducing social disability in severe mental disorders, such as schizophrenia. However, the degree of agreement between patients and their therapists in the assessment of needs warrants further investigation, regarding that high patient-therapist agreement is associated with improved outcomes.

Current symptomatology might differentially affect the self-report and clinician-rated appraisal of schizophrenia patients’ needs.

To examine the potential impact of current symptoms on patients’ and therapists’ assessment of patients’ needs.

Fifty-three schizophrenia patient–staff pairs were interviewed using the Greek research version of the Camberwell Assessment of Need (CAN-R). Patients’ symptom severity was assessed with the Positive and Negative Syndrome Scale (PANSS).

The degree of agreement between staff and patients in the assessment of needs was high. Significant correlations were found between the total number of needs and all the dimensions of PANSS (positive, negative, general psychopathology) in the staff group but not in the patient group. In both groups, the total number of unmet needs was significantly correlated with the general psychopathology and the total PANSS scores.

The constancy of the therapeutic context might contribute to a high rate of agreement between patients and staff about needs of the latter. The severity of symptoms may influence clinicians’ assessment of schizophrenia patients’ needs. Nevertheless, according to both patients’ and therapists’ assessments symptom severity is associated with greater number of unmet needs.