The Role of Premorbid Adjustment in Predicting Post-Illness Psychosocial Functioning in the Early Stages of Psychosis

Schizophrenia is a chronic, debilitating illness with significant heterogeneity of onset, illness course, and outcome. Although affecting 1% of the population, disability costs ranked 11^th of all health disorders internationally. Efforts to best understand how this disease process causes poor outcomes are imperative. Premorbid functioning, social and academic adjustment throughout development before illness onset, may inform long-term outcomes in psychosis. Chapter I details a systematic review of this relationship in early psychosis patients. Findings were supportive of a robust relationship between premorbid functioning and post-illness psychosocial functioning, particularly when social or academic premorbid domain approaches were used. No identified study used a domain by developmental period approach to predict psychosocial outcomes. To address this gap and improve on identified methodological concerns in previous literature, two studies were conducted using primary data in a sample of early psychosis patients. Using a comprehensive domain by trajectory approach, the first study examined associations between premorbid social and academic patterns and post-onset psychosocial functioning in early psychosis patients at study entry. The second study examined these same relationships for distal outcomes longitudinally at two-year follow-up. Study entry results, reported in Chapter II, illustrated significant relationships between trajectories of premorbid functioning and global and social functioning. Specifically, global psychosocial functioning was predicted by the change of social adjustment over development and initial academic performance. Study entry social functioning was associated with initial social performance and change of social performance over development. The two-year follow-up study, Chapter III, illustrated these relationships hold up over time. Two-year global functioning was predicted by academic premorbid patterns. Two-year social functioning was associated with social premorbid patterns and initial academic performance. Occupational functioning was associated with academic premorbid patterns. These findings demonstrate the importance of premorbid functioning to inform longitudinal post-illness psychosocial functioning. Findings from these studies suggest that using premorbid data is a fruitful endeavor to inform psychosocial recovery interventions, which can be specifically tailored to individual patients’ strengths. Future studies should continue to assess these patterns at further follow-up throughout the course of illness and design causal model investigations with these variables.