Symptoms of schizophrenia usually develop in the late teen years and early adulthood. But many individuals who develop schizophrenia exhibit symptoms long before the onset of the illness. The Premorbid Adjustment Scale (PAS) has been used to describe three distinct categories of premorbid symptoms found in individuals with schizophrenia. However, knowing how these early symptoms affect later severity and functioning is less clear. To better understand how these classifications determine illness development and course, Veronica T. Cole of the Clinical Brain Disorders Branch at the National Institute of Mental Health in Bethesda, Maryland, analyzed the premorbid symptoms and subsequent symptom severity in individuals with good-stable adjustment, insidious-onset adjustment, and poor-deteriorating adjustment prior to illness diagnosis.
Previous research has linked schizophrenic premorbid academic and social deficiencies to earlier illness onset, increased symptom severity, higher incidence of relapse, poorer outcome as measured by the Global Assessment of Functioning (GAF) scale, and even suicide. Cole looked specifically at how early warning signs in academic and social functioning would predict later outcomes in these three categories of individuals. For her study, Cole analyzed data collected from 208 individuals who were part of a larger study on schizophrenia.
The findings revealed that the insidious-onset group represented the largest number of participants who had relatively normal social and academic adjustment in youth that steadily declined until illness diagnosis. Looking more closely, Cole found that the good-stable subset had the highest levels of cognitive functioning and education prior to illness onset and experienced milder symptoms than the other groups after the illness developed. In contrast, the individuals who fell into the poor-deteriorating class had the lowest levels of academic and social adjustment prior to illness onset and received diagnoses nearly 5 years earlier than the other subjects. Although the good-stable and the poor-deteriorating groups were clearly identified, the insidious-onset group’s symptom trajectory was less obvious. Cole added, “Our findings illustrate a potentially powerful methodological approach to the problem of heterogeneity in schizophrenia research and add weight to the notion that aspects of premorbid history may be useful for subtyping schizophrenia patients.”
Cole, V. T., Apud, J. A., Weinberger, D. R., Dickinson, D. (2012, January 16). Using Latent Class Growth Analysis to Form Trajectories of Premorbid Adjustment in Schizophrenia. Journal of Abnormal Psychology. Advance online publication. doi: 10.1037/a0026922
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