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

Published online by Cambridge University Press:  06 September 2017

S. I. Tarbox-Berry ,
D. O. Perkins ,
S. W. Woods  and
J. Addington
S. I. Tarbox-Berry*
Affiliation:
Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
D. O. Perkins
Affiliation:
Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
S. W. Woods
Affiliation:
Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
J. Addington
Affiliation:
Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
*
*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: [email protected])
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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.

Keywords

Predictionprodromepsychosis-riskschizophreniaSIPS
Type
Original Articles
Information
Psychological Medicine , Volume 48 , Issue 6 , April 2018 , pp. 983 - 997
Copyright
Copyright © Cambridge University Press 2017 

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