PREMORBID ADJUSTMENT AND REMISSION OF POSITIVE SYMPTOMS IN FIRST-EPISODE PSYCHOSIS

The impact of premorbid social and intellectual functioning in childho od and early adolescence on the developmental course of schizophrenia is not sufficiently understood. In a retrospective case study (93 cons ecutive in-patients, 43 males and 50 females) of first-episode psychos is occurring in adolescence, the relationship between premorbid adjust ment and short-term therapeutic outcome under treatment conditions was examined. All of the patients had a DSM-LU-R diagnosis of schizophren ia (n=56) or schizoaffective disorder (n=37). The mean age of the pati ents at the time of the study was 15.8 (SD=1.0). Premorbid functioning during childhood and early adolescence was assessed by using the Cann on-Spoor et al. Premorbid Adjustment Scale (PAS) and studied with resp ect to its prognostic relevance for short-term therapeutic outcome (ei ght weeks) under neuroleptic treatment (350-700 mg Chlorpromazin dose equivalent). Criteria for clinical outcome were obtained from the stud y by Pearlson et al. (1989) which defines three grades (complete remis sion, partial remission and no response), according to the degree of p ositive symptomatology. Statistical analysis was based on nonparametri c variance analysis. Patients with complete remission of positive symp toms after eight weeks of therapy had experienced far better premorbid adjustment in early adolescence and in childhood. Diagnosis and gende r did not bias this result. Our data suggest that premorbid social fun ctioning is a crucial variable with regard to therapeutic outcome in f irst-episode psychosis. Previous studies have reported a relation betw een poor premorbid functioning and negative symptoms. We found premorb id adjustment related to the course of positive symptoms.