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The British Journal of Psychiatry (2004) 185: 108-115
© 2004 The Royal College of Psychiatrists

Premorbid adjustment in first-episode non-affective psychosis: distinct patterns of pre-onset course

TOR K. LARSEN, MD

Helse Stavanger HF, Stavanger

SVEIN FRIIS, MD

University of Oslo, Norway

ULRIK HAAHR, MD

Fjorden Hospital, Roskilde, Denmark

JAN OLAV JOHANNESSEN, MD

Helse Stavanger HF, Stavanger

INGRID MELLE, MD, STEIN OPJORDSMOEN, MD and BJØRN RISHOVD RUND, PhD

University of Oslo, Norway

ERIK SIMONSEN, MD

Fjorden Hospital, Roskilde, Denmark

PER VAGLUM VAGLUM, MD

University of Oslo, Norway

THOMAS H. McGLASHAN, MD

Yale Psychiatric Institute, New Haven, Connecticut, USA

Correspondence: Tor K. Larsen, MD, Helse Stavanger HF, Psychiatric Clinic, Armauer Hansensv. 20, PO Box 8100, N-4068 Stavanger, Norway. Tel: 47 51 51 51 51; fax: 47 51 51 50 50; e-mail: tklarsen{at}online.no

Declaration of interest None.

Funding detailed in Acknowledgements.

Background Knowledge about premorbid development in psychosis can shed light upon theories about aetiology and schizophrenic heterogeneity, and form a basis for early detection initiatives.

Aims To identify and validate patterns of premorbid functioning in first-episode psychosis.

Method The Premorbid Adjustment Scale was used to examine 335 patients.

Results Social and academic function constituted fairly independent dimensions. Cluster analysis identified groups varying both in level and course. Patients with a stable social course compared with a deteriorating one had a shorter duration of untreated psychosis, were older, had more friends and less negative symptoms. Good childhood academic function correlated with more education, more meaningful activities and better working memory. Patients with a stable academic course were older at admission.

Conclusions Patterns of premorbid development suggest both neurodevelopmental and neuroregressive pathways to illness.


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