Longitudinal Trajectories of Premorbid Social and Academic Adjustment in Youth at Clinical High Risk for Psychosis: Implications for Conversion

Henry R Cowan; Vijay A Mittal; Jean Addington; Carrie E Bearden; Kristin S Cadenhead; Barbara A Cornblatt; Matcheri Keshavan; Daniel H Mathalon; Diana O Perkins; William Stone; Ming T Tsuang; Scott W Woods; Tyrone D Cannon; Elaine F Walker

doi:10.1093/schbul/sbae050

Longitudinal Trajectories of Premorbid Social and Academic Adjustment in Youth at Clinical High Risk for Psychosis: Implications for Conversion

Schizophr Bull. 2024 May 6:sbae050. doi: 10.1093/schbul/sbae050. Online ahead of print.

Authors

Henry R Cowan^{1

2}, Vijay A Mittal³, Jean Addington⁴, Carrie E Bearden^{5

6}, Kristin S Cadenhead⁷, Barbara A Cornblatt⁸, Matcheri Keshavan⁹, Daniel H Mathalon^{10

11}, Diana O Perkins¹², William Stone⁹, Ming T Tsuang⁷, Scott W Woods¹³, Tyrone D Cannon^{13

14}, Elaine F Walker¹⁵

Affiliations

¹ Psychiatry, The Ohio State University, Columbus, OH, USA.
² Psychology, Michigan State University, East Lansing, MI, USA.
³ Psychology, Psychiatry, Medical Social Sciences, Northwestern University, Evanston, IL, USA.
⁴ Psychiatry, University of Calgary, Calgary, AB, Canada.
⁵ Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA.
⁶ Psychology, University of California Los Angeles, Los Angeles, CA, USA.
⁷ Psychiatry, University of California San Diego, San Diego, CA, USA.
⁸ Psychiatry, Zucker Hillside Hospital, Glen Oaks, NY, USA.
⁹ Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston, MA, USA.
¹⁰ Psychiatry, University of California San Francisco, San Francisco, CA, USA.
¹¹ San Francisco VA Medical Center, San Francisco, CA, USA.
¹² Psychiatry, University of North Carolina, Chapel Hill, NC, USA.
¹³ Psychiatry, Yale University, New Haven, CT, USA.
¹⁴ Psychology, Yale University, New Haven, CT, USA.
¹⁵ Psychology and Psychiatry, Emory University, Atlanta, GA, USA.

PMID: 38706103
DOI: 10.1093/schbul/sbae050

Abstract

Background and hypothesis: Social and academic adjustment deteriorate in the years preceding a psychotic disorder diagnosis. Analyses of premorbid adjustment have recently been extended into the clinical high risk for psychosis (CHR) syndrome to identify risk factors and developmental pathways toward psychotic disorders. Work so far has been at the between-person level, which has constrained analyses of premorbid adjustment, clinical covariates, and conversion to psychosis.

Study design: Growth-curve models examined longitudinal trajectories in retrospective reports of premorbid social and academic adjustment from youth at CHR (n = 498). Interaction models tested whether known covariates of premorbid adjustment problems (attenuated negative symptoms, cognition, and childhood trauma) were associated with different premorbid adjustment trajectories in converters vs non-converters (ie, participants who did/did not develop psychotic disorders within 2-year follow-up).

Study results: Converters reported poorer social adjustment throughout the premorbid period. Converters who developed psychosis with an affective component reported poorer academic adjustment throughout the premorbid period than those who developed non-affective psychosis. Tentatively, baseline attenuated negative symptoms may have been associated with worsening social adjustment in the premorbid period for non-converters only. Childhood trauma impact was associated with fewer academic functioning problems among converters. Cognition effects did not differ based on conversion status.

Conclusions: Premorbid social function is an important factor in risk for conversion to psychosis. Negative symptoms and childhood trauma had different relationships to premorbid functioning in converters vs non-converters. Mechanisms linking symptoms and trauma to functional impairment may be different in converters vs non-converters, suggesting possible new avenues for risk assessment.

Keywords: childhood trauma; clinical high risk for psychosis (CHR); negative symptoms; premorbid adjustment; prospective.

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Grants and funding

U01MH081984/MH/NIMH NIH HHS/United States