TY - JOUR
T1 - Premorbid adjustment
T2 - A phenotype highlighting a distinction rather than an overlap between schizophrenia and bipolar disorder
AU - Rietschel, Marcella
AU - Georgi, Alexander
AU - Schmael, Christine
AU - Schirmbeck, Frederike
AU - Strohmaier, Jana
AU - Boesshenz, Katja V.
AU - Schwarz, Markus
AU - Nöthen, Markus M.
AU - Schulze, Thomas G.
PY - 2009/5
Y1 - 2009/5
N2 - Background: Premorbid adjustment (PMA) in schizophrenia (SZ) has been widely studied and shown to be worse in individuals who develop SZ as compared to controls. It has been proposed as a predictor of clinical presentation and outcome, and may delineate a specific SZ phenotype for genetic and other biological studies. Research into PMA in BD has been scarce and inconclusive. Aims: The authors compared PMA in individuals suffering from BD with that of healthy controls and investigated whether levels of PMA in BD patients correlate with specific phenotypic features. Methods: The authors investigated 344 BD patients and 137 population-based controls. Retrospective PMA assessment was performed using the Premorbid Adjustment Scale (PAS). An overall score as well as sub-scores for age ranges and functional domains were obtained. Results: Patients had a better overall PAS score than controls and outperformed controls during early and late adolescence. They scored significantly better than controls in the functional domains "sociability and withdrawal" and "adaptation to school". No differences were observed for the other subscales and there were no differences between groups during childhood. No association was observed between PMA and any of the phenotype characteristics investigated. Conclusions: In the largest study to date on PMA in BD, PMA was shown to be better in bipolar patients than in healthy controls. PMA in BD is not a simple proxy for commonly studied phenotypic markers of severity. PMA emerges as a phenotype in its own right, and highlights an aspect of disparity rather than overlap between SZ and BD.
AB - Background: Premorbid adjustment (PMA) in schizophrenia (SZ) has been widely studied and shown to be worse in individuals who develop SZ as compared to controls. It has been proposed as a predictor of clinical presentation and outcome, and may delineate a specific SZ phenotype for genetic and other biological studies. Research into PMA in BD has been scarce and inconclusive. Aims: The authors compared PMA in individuals suffering from BD with that of healthy controls and investigated whether levels of PMA in BD patients correlate with specific phenotypic features. Methods: The authors investigated 344 BD patients and 137 population-based controls. Retrospective PMA assessment was performed using the Premorbid Adjustment Scale (PAS). An overall score as well as sub-scores for age ranges and functional domains were obtained. Results: Patients had a better overall PAS score than controls and outperformed controls during early and late adolescence. They scored significantly better than controls in the functional domains "sociability and withdrawal" and "adaptation to school". No differences were observed for the other subscales and there were no differences between groups during childhood. No association was observed between PMA and any of the phenotype characteristics investigated. Conclusions: In the largest study to date on PMA in BD, PMA was shown to be better in bipolar patients than in healthy controls. PMA in BD is not a simple proxy for commonly studied phenotypic markers of severity. PMA emerges as a phenotype in its own right, and highlights an aspect of disparity rather than overlap between SZ and BD.
KW - Depression
KW - Manic-depressive illness
KW - Premorbid functioning
KW - Psychosis
KW - Psychosocial factors
KW - Schizophrenia
UR - http://www.scopus.com/inward/record.url?scp=64749108994&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=64749108994&partnerID=8YFLogxK
U2 - 10.1016/j.schres.2009.03.007
DO - 10.1016/j.schres.2009.03.007
M3 - Article
C2 - 19345565
AN - SCOPUS:64749108994
SN - 0920-9964
VL - 110
SP - 33
EP - 39
JO - Schizophrenia Research
JF - Schizophrenia Research
IS - 1-3
ER -