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.

中文翻译：

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精神病临床高危青年病前社会和学业调整的纵向轨迹：对转换的影响


背景和假设 社会和学术适应在精神病诊断之前的几年内恶化。病前调整的分析最近已扩展到精神病 （CHR） 综合征的临床高风险，以确定精神病的危险因素和发展途径。到目前为止，工作一直在人与人层面，这限制了对病前调整、临床协变量和转化为精神病的分析。研究设计 生长曲线模型检查了 CHR 青年病前社会和学业适应的回顾性报告中的纵向轨迹 （n = 498）。交互模型测试了已知的病前适应问题的协变量 （减弱的阴性症状、认知和童年创伤） 是否与转换者与非转换者 （即，在 2 年随访内发生/没有发生精神障碍的参与者） 的不同病前适应轨迹相关。研究结果 Converters 报告了整个病前时期较差的社会适应。与发展为非情感性精神病的人相比，发展为情感成分的精神病的转换者报告在整个发病前时期的学业适应能力较差。暂定地，基线减弱阴性症状可能仅与非转化者在发病前的社会适应恶化有关。童年创伤影响与转化者中较少的学业功能问题相关。认知效果不因皈依状态而异。结论 病前社会功能是转为精神病风险的重要因素。阴性症状和童年创伤与转化者与转化者和非转化者的病前功能有不同的关系。 将症状和创伤与功能障碍联系起来的机制在转化者和非转化者中可能不同，这表明可能的风险评估新途径。