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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精神病临床高风险青少年病前社会和学业调整的纵向轨迹：对转变的影响


背景和假设 在精神障碍诊断前的几年里，社会和学业适应能力会恶化。病前调整的分析最近已扩展到临床精神病高风险（CHR）综合征，以确定精神病的危险因素和发展途径。迄今为止的工作一直处于人与人之间的水平，这限制了对病前调整、临床协变量和精神病转化的分析。研究设计 生长曲线模型检查了 CHR 青少年病前社会和学业调整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）是否与转化者和非转化者（即在 2 年内发生/未发生精神障碍的参与者）的不同病前调整轨迹相关后续）。研究结果 皈依者报告说，在整个病前时期，社会适应能力较差。与那些患有非情感性精神病的人相比，患有情感性精神病的转化者在整个发病前期间的学业适应能力较差。初步认为，基线阴性症状减弱可能仅与未转化者病前社会适应恶化有关。童年创伤的影响与皈依者较少的学术功能问题有关。认知效果不会因转换状态而有所不同。结论 病前社会功能是转化为精神病风险的重要因素。转化者和非转化者的阴性症状和童年创伤与病前功能有不同的关系。 转化者与非转化者将症状和创伤与功能障碍联系起来的机制可能有所不同，这表明可能存在风险评估的新途径。