Preliminary Findings for Two New Measures of Social and Role Functioning in the Prodromal Phase of Schizophrenia

TLDR

Schizophrenia prediction research increasingly focuses on early prodromal social and role dysfunction, which are stable, developmentally early, and treatment‑resistant. The study presents two new measures—Global Functioning: Social and Global Functioning: Role—and reports preliminary psychometric data and trajectories of social and role functioning in prodromal psychosis. The sample comprised 121 prodromal individuals (ages 12–29, meeting Attenuated Positive Symptom syndrome criteria) and 44 normal controls, with retrospective, baseline, and prospective follow‑up data collected at 6 and 12 months. Prodromal participants showed baseline impairments in social and role functioning; role functioning worsened before ascertainment but improved over 12 months, while social impairment remained stable and predicted later psychosis, indicating social functioning as a stable trait marker and role functioning as a treatment‑sensitive barometer.

Abstract

Research on prediction and prevention of schizophrenia has increasingly focused on prodromal (prepsychosis) social and role dysfunction as developmentally early, stable, and treatment-resistant illness components. In this report, 2 new measures, Global Functioning: Social and Global Functioning: Role, are presented, along with preliminary findings about psychometric properties and course of social and role (academic/work) functioning in the prodromal phase of psychosis.Subjects included 69 participants from the Recognition and Prevention program and 52 from the Center for the Assessment and Prevention of Prodromal States. Ages ranged from 12 to 29 years, and all met criteria for Attenuated Positive Symptom syndrome. Retrospective (past year) and baseline data are reported for all 121 prodromal subjects and for 44 normal controls (NCs). Prospective follow-up data are reported for a subsample of patients reevaluated at both 6 and 12 months (N = 44).For both scales, interrater reliability was high, and preliminary data supported construct validity. Relative to NCs, prodromal individuals displayed impaired social and role functioning at baseline. Analyses of change over time indicated that role functioning declined over the year before ascertainment and improved over 12-month follow-up, presumably with treatment. Social impairment, by contrast, was constant across time and predicted later psychosis (P = .002).Using 2 new global measures, social functioning was found to be a stable trait, unchanged by treatment, with considerable potential to be a marker of schizophrenia. Role functioning, by contrast, may be a more direct barometer of clinical change and may be responsive to treatment and environmental change.