Premorbid adjustment trajectories in schizophrenia and bipolar disorder: A transdiagnostic cluster analysis. (February 2019)

• Record Type: Journal Article
• Authors: Chan, Chi C.; Shanahan, Megan; Ospina, Luz H.; Larsen, Emmett M.; Burdick, Katherine E.
• Is Part Of: Psychiatry research. Volume 272(2019)
• Page Start: 655
• Page End: 662
• Publication Date: 2019-02
• Subjects: Psychiatry -- Periodicals; Psychiatry -- periodicals; Psychiatrie -- Périodiques; 616.89
• DOI: 10.1016/j.psychres.2018.12.169
• Languages: English
• ISSNs: 0165-1781

Abstract

Highlights: Premorbid adjustment problems are shared by schizophrenia and bipolar disorder. Empirically-derived premorbid adjustment trajectory clusters cut across diagnoses. Premorbid adjustment trajectories in social and academic domains are distinct. Trajectory clusters differ on childhood neglect history and later symptom severity. Abstract: Despite the overlap between schizophrenia and bipolar disorder, neurodevelopmental abnormalities are thought to be associated primarily with schizophrenia. Transdiagnostic and empirical identification of subgroups based on premorbid adjustment (PMA) may enhance understanding of illness trajectories. 160 patients with bipolar I or II disorder (BD; n = 104) or schizophrenia or schizoaffective disorder (SZ; n = 56) were assessed on PMA course from childhood to late adolescence and current symptoms and functioning. A hierarchical cluster analysis was performed using social and academic PMA scores, resulting in three optimal clusters. Cluster 1 (n = 28 SZ, 65 BD) had normal social and academic PMA, the most education, and mildest current symptoms. Cluster 2 (n = 15 SZ, 24 BD) had normal social PMA but an impaired-declining academic course and had a greater proportion of males than Cluster 1. Cluster 3 (n = 13 SZ, 15 BD) had an impaired-stable social PMA and an impaired-declining academic course and the most severe current negative symptoms and childhood trauma. The proportions of SZ and BD diagnoses, current neurocognition, and functioning did not differ between clusters. These findings suggest shared neurodevelopmental abnormalities between SZ and BD, with subgroups exhibiting distinct PMA trajectories that cut across disorders.