title: Trajectories of social withdrawal and cognitive decline in the schizophrenia prodrome.
abstract: OBJECTIVE
  Schizophrenia is a heterogeneous neurodevelopmental disorder. Patients with high levels of negative symptoms have been identified as a specific subtype, but little is known about how the neurodevelopmental course may differ in this group. This study aimed to characterize developmental trajectories of premorbid social withdrawal and cognitive decline between patients with high versus low levels of negative symptoms in youth with schizophrenia-spectrum disorders.
  
  
  METHODS
  A standardized timeline was used to delineate the emergence of psychosis, social withdrawal, and cognitive decline in 52 subjects aged 8 to 19 with schizophrenia (n=36), schizophreniform (n=6), or schizoaffective disorder (n=10). The sample was divided into subgroups of high- (n=26) versus low- (n=26) negative symptoms, and developmental trajectories of premorbid symptoms were compared between groups.
  
  
  RESULTS
  Mean ages for emergence of social withdrawal, cognitive decline, and psychosis were 11.1 years (SD=2.5), 11.9 (SD=4.4) and 13.2 years (SD=1.2), respectively. In the high-negative symptom group, the premorbid developmental trajectory for social withdrawal was more protracted. This group also had more severe cognitive decline at the onset of psychosis, but the premorbid trajectories for cognitive decline did not differ significantly between groups.
  
  
  CONCLUSIONS
  This work documents a more severe and protracted trajectory of premorbid social withdrawal in patients with high levels of negative symptoms in comparison to those with low-negative symptoms. The findings reported here are supportive of the hypothesis that patients with illness characterized by high levels of negative symptoms may represent a subgroup with distinct neurodevelopmental abnormalities.
authors.affiliation: Department of Psychiatry, University of Minnesota School of Medicine, Minneapolis, MN, USA. rega0026@umn.edu
authors.forename: Kathryn
authors.initials: K
authors.lastname: Cullen
authors.forename: Angela
authors.initials: A
authors.lastname: Guimaraes
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Wozniak
authors.forename: Afshan
authors.initials: A
authors.lastname: Anjum
authors.forename: S Charles
authors.initials: SC
authors.lastname: Schulz
authors.forename: Tonya
authors.initials: T
authors.lastname: White
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D002648:Child; D003072:Cognition Disorders / Q000453:epidemiology / Q000523:psychology*; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D010553:Personality Development; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D012559:Schizophrenia / Q000175:diagnosis / Q000453:epidemiology*; D012565:Schizophrenic Psychology; D012917:Social Adjustment; D055815:Young Adult