title: Symptom dimensions and functional impairment in early psychosis: more to the story than just negative symptoms.
abstract: Functional impairment is a defining feature of psychotic disorders and usually appears well before their onset. Negative symptoms play a prominent role in the impaired functioning of individuals with schizophrenia and those at clinical-high-risk (CHR) for psychosis. Despite high rates of depression and anxiety in early psychosis, few studies have examined the contribution of these symptoms to functioning in the putative 'prodrome.' In the current study, we tested the hypotheses that 1) worse negative and disorganized, but not positive, symptoms would be significantly related to impaired social and role functioning in two cohorts of CHR individuals (combined N=98) and a separate sample of individuals with recent-onset (RO) psychotic disorders (N=88); and 2) worse anxiety and depression would be significantly related to impaired functioning in both samples, above and beyond the contributions of negative and disorganized symptoms. Findings largely supported our hypotheses that more severe negative and disorganized symptoms were related to poorer social and role functioning in both samples. Anxiety and depression severity were significantly related to poorer functioning in both samples. In addition, depression, but not anxiety, predicted poorer global and social functioning above and beyond that explained by negative symptoms in the CHR sample. These results suggest the need for phase-specific treatment in early psychosis, with a focus on symptom dimensions to improve functional outcomes for CHR individuals.
authors.affiliation: University of California, San Francisco, United States. Electronic address: daniel.fulford@ucsf.edu.
authors.forename: Daniel
authors.initials: D
authors.lastname: Fulford
authors.affiliation: University of California, Davis, United States.
authors.forename: Tara A
authors.initials: TA
authors.lastname: Niendam
authors.affiliation: University of California, Davis, United States.
authors.forename: Erin G
authors.initials: EG
authors.lastname: Floyd
authors.affiliation: University of California, Davis, United States.
authors.forename: Cameron S
authors.initials: CS
authors.lastname: Carter
authors.affiliation: University of California, San Francisco, United States; San Francisco VA Healthcare System, United States.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Mathalon
authors.affiliation: University of California, San Francisco, United States; San Francisco VA Healthcare System, United States.
authors.forename: Sophia
authors.initials: S
authors.lastname: Vinogradov
authors.affiliation: University of California, San Francisco, United States.
authors.forename: Barbara K
authors.initials: BK
authors.lastname: Stuart
authors.affiliation: University of California, San Francisco, United States.
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Loewy
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000503:physiopathology*; D012044:Regression Analysis; D012307:Risk Factors; D012559:Schizophrenia / Q000175:diagnosis* / Q000503:physiopathology*; D012917:Social Adjustment; D055815:Young Adult