title: The impact of premorbid adjustment, neurocognition, and depression on social and role functioning in patients in an early psychosis treatment program.
abstract: OBJECTIVE
  Functional impairments are debilitating concomitants of psychotic disorders and are present early in the illness course and, commonly, prior to psychosis onset. The factors affecting social and role functioning in early psychosis (EP) following treatment are unclear. We evaluated whether six months of participation in the PREP(R), Boston, EP treatment program, part of a public-academic community mental health center, was related to improvements in social and role functioning and whether premorbid adjustment in adolescence, baseline neurocognition, and depression symptoms predicted functional improvement.
  
  
  METHODS
  The Global Functioning Social and Role scales, MATRICS neurocognitive battery, and Calgary Depression Scale were assessed at baseline and six months during naturalistic treatment, while premorbid adjustment was measured at baseline. All participants were psychotic disorder patients in PREP(R) (n = 46 with social functioning and 47 with role functioning measures at both time points).
  
  
  RESULTS
  Large improvements were observed in role functioning (d = 0.84) and medium to large improvements were observed in social functioning (d = 0.70). Models consisting of adolescent premorbid adjustment and change in depression symptoms predicted social and role functioning change, whereas neuropsychological functioning did not.
  
  
  CONCLUSIONS
  Substantial improvements in social and role functioning were observed among this sample participating in a recovery-based EP program. The impact of clinical factors on social and role functioning was highlighted. Further studies of premorbid adjustment in adolescence and the treatment of depression in EP programs in controlled treatment trials are needed to confirm these findings.
authors.affiliation: Department of Psychology, Indiana University - Purdue University Indianapolis, Indianapolis, IN, USA ksminor@iupui.edu.
authors.forename: Kyle S
authors.initials: KS
authors.lastname: Minor
authors.affiliation: Department of Psychiatry, Harvard Medical School, Boston, MA, USA Massachusetts Mental Health Center Division of Public Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Friedman-Yakoobian
authors.affiliation: Massachusetts Mental Health Center Division of Public Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Y Jude
authors.initials: YJ
authors.lastname: Leung
authors.affiliation: U.S. Department of Veteran Affairs VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA Central Texas Veterans Healthcare System, Temple, TX, USA.
authors.forename: Eric C
authors.initials: EC
authors.lastname: Meyer
authors.affiliation: Department of Psychiatry, Harvard Medical School, Boston, MA, USA Massachusetts Mental Health Center Division of Public Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Suzanna V
authors.initials: SV
authors.lastname: Zimmet
authors.affiliation: Private Practice, Boston, MA, USA.
authors.forename: Brina
authors.initials: B
authors.lastname: Caplan
authors.affiliation: Massachusetts Mental Health Center Division of Public Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA Department of Mental Health, Massachusetts Mental Health Center, Boston, MA, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Monteleone
authors.affiliation: Massachusetts Mental Health Center Division of Public Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Bryant
authors.affiliation: Massachusetts Mental Health Center Division of Public Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA Department of Mental Health, Massachusetts Mental Health Center, Boston, MA, USA.
authors.forename: Margaret
authors.initials: M
authors.lastname: Guyer
authors.affiliation: Department of Psychiatry, Harvard Medical School, Boston, MA, USA Massachusetts Mental Health Center Division of Public Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Matcheri S
authors.initials: MS
authors.lastname: Keshavan
authors.affiliation: Department of Psychiatry, Harvard Medical School, Boston, MA, USA Massachusetts Mental Health Center Division of Public Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Larry J
authors.initials: LJ
authors.lastname: Seidman
mesh_terms: D000293:Adolescent; D000328:Adult; D003071:Cognition; D003863:Depression / Q000175:diagnosis*; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008960:Models, Psychological; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis*; D012380:Role; D012559:Schizophrenia / Q000175:diagnosis*; D012919:Social Behavior; D055815:Young Adult
keywords: depression; early psychosis; premorbid adjustment; role functioning; social functioning