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.
Bibliographical noteFunding Information:
Preparation of this manuscript was supported by the National Institutes of Mental Health (2T32 MH018261-27 awarded to DF, 1K23MH087708-01A1, awarded to TN, 5R01MH059883 awarded to CC, and R01MH076989 awarded to DM) and the Brain and Behavior Research Fund (awarded to RL and DM).
DM consults for Bristol Myers Squibb. CC has served as a one-time consultant for Pfizer, Merck, Lilly, Servier, and has received research funding from GlaxoSmithKline. SV is a paid consultant for Brain Plasticity Institute, Amgen, Hoffman La Roche, and Genentech. DF, TN, EF, BS, and RL declare no conflicts of interest.
- Clinical high risk
- Negative symptoms
- Psychosocial functioning
- Recent onset psychosis