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Twenty year study finds little change in social functioning in people with psychosis

Researchers found that patterns of patients’ social functioning began to emerge in childhood and adolescence, changing prior to onset of illness, but remaining largely unchanged after the first hospitalisation

by George Wigmore (Senior Communications Officer)

Researchers have found that levels of social impairment in people with schizophrenia remained remarkably stable in the years after the first hospitalisation for psychosis.

The research team from Icahn School of Medicine at Mount Sinai, City, University of London and Stony Brook University found that patterns of patients’ social functioning began to emerge in childhood and adolescence, changing prior to onset of illness, but remaining largely unchanged after the first hospitalisation.

The Suffolk Country Mental Health Project, which followed a large sample of individuals with psychosis over 20 years, is one of the first long term studies of the illness looking over two decades.

To investigate how social functioning changed over time, 628 patients with psychotic disorders were recruited between 1989 and 1995. All participants were aged between 15 and 60 and had been recently hospitalised for their illness for the first time.

As part of the study, which is published in the American Journal of Psychiatry, participants’ social functioning was assessed six months after first hospitalisation and again two, four, 10, and 20 years later. The researchers also retrospectively assessed individuals’ social functioning in childhood and adolescence, prior to the onset of their illness. After 20 years the remaining participants were compared with a comparison group who had never experienced psychosis.

The researchers found that people with schizophrenia and related disorders tended to experience more social impairments over the 20 year period than individuals diagnosed with psychotic mood disorders. However, the degree of social impairment varied significantly between individuals, regardless of what diagnosis they had.

For some individuals with psychotic mood disorders, social functioning was similar to that of individuals in the “never psychotic” group. But, 35 percent of participants with major depressive disorder and 18 percent of those with bipolar disorder, were affected by severe and persistent social impairments. In the participants with schizophrenia spectrum disorders, 75 percent had severe and persistent social impairments.

It was also seen that 20 years into the study functional outcomes, such as whether individuals had earned a high school diploma, their employment status, and their financial independence, were poorest in those groups in the study with the lowest levels of social functioning.

Dr Anne-Kathrin Fett, co-author of the study and a lecturer in the Department of Psychology at City, University of London, said:

“In our study we saw that following the initial hospitalisation for psychosis, the level of social impairment in people with schizophrenia remained remarkably stable. As these patterns can first emerge before the first hospitalization somewhere in between the late childhood and teenage years, it supports the importance of early intervention and treatment.”

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