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Schizophrenia carries greatest impairment in social functioning

Among individuals with schizophrenia spectrum disorders, major depressive disorder with psychosis and bipolar disorder with psychosis, impaired social functioning was most common in schizophrenia.

“While considerable research has been done in schizophrenia, social outcomes in other psychotic illnesses have been less studied,” Eva Velthorst, PhD, of Icahn School of Medicine at Mount Sinai, New York, and colleagues wrote. “It is generally assumed that schizophrenia is associated with worse social functional outcomes compared with other psychotic disorders, but the few studies that directly tested this assumption by comparing the longitudinal courses of social functioning in affective and nonaffective psychoses have yielded conflicting findings.”

To determine longitudinal trajectories of social functioning in individuals with psychotic disorders, researchers analyzed data from the Suffolk County Mental Health Project, a 20-year prospective study of individuals first admitted with psychotic disorders. The cohort included individuals with schizophrenia spectrum disorders (n = 269), major depressive disorder with psychosis (n = 77), bipolar disorder with psychosis (n = 139), and a comparison group without psychotic disorders.

Findings indicated four “mostly stable” trajectories of social impairment: preserved (n = 82), moderately impaired (n = 148), severely impaired (n = 181) and profoundly impaired (n = 74).

Multiple trajectories were found in each disorder. However, impaired social functioning trajectories were more common among individuals with schizophrenia spectrum disorders, while those with mood disorders had better social functioning trajectories.

At 20 years’ follow-up, social functioning outcomes were significantly worse among individuals with profoundly (P < .001), severely (P < .001) and moderately (P < .001) impaired social functioning, compared with the comparison group.

Outcomes were similar among individuals with preserved functioning and those without psychotic disorders.

At the group level, differences in social functioning were evident in childhood. Participants with worse social functioning in childhood exhibited a larger decline in social functioning scores in adolescence to scores 6 months after first admission, particularly those with profoundly (P < .001) and severely impaired functioning (P < .001).

“Our findings are consistent with recent programs of research focused on adolescence as the critical intervention window and support current early intervention strategies for high-risk individuals and those that offer intensive treatment to first admission patients aimed to prevent social withdrawal in severe psychotic illnesses,” the researchers concluded. – by Amanda Oldt

Disclosure: Velthorst reports receiving support from Netherland Organization for Scientific Research (NWO) VENI Grant 916-15-005. Please see the study for a full list of relevant financial disclosures.