Am J Psychiatry 1995; 152:1009-1015
Copyright © 1995 by American Psychiatric Association
Vulnerability to psychosis in unipolar major depression: is premorbid functioning involved?
JR Sands and M Harrow
Department of Psychiatry, University of Illinois College of Medicine, Chicago 60612, USA.
OBJECTIVE: This research examined whether deficits in premorbid functioning
are associated with a vulnerability to psychosis in unipolar major
depressive disorder. METHOD: A group of 92 inpatients with unipolar major
depression were assessed for premorbid functioning and psychotic symptoms
during an index hospitalization. They were prospectively assessed for
psychotic symptoms 2.0 and 4.5 years after hospital discharge. RESULTS: The
psychotic depressed patients had significantly poorer premorbid
functioning--particularly, adolescent social functioning--than the
nonpsychotic depressed patients. Longitudinal analyses indicated that poor
premorbid social adaptation was significantly associated with the emergence
of psychosis during the follow-up period in depressed patients who had not
been psychotic as inpatients. CONCLUSIONS: Factors related to a
vulnerability to psychosis among patients with major depression are present
even years before the onset of overt psychotic symptoms. The data could
support the view that impaired premorbid functioning is one manifestation
of prepsychotic processes that constitute an underlying diathesis for
psychotic episodes during the longitudinal course of unipolar major
depression. These findings are consistent with other emerging findings
pointing to early developmental deficits in patients who subsequently
develop psychotic disorders.
