Investigations in the premorbid and early phases of psychosis are important for enhancing early intervention programmes. The purpose of the present study was to examine premorbid functioning in a large sample of individuals admitted to their first treatment for psychosis.

184 first-episode psychotic patients participated in the study. The relationship between premorbid adjustment, initial presentation and one-year outcome was examined using Premorbid Adjustment Scale (PAS), Positive and Negative Symptoms Scale (PANSS) and Global Assessment of Functioning (GAF). Social and academic dimension of PAS was analysed. Cluster analyses were used to identify patterns of premorbid adjustment over four developmental periods.

A poorer premorbid adjustment was consistently related to more negative symptoms at initial presentation and more negative symptoms and poorer social functioning at one-year outcome. PAS contributed to outcome at one year independent of initial presentation. No relationship between premorbid adjustment and DUP was found and DUP was associated only with positive symptoms at one year. A stable-poor and a deteriorating premorbid adjustment course lead to a similar poorer initial presentation and poorer outcome at one year compared to a stable-good premorbid adjustment. The social dimension seems to contribute more importantly to outcome than the academic dimension.

The results support a heterogenetic view of schizophrenia where premorbid adjustment and DUP could be understood as influencing different rather independent pathological domains. The findings point to a possible need for early intervention in case of social maladjustment, independent of later transition to psychosis.