Research paperSocial and academic premorbid adjustment domains predict different functional outcomes among youth with first episode mania

- Childhood and adolescent adjustment predicted functioning, but not illness severity in the short to medium term after onset.
- Social adjustment predicted later interpersonal functioning while academic adjustment predicted vocational functioning.
- Premorbid adjustment may help identify subgroups that may benefit from different interventions.

BackgroundPremorbid characteristics may help predict the highly variable functional and illness outcomes of young people with early stage Bipolar Disorder (BD). We sought to examine the relationships between premorbid adjustment and short to medium-term outcomes after a first treated episode of mania.MethodsWe examined the baseline and 18-month follow-up characteristics of 117 participants with first episode of mania, treated at two tertiary early intervention services in Melbourne, Australia. The baseline demographic, family history, diagnoses, comorbidity and clinical features were determined using unstructured questionnaires and structured diagnostic interviews. Premorbid adjustment was determined using the Premorbid Adjustment Scale (PAS), the components of which were identified using a principal component analysis. Eighteen-month follow-up outcome measures included the Clinical Global Impressions scale, Social and Occupational Functioning Assessment Scale and the Heinrichs' Quality of Life Scale (QLS). Correlations and linear regressions were utilised to examine the relationships between component scores and outcomes, while controlling for baseline and follow-up confounders.ResultsThe social adjustment component of the PAS correlated with the interpersonal relations (rs = −0.46, p<0.001) domain of QLS while the academic adjustment component of the PAS correlated with the vocational functioning domain of QLS (rs =−0.39, p = 0.004). Premorbid adjustment did not predict illness severity or objective functioning.LimitationsLack of information on cognition, personality factors and prodromal symptoms limited the assessment of their impact on outcomes.ConclusionsImpairments in domains of premorbid adjustment may be early markers of persistent difficulties in social and vocational functioning and may benefit from targeted interventions.