Early Functional Impairment and Social Consequences

Because of the early emergence of negative symptoms and functional impairment, most patients with schizophrenia started to suffer from social disability (Disability Assessment Schedule, DAS score > 2) 51 to 24 months before first admission, long before they received appropriate treatment. Two years before first admission, 57% of the patients were considerably impaired, when judged by the overall DAS score (> 2), in the domains of work performance, household activities, communication and leisure activitites. This result raises the question at which point do the social consequences actually emerge.

The effect of early social disability on the further illness course can only be judged against a baseline, i.e. the social status or level of social development at illness onset. In the ABC first-episode sample, no significant differences were observable in the fulfilment of six main social roles between patients and controls at the age of illness onset. By the time of first admission, patients with schizophrenia had fallen significantly behind the controls in several roles, most markedly in marriage or stable partnership. In sum, before illness onset, patients with schizophrenia were probably slightly, but not yet markedly and significantly, socially disadvantaged [62].

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