The early developmental context and course of First-Episode Psychosis.

While there is a wealth of knowledge concerning premorbid risk factors for first-episode episode psychosis (FEP), premorbid development can also account for some of the heterogeneity in clinical features of FEP associated with poor post-onset outcome. The current study was therefore designed to evaluate the following hypotheses: 1) low cognitive reserve would confer greater vulnerability to cognitive decline in FEP, 2) more “difficult” premorbid temperamental styles would increase susceptibility to substance abuse in FEP, and 3) FEP onset would lead to increasing dependence on family members to meet attachment needs. Fifty-four individuals with FEP and their parents provided consent for collection of data pertaining to early central nervous system development, premorbid temperament, premorbid and post-onset attachment networks, as well as clinical status and cognition through the early phase of psychosis. Our results indicate that, first, individuals with low and normal cognitive reserve experienced cognitive declines of similar magnitude early in psychosis. Second, more “difficult” permorbid temperamental styles were associated with significantly increased odds for substance abuse at presentation. Finally, increasing emotional dependence on family members was not universally reported; instead, only those without romantic partners showed consolidation of attachment networks into a few family relationships. Longer duration of illness predicted intensified dependence on family members, and more severe negative symptoms were associated with difficulties forming new peer attachments. These results suggest that risk factors from the developmental literature can account for some of the heterogeneity in particular clinical features of FEP. Some aspects of premorbid development, such as temperament, are especially useful predictors of specific difficulties early in FEP.