Negative labelling of individuals with first episode schizophrenia: the effect of premorbid functioning

This study examines the hypothesis that negative labelling of individuals with a first episode of schizophrenia is related to the length and intensity of behavioural disturbance prior to first hospitalization. Forty-five individuals with first episode schizophrenia were assessed at admission to hospital for the presence and severity of symptoms, duration of untreated illness and premorbid social and occupational functioning. Negative labelling was assessed from ratings obtained from individuals designated as a significant other by the individuals with schizophrenia. Identical measures of labelling were obtained from individuals designated as a significant other by a comparison group (n = 70) who had no history of psychiatric disorder. The results indicated that the individuals with schizophrenia received more negative labels than the asymptomatic individuals. The negative attributions were associated with older age at onset of psychosis, a long period of deterioration before the onset of psychosis, and poor occupational functioning in the 9 months prior to hospitalization. These findings are consistent with results from studies that have examined expressed emotion (EE) in first episode schizophrenia and suggest that the reported association of high EE with relapse in first episode schizophrenia may be confounded with premorbid functioning that is typically associated with poor outcome.