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Protocol - Premorbid Adjustment in Psychosis

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Description:

The Modified Cannon-Spoor Premorbid Adjustment Scale (PAS) is an interviewer-administered rating scale that assesses functioning levels in four major areas of the subject’s life: social accessibility-isolation, peer relationships, ability to function outside the nuclear family, and capacity to form intimate socio-sexual ties. The scale is divided into four life period sections. The life period sections are Childhood (6-11 years), Early Adolescence (12-15 years), Late Adolescence (16-18 years), and Adulthood (19 years and up). Each section of the scale contains several items that are scored on a Likert-type scale of 0-6, where lower numbers indicate normal, healthy functioning and higher numbers suggest abnormal development.

The protocol measures only premorbid functioning, which is considered as the period ending 12 months before psychotic symptoms.

Protocol:

Subject’s Initials:

___________________________

Interviewer:

___________________________

Date of Interview (ddmmyyyy):

___________________________

Date of birth (ddmmyyyy):

___________________________

Date of first onset of psychotic symptoms (ddmmyyyy):

___________________________

Date of first psychiatric hospitalization (ddmmyyyy):

___________________________

Age at time of onset of first psychotic symptoms (ddmmyyyy):

___________________________

Sections to be administered

Put a check mark next to all sections up to 1 year prior to age at time of onset. These will represent the section of the PAS to be administered. For example, if the first psychotic symptoms were manifest at the age of 16, the interviewer would ask all the questions about life until the age of 15 inclusive [i.e., Childhood (up to the age of 11) and Early teens (ages 12 - 15)].

Childhood (ages 6 to 11):

Early teens (ages 12 to 15):

Late adolescence (ages 16 to 18):

Adulthood (19 and above):

Note: To help the respondent, throughout the interview repeat for each question the relevant age range. This is to help insure that the subject responds with reference to the relevant age range. Questions a to g below are intended to get the subject thinking about the past and act as a preliminary stage to the interview.

Insert the subject’s name instead of "you" if collected from someone other than the subject. I’d like to begin by asking you some short questions about what you were like growing up.

(a) Where were you born?

(b) Where did you grow up?

(c) Who did you live with when you were very young?

(d) Where did you go to school?

(e) How did you get to school?

Childhood (ages 6 to 11)

Now, I’d like to ask you some questions about your first years in school, from age 6 to 11.

I. Sociability and withdrawal childhood (ages 6 to 11)

Note: If onset was during this period, use for upper age ("to ____") age of onset -1.

First, I’d like to ask you about your friendships from the age of 6 to ____.

1. Did you have friends at school or in your neighborhood?

If "no" then skip to question 5.

2. What did you and your friends do together?

3. Who mostly made plans to do things, you or your friends?

4. Did you prefer to stay by yourself or get together with friends?

5. What kinds of things did you like to do at that age?

6. Did you spend a lot of time by yourself?

7. Did you daydream a lot?

II. Peer relationships childhood (ages 6 to 11)

If no friends or acquaintances at all are noted in the previous section (I. Sociability and withdrawal) score this section based on information already obtained and skip questions 1 to 5.

Note: If onset was during this period, use for upper age ("to ____") age of onset -1.

1. About how many friends did you have?

2. Were you close to any of them?

3. Did you have a best friend?

4. If yes: What was he/she like?

5. How often did you get together with your best friend?

6. What did you do when you got together with your best friend?

7. Did you have a friend who you could tell things that you did not want other people to know?

8. Were most of your friends your age?

9. If not, how much younger/older were they?

III. Scholastic performance childhood (ages 6 to 11)

Note: If onset was during this period, use for upper age ("to ____") age of onset -1.

I’d like to ask you some questions about school from the age of 6 to ____.

1. What was the name of your school?

Was it a public school, religious school, or another type of school? Did you go to a "special needs" school?

Note: Special school refers to a school for children with severe learning or emotional difficulties. If the respondent studied in special school then the highest possible rating on this item is 4.

If attended regular school: Did you attend regular classes with most other kids or did you go to a special class in a regular school?

2. Some kids find school very difficult. How hard were your subjects? Note: If you have local standards for excellent, good, average, fair and failing use them to illustrate. For example A, B, C, D and F.

3. What subject did you do the best in? What was the best grade you ever got?

4. What subjects did you have the hardest time in? What was the worst grade you ever got?

5. Compared to other kids, how did you do in school at this age? (Note the relevant years of schooling)

6. Thinking about all your subjects, how did you do overall, excellent, good, average, fair or failing student?

7. Did you repeat any years of schooling?

8. Would your exam marks have been good enough for you to get into any school?

IV. Adaptation to school childhood (ages 6 to 11)

Insert before each question "From the age of 6 to ____"

1. Did you enjoy school?

2. Would you say that you liked most of your teachers or would you say that you did not like most of your teachers?

3. Who was your favorite teacher?

What did you like about him/her?

4. Which teacher did you dislike the most?

Why didn’t you like him/her?

5. Did you have friends in school?

6. Did you turn off during class - like daydream or just not pay attention? How do you do that?

7. Were you involved in any school activities like teams, clubs, anything like that?

8. Some kids get into trouble at school. How often did you get into trouble at school?

What kinds of things happened?

If yes, probe to see if this was serious.

9. Did you leave school without permission? (A lot?)

10. Some kids break things at school, or rip their books. Did you ever damage school property?

Could you tell me about it?

If yes, probe to see if this was serious.

11. As punishment for being bad were you ever sent home from school for a few days or more from school? If yes, for how long?

12. For being bad were you ever told you are not allowed to go back to school?

Early adolescence (ages 12 to 15)

Now I am going to ask you some questions about your life between the ages of 12 to 15 (note for subject approximate school grade _____).

I. Sociability and withdrawal early adolescence (ages 12 to 15)

Note: If onset was during this period, use for upper age ("to ____") age of onset -1.

First, I’d like to ask you about your friendships from the age of 12 to ____.

Insert before each question "From the age of 12 to ____"

1. Did you have friends at school or in your neighborhood?

If "no" then skip to question 5.

2. What did you and your friends do together?

3. Who mostly made plans to do things, you or your friends?

4. Did you prefer to stay by yourself or get together with friends?

5. What kinds of things did you like to do at that age?

6. Did you spend a lot of time by yourself?

7. Did you daydream a lot?

II. Peer relationships early adolescence (ages 12 to 15)

If no friends or acquaintances at all are noted in the previous section (I. Sociability and withdrawal) score this section based on information already obtained and skip questions 1 to 5.

Note: If onset was during this period, use for upper age ("to ____") age of onset -1.

Insert before each question "From the age of 12 to ____:

1. About how many friends did you have?

2. Were you close to any of them?

3. Did you have a best friend?

If yes: What was he/she like?

How often did you get together with your best friend?

What did you do when you got together with your best friend?

4. Did you have a friend who you could tell things that you did not want other people to know?

5. Were most of your friends your age?

If not, how much younger/older were they?

III. Scholastic performance early adolescence (ages 12 to 15)

Note: If onset was during this period, use for upper age ("to ____") age of onset -1.

I’d like to ask you some questions about school from the age of 12 to ____.

Insert before each question "From the age of 12 to ____"

1. What was the name of your school?

2. Was it a public school, religious school, or another type of school?

3. Did you go to a "special needs" school?

Note to interviewer: Special school refers to a school for children with severe learning or emotional difficulties, if the respondent studied in special school they would not be rated higher than 4 on this item.

If attended regular school: Did you attend regular classes with most other kids or did you go to a special class in a regular school?

4. Some kids find school very difficult. How hard were your subjects?

Note to interviewer: If you have local standards for excellent, good, average, fair and failing use them to illustrate. For example A, B, C, D and F.

5. What subject did you do the best in? What was the best grade you ever got?

6. What subjects did you have the hardest time in? What was the worst grade you ever got?

7. Compared to other kids, how did you do in school at this age? (Note the relevant ages or years of schooling)

8. Thinking about all your subjects, how did you do overall, excellent, good, average, fair or failing student?

9. Did you repeat any years of schooling?

10. Would your exam marks have been good enough for you to get into any school?

IV. Adaptation to school early adolescence (ages 12 to 15)

Insert before each question "From the age of 12 to ____"

1. Did you enjoy school?

2. Did you like or dislike most of your teachers?

3. Who was your favorite teacher? What did you like about him/her?

4. Which teacher did you dislike the most? Why didn’t you like him/her?

5. Did you have friends in school?

6. Did you turn off during class - like daydream or just not pay attention? How often did that happen to you?

7. Were you involved in any school activities like teams, clubs, anything like that?

8. Some kids get into trouble at school. How often did you get into trouble at school? What kinds of things happened?

If yes, probe to see if this was serious.

9. Did you leave school without permission? (A lot?)

10. Some kids break things at school, or rip their books. Did you ever damage school property? Could you tell me about it?

If yes, probe to see if this was serious.

11. As punishment for being bad were you ever sent home from school for a few days or more from school? If yes, for how long?

12. For being bad were you ever told you are not allowed to go back to school?

V. Social-sexual aspects of life during early adolescence (ages 12 to 15)

Note: If onset was during this period, use for upper age ("to ____") age of onset -1.

I am going to ask you some questions about your relationships.

1. Did you have friends of the opposite sex, the same sex or both?

2. Did you socialize with boys and girls?

3. Did you have any romantic interests?

4. Did you ever have a crush?

5. Did you date?

6. Did you have a steady romantic relationship?

7. Were your partner(s) boy(s) and/or girl(s)?

8. Did you ever hug or kiss or have other sexual contact with your boy or girlfriend?

Late adolescence (ages 16 to 18)

Now I’d like to ask you about your late teens. Were you still in school from the age of 16 to 18?

I. Sociability and withdrawal late adolescence (ages 16 to 18)

Note: If onset was during this period, use for upper age ("to ____") age of onset -1.

1. Did you have friends at school or in your neighborhood?

If "no" then skip to question 5.

2. What did you and your friends do together?

3. Who mostly made plans to do things, you or your friends?

4. Did you prefer to stay by yourself or get together with friends?

5. What kinds of things did you like to do at that age?

6. Did you spend a lot of time by yourself?

7. Did you daydream a lot?

II. Peer relationships late adolescence (ages 16 to 18)

If no friends or acquaintances at all are noted in the previous section (I. Sociability and withdrawal) score this section based on information already obtained and skip questions 1 to 5.

Note: If onset was during this period, use for upper age ("to ____") age of onset -1.

1. About how many friends did you have?

2. Were you close to any of them?

3. Did you have a best friend?

If yes: What was he/she like?

How often did you get together with your best friend?

What did you do when you got together with your best friend?

4. Did you have a friend who you could tell things that you did not want other people to know?

5. Were most of your friends your age?

If not, how much younger/older were they?

III. Scholastic performance late adolescence (ages 16 to 18)

Note: If onset was during this period, use for upper age ("to ____") age of onset -1.

I’d like to ask you some questions about school from the age of 16 to ____.

1. What was the name of your school?

Was it a public school, religious school, or another type of school? Did you go to a "special needs" school?

Note: Special school refers to a school for children with severe learning or emotional difficulties, if the respondent studied in special school they would not be rated higher than 4 on this item.

If attended regular school: Did you attend regular classes with most other kids or did you go to a special class in a regular school?

2. Some kids find school very difficult. How hard were your subjects?

Note: If you have local standards for excellent, good, average, fair and failing use them to illustrate. For example A, B, C, D and F.

3. What subject did you do the best in? What was the best grade you ever got?

4. What subjects did you have the hardest time in? What was the worst grade you ever got?

5. Compared to other kids, how did you do in school at this age? (Note the relevant ages or years of schooling)

6. Thinking about all your subjects, how did you do overall, excellent, good, average, fair or failing student?

7. Did you repeat any years of schooling?

8. Would your exam marks have been good enough for you to get into any school?

IV. Adaptation to school late adolescence (ages 16 to 18)

Insert before each question "From the age of 16 to ____"

1. Did you enjoy school?

2. Would you say that you liked most of your teachers or would you say that you did not like most of your teachers?

3. Who was your favorite teacher? What did you like about him/her?

4. Which teacher did you dislike the most? Why didn’t you like him/her?

5. Did you have friends in school?

6. Did you turn off during class - like daydream or just not pay attention? How often did that happen to you?

7. Were you involved in any school activities like teams, clubs, anything like that?

8. Some kids get into trouble at school. How often did you get into trouble at school? What kinds of things happened? If yes, probe to see if this was serious.

9. Did you leave school without permission? (A lot?)

10. Some kids break things at school, or rip their books. Did you ever damage school property?

Could you tell me about it?

If yes, probe to see how serious this was.

11. As punishment for being bad were you ever sent home from school for a few days or more from school?

If yes, for how long?

12. For being bad were you ever told you are not allowed to go back to school?

V. Social-sexual aspects of life during late adolescence (ages 16 to 18)

Note: If onset was during this period, use for upper age ("to ____") age of onset -1.

I am going to ask you some questions about your relationships during the age of 16 to ____.

1. Did you ever go steady with another boy or girl for a long time? If so then ask:

How many steady relationships did you have?

Was it / were they sexual relationship(s)?

How long did the relationship last?

2. Did you date other boys, girls or both? Which? If so did you have ‘casual sex’?

4. Did you ever willingly hug, kiss or have other sexual contact with another boy or girl?

5. Were your friends male, female or both?

If the above answers show no sign of interest is shown then ask:

Were you not interested being with a boy or girl sexually, or for another reason?

Note to interviewer If no sexual interest is shown probe and if verified allocate 6 and go to the next section.

Adulthood (ages 19 and above)

Now I’d like to ask you some questions about your life from the age of 19 until ____(age of onset less one year as noted in the instructions before starting the interview).

Were you working or in school from the age of 19 to ____(use age from previous paragraph)?

I. Sociability and withdrawal adulthood (ages 19 and above)

Note: If onset was during this period, use for upper age ("to ____") age of onset -1.

How about your friendships from the age of 19 to ____.

1. Did you have friends at school or in your neighborhood?

If "no" then skip to question 5.

2. What did you and your friends do together?

3. Who mostly made plans to do things, you or your friends?

4. Did you prefer to stay by yourself or get together with friends?

5. What kinds of things did you like to do at that age?

6. Did you spend a lot of time by yourself?

7. Did you daydream a lot?

II. Peer relationships adulthood (ages 19 and above)

If no friends or acquaintances at all are noted in the previous section (I. Sociability and withdrawal) score this section based on information already obtained and skip questions 1 to 5.

Note: If onset was during this period, use for upper age ("to ____") age of onset -1.

1. About how many friends did you have?

2. Were you close to any of them?

3. Did you have a best friend or best friends?

If yes: What was he/she like?

How often did you get together with your best friend(s)?

What did you do when you got together with your best friend(s)?

4. Did you have a friend who you could tell things that you did not want other people to know?

5. Were most of your friends your age?

If not, how much younger/older were they?

Now I am going to ask you some questions about your relationships from age 19 to _____(age of onset -1).

Are you now or have you ever been married?

Note to Interviewer: If yes: Go to V.1.

If never married and over 30 year olds: Go to V.2.

If never married, age 19-29 years: Go to V.3.

V1. Aspects of adult social-sexual life (for persons married now or previously)

1. Are you now married?

2. How long have you been married?

3. Would you say that you are overall happily married?

4. Many couples argue a lot. How often do you and your spouse argue?

5. How satisfied are you with your sex life?

6. Is this your first marriage?

7. During this marriage, have you ever had an affair?

If this is a first marriage, then skip to next section "General", if not continue.

8. How many times were you married?

9. What year or how old were you when you first got married?

10. How did the marriage end? When did this happen? (Continue to ask about each marriage up to onset age -1).

V.2 Never married, over 30 years of age- Aspects of adult social-sexual life

1. Have you ever been engaged or in a steady relationship?

If yes: How long was your longest relationship?

2. Were these relationships sexual?

If yes: How often did you have sex?

3. If the answers to the above were no then ask: Have you had any romantic interests?

V.3 Never married, age 19-29 years - Aspects of adult social-sexual life

1. Have you had any romantic interests?

If no: Was this by choice or for another reason?

Did you ever want to get married or go steady but your partner(s) did not?

2. Were you ever engaged or did you go steady? How long was this?

3. Did you live together?

4. Have you had sexual relations?

If yes: How often did you have sex?

Was sex with the same partner?

If no: What was the longest such relationship?

PLEASE CHECK THAT YOU HAVE COMPLETED ALL THE PAS QUESTIONS ON THE REPORTING FORM

Appendix I: Premorbid Adjustment Scale with modifications

Instructions

This scale is designed to measure only premorbid functioning, where "premorbid" is defined as the period ending 12 months before evidence of characteristic florid psychotic symptomatology.

Only those life periods that are premorbid by this definition should be rated on this scale, regardless of the present age of the subject (e.g., a 39-year-old who had his first psychotic episode at age 17 would not be rated on the adult section, but would be rated on all other sections). In order to determine if a particular section should be scored, the onset date recorded in the chart should be consulted. If the individual showed signs of psychotic symptoms less than 12 months prior to this date, the section corresponding to this time frame should not be scored because it does not fall under the "premorbid period."

Scoring

Items are rated from 0 to 6. If it is impossible to rate an item, it should be marked as N/A (not available) on the scoring sheet. The possible score indicates the highest score obtainable by adding the maximum score for all items completed (e.g., if a subject receives ratings of 2, 3, 3 and 2 for the 4 items in the childhood section, the total score is 10. The possible score is 6 + 6 + 6 + 6 = 24. The total score divided by the possible score is 0.42). The score for any one section is expressed as a total score divided by possible score for the items rated. If only 3 items could be rated, then the possible score would be 18 (6 + 6 + 6), the total score would be 8 (2 + 3 + 3) and the section score 0.44.

The overall score is obtained by averaging all the subscale scores.

When scoring particular items, the patient need not meet all criteria set out in the anchor points. For example, on item 1 (sociability and withdrawal), the anchor point given for a score of 4, a patient must show moderate withdrawal. Daydreaming and excessive fantasy are offered in the anchor point to suggest the types of behaviour that might be exhibited by an individual who would receive this score. It is important to remember, however, that these are simply guidelines, and the individual is not required to meet all of the criteria offered in the anchor point in order to receive that score.

Childhood (up through age 11)

1. Sociability and withdrawal

[ ] 0 Not withdrawn, actively and frequently seeks out social contacts

[ ] 2 Mild withdrawal, enjoys socialization when involved, occasionally seeks opportunities to socialize

[ ] 4 Moderately withdrawn, given to daydreaming and excessive fantasy, may passively allow self to be drawn into contact with others, but does not seek it

[ ] 6 Unrelated to others, withdrawn and isolated, avoids contacts

2. Peer relationships

[ ] 0 Many friends (more than 5), close relationships ("best friends" or people you could confide in) with several

[ ] 1 2-5 friends

[ ] 2 Close relationships with a few friends (1 or 2), casual friendships with others

[ ] 3 Only casual friends

[ ] 4 Deviant (unusual) friendship patterns: friendly with children younger or older only, or relatives only, or casual relationships only

[ ] 6 Social isolate, no friends, not even superficial relationships

3. Scholastic performance (as compared with all other students that age in the general population [i.e., a student doing very well in a special needs school would rate no higher than a 4])

[ ] 0 Excellent student (straight A’s-likely to attend a post-secondary institution)

[ ] 1 A’s and B’s (likely to pursue post-secondary studies)

[ ] 2 Good student (B’s-post-secondary)

[ ] 3 Average student (B’s and C’s)

[ ] 4 Fair student (C’s)

[ ] 5 D’s-failing some classes

[ ] 6 Failing all classes

4. Adaptation to school

[ ] 0 Good adaptation, enjoys school, no or rare discipline problems, has friends at school, likes most teachers

[ ] 1 Likes school, few discipline problems

[ ] 2 Fair adaptation, occasional discipline problems, not very interested in school, but no truancy or rare. Has friends in school, but does not often take part in extracurricular activities

[ ] 3 Sometimes truant

[ ] 4 Poor adaptation, dislikes school, frequent truancy, frequent discipline problem (may have been suspended)

[ ] 5 Expelled from school

[ ] 6 Refuses to have anything to do with school - delinquency or vandalism directed against school

Early adolescence (12-15 years of age)

1. Sociability and withdrawal

[ ] 0 Not withdrawn

[ ] 2 Mild withdrawal, enjoys socialization when involved, occasionally seeks opportunities to socialize

[ ] 4 Moderately withdrawn, given to daydreaming and excessive fantasy, may passively allow self to be drawn into contact with others, but does not seek it

[ ] 6 Unrelated to others, withdrawn and isolated, avoids contact

2. Peer relationships

[ ] 0 Many friends (more than 5), close relationships ("best friends" or people you could confide in) with several

[ ] 1 2-5 friends

[ ] 2 Close relationships with a few friends (1 or 2), casual friendships with others

[ ] 3 Only casual friends

[ ] 4 Deviant (unusual) friendship patterns: friendly with children younger or older only, or relatives only, or casual relationships only

[ ] 6 Social isolate, no friends, not even superficial relationships

3. Scholastic performance (as compared with all other students that age in the general population [i.e., a student doing very well in a special needs school would rate no higher than a 4])

[ ] 0 Excellent student (straight A’s-likely to attend a post-secondary institution)

[ ] 1 A’s and B’s (likely to pursue post-secondary studies)

[ ] 2 Good student (B’s-post-secondary)

[ ] 3 Average student (B’s and C’s)

[ ] 4 Fair student (C’s)

[ ] 5 D’s-failing some classes

[ ] 6 Failing all classes

4. Adaptation to school

[ ] 0 Good adaptation, enjoys school, no or rare discipline problems, has friends at school, likes most teachers

[ ] 1 Likes school, few discipline problems

[ ] 2 Fair adaptation, occasional discipline problems, not very interested in school, but no truancy or rare. Has friends in school, but does not often take part in extracurricular activities

[ ] 3 Sometimes truant

[ ] 4 Poor adaptation, dislikes school, frequent truancy, frequent discipline problem (may have been suspended)

[ ] 5 Expelled from school

[ ] 6 Refuses to have anything to do with school - delinquency or vandalism directed against school

5. Social-sexual aspects of life during early adolescence

[ ] 0 Started dating, showed a "healthy interest" in the opposite sex, may have gone "steady," may include some sexual activity

[ ] 1 Attachment and interest in others, may be same-sex attachments, may be a member of a group, interested in the opposite sex, although may not have close, emotional relationship with someone of the opposite sex, "crushes" and flirtations

[ ] 2 Consistent deep interest in same-sex attachments with restricted or no interest in the opposite sex

[ ] 3 Casual same-sex attachments with inadequate attempts at relationships with the opposite sex. Casual contacts with both sexes

[ ] 4 Casual contacts with the same sex, no interest in the opposite sex

[ ] 5 A loner, no or rare contacts with either boys or girls

[ ] 6 Antisocial, avoids and avoided by peers (differs from above in that an active avoidance of others rather than a passive withdrawal is implied)

Late adolescence (16-18 years of age)

1. Sociability and withdrawal

[ ] 0 Not withdrawn

[ ] 2 Mild withdrawal, enjoys socialization when involved, occasionally seeks opportunities to socialize

[ ] 4 Moderately withdrawn, given to daydreaming and excessive fantasy, may passively allow self to be drawn into contact with others, but does not seek it

[ ] 6 Unrelated to others, withdrawn and isolated, avoids contact

2. Peer relationships

[ ] 0 Many friends (more than 5), close relationships ("best friends" or people you could confide in) with several

[ ] 1 2-5 friends

[ ] 2 Close relationships with a few friends (1 or 2), casual friendships with others

[ ] 3 Only casual friends

[ ] 4 Deviant (unusual) friendship patterns: friendly with children younger or older only, or relatives only, or casual relationships only

[ ] 6 Social isolate, no friends, not even superficial relationships

3. Scholastic performance (as compared with all other students that age in the general population [i.e., a student doing very well in a special needs school would rate no higher than a 4])

[ ] 0 Excellent student (straight A’s-likely to attend a post-secondary institution)

[ ] 1 A’s and B’s (likely to pursue post-secondary studies)

[ ] 2 Good student (B’s-post-secondary)

[ ] 3 Average student (B’s and C’s)

[ ] 4 Fair student (C’s)

[ ] 5 D’s-failing some classes

[ ] 6 Failing all classes

4. Adaptation to school

[ ] 0 Good adaptation, enjoys school, no or rare discipline problems, has friends at school, likes most teachers

[ ] 1 Likes school, few discipline problems

[ ] 2 Fair adaptation, occasional discipline problems, not very interested in school, but no truancy or rare. Has friends in school, but does not often take part in extracurricular activities

[ ] 3 Sometimes truant

[ ] 4 Poor adaptation, dislikes school, frequent truancy, frequent discipline problem (may have been suspended)

[ ] 5 Expelled from school

[ ] 6 Refuses to have anything to do with school - delinquency or vandalism directed against school

5. Social-sexual aspects of life during early adolescence

[ ] 0 Always showed a "healthy interest" in the opposite sex, dating, has gone "steady," has engaged in some sexual activity (not necessarily intercourse)

[ ] 1 Dated regularly. Had only one friend of the opposite sex with whom the subject went "steady" for a long time. (Includes sexual aspects of a relationship, although not necessarily intercourse; implies a twosome, pairing off into couples as distinguished from below)

[ ] 2 Always mixed closely with boys and girls. (Involves membership in a crowd, interest in and attachment to others, no couples)

[ ] 3 Consistent deep interest in same-sex attachments with restricted or no interest in the opposite sex

[ ] 4 Casual same-sex attachments with inadequate attempts at adjustment to going out with the opposite sex. Casual contacts with both sexes

[ ] 5 Casual contacts with the same sex, with a lack of interest in the opposite sex. Occasional contacts with the opposite sex

[ ] 6 No desire to be with boys and girls, never went out with the opposite sex

Adulthood (age 19 and above)

1. Sociability and withdrawal

[ ] 0 Not withdrawn, actively and frequently seeks out social contact

[ ] 2 Mild withdrawal, enjoys socialization when involved, occasionally seeks opportunities to socialize

[ ] 4 Moderately withdrawn, given to daydreaming and excessive fantasy, may passively allow self to be drawn into contact with others, but does not seek it

[ ] 6 Unrelated to others, withdrawn and isolated, avoids contact

2. Peer relationships

[ ] 0 Many friends (more than 5), close relationships ("best friends" or people you could confide in) with several

[ ] 1 2-5 friends

[ ] 2 Close relationships with a few friends (1 or 2), casual friendships with others

[ ] 3 Only casual friends

[ ] 4 Deviant (unusual) friendship patterns: friendly with children younger or older only, or relatives only, or casual relationships only

[ ] 6 Social isolate, no friends, not even superficial relationships

3. Aspects of adult social-sexual life

A. Married presently or formerly

[ ] 0 Married, only one marriage (or remarried as a result of death of spouse), living as a unit, adequate sexual relations

[ ] 1 Currently married with a history of low sexual drive, periods of difficult sexual relations, or extramarital affair

[ ] 1 Married more than one time, currently remarried. Adequate sexual relations during at least one marriage

[ ] 2 Married, or divorced and remarried, with chronically inadequate sex life

[ ] 2 Married and apparently permanently separated or divorced without remarriage, but maintained a home in one marriage for at least 3 years

[ ] 3 Same as above, but divorce occurred over 3 years ago and while married, maintained a home for less than 3 years

B. Never married, over 30 years of age

[ ] 2 Has been engaged one or more times or has had a long-term relationship (at least 2 years) involving heterosexual or homosexual relations, or apparent evidence of a love affair with one person, but unable to achieve a long-term commitment such as marriage

[ ] 3 Long-term heterosexual or homosexual relationship lasting over 6 months, but less than 2 years

[ ] 4 Brief or short-term dating experiences (heterosexual or homosexual) with one or more partners, but no long-lasting sexual experience with a single partner

[ ] 5 Sexual and/or social relationships rare or infrequent

[ ] 6 Minimal sexual or social interest in either men or women, isolated

C. Never married, age 19-29 years

[ ] 0 Has had at least one long-term love affair (minimum 6 months) or engagement, even though religious or other prohibitions or inhibitions may have prevented actual sexual union. May have lived together

[ ] 1 Has dated actively, had several "boyfriends" or "girlfriends." Some relationships have lasted a few months, but no long-term relationships. Relationships may have been serious but a long-term commitment such as marriage was not understood to be an eventuality

[ ] 3 Brief or short-term dating experiences or affairs with one or more partners, but no long-lasting sexual experience with a single partner

[ ] 4 Casual sexual or social relationships with persons of either sex with no deep emotional bonds

[ ] 5 Sexual and/or social relationships rare or infrequent

[ ] 6 Minimal sexual or social interest in either men or women, isolated

Protocol Name from Source:

Modified Cannon-Spoor Premorbid Adjustment Scale (PAS)

Availability:

Publicly available

Personnel and Training Required

The interviewer must be trained to conduct personal interviews with individuals from the general population. The interviewer must be trained and found to be competent (i.e., tested by an expert) at the completion of personal interviews. The interviewer should be trained to prompt respondents further if a "don’t know" response is provided.

Equipment Needs

None

Requirements
Requirement CategoryRequired
Major equipment No
Specialized training Yes
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual Yes
Mode of Administration

Interviewer-administered questionnaire

Life Stage:

Child, Adolescent, Adult

Participants:

Children, adolescents, adults, ages 6 years and older

Specific Instructions:

The Cannon-Spoor Premorbid Adjustment Scale (PAS) was modified as described by van Mastrigt and Addington (2002). The modifications were to slightly alter the scoring of the traditional scale to enhance use of the scale in first-episode psychosis.

The date of onset of the psychotic illness must be established before the end of the premorbid period can be determined. Consider symptoms that were both noticeable and of concern when estimating the date of onset. These symptoms should be clearly noticed by the individual, the family or both. The end of the premorbid period should be taken as 1 year before the date of onset.

Methods of training and inter-rater reliability should be reported.

Selection Rationale

The Modified Cannon-Spoor Premorbid Adjustment Scale (PAS) was chosen for the following reason: it is slightly shorter than the original Cannon-Spoor PAS, and it has more sensitive language to gender issues. The original Cannon-Spoor PAS was designed to evaluate the degree of achievement of developmental goals at each of several periods of a subject’s life before the onset of schizophrenia. It has been found to be useful in identifying patients likely to become chronically hospitalized or at high risk for readmission. Currently, it is one of the most widely used measures of premorbid adjustment in schizophrenia populations.

The Early Psychosis Working Group omitted the general scale as it is not typically performed in the field of psychosis research and has acknowledged limitations as documented by van Mastrigt and Addington (2002).

Language

English

Standards
StandardNameIDSource
Common Data Elements (CDE) Psychosis Premorbid Adjustment Assessment Scale 5627340 CDE Browser
Process and Review

The Expert Review Panel has not reviewed this measure yet.

Source

van Mastrigt, S., & Addington, J. (2002, March). Assessment of premorbid function in first-episode schizophrenia: Modifications to the Premorbid Adjustment Scale. Journal of Psychiatry and Neuroscience, 27(2), 92-101.

General References

Brill, N., Reichenberg, A., Weiser, M., & Rabinowitz, J. (2008). Validity of the premorbid adjustment scale. Schizophrenia Bulletin, 34(5), 981-983.

Cannon-Spoor, H. E., Potkin, S. G., & Wyatt, R. J. (1982). Measurement of premorbid adjustment in chronic schizophrenia. Schizophrenia Bulletin, 8(3), 470-484.

Protocol ID:

660801

Variables:
Export Variables
Variable NameVariable IDVariable DescriptionVersiondbGaP Mapping
Research Domain Information
Measure Name:

Premorbid Adjustment in Psychosis

Release Date:

January 17, 2017

Definition

An interview to evaluate an individual’s psychological functioning before the onset of psychotic disorders such as schizophrenia.

Purpose

This measure can be used to characterize the social-interpersonal and role functioning in childhood through early adulthood for people with severe mental illness.

Keywords

Schizophrenia, premorbid functioning, Modified Cannon-Spoor Premorbid Adjustment Scale, PAS, recall bias, premorbid history, sociability, scholastic performance, peer relationships, social-sexual tie, social-personal adjustment, Psychiatric Status Rating Scales, psychotic disorders