Premorbid Adjustment in Bipolar Disorder

Premorbid Adjustment in Bipolar Disorder:

Why being superior is not always good*

* Untersuchung von Alexander Georgi (Sigma Tagesklinik, Bad Säckingen) sowie Christine Schmael, Frederike Schirmbeck, Jana Strohmaier, Katja Bößhenz, Marcella Rietschel (Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Mannheim),Markus M. Nöthen (Life and Brain Center, University of Bonn), Thomas G. Schulze (Clinical Research Group 241, University of Göttingen), präsentiert auf dem 15ten World Congress of Psychiatric Genetics der International Society of Psychiatric Genetics (ISPG).


Disentangling the various environmental and biological factors involved in the etiology and course of psychiatric disorders is a prerequisite for the development of effective treatment and potentially prevention strategies. As for genetic research, the ever increasing sophistication of molecular genetic tools is accompanied by a call for a thorough assessment and systematic exploitation of all available phenotype information.

For the case of schizophrenia (SCZ) or bipolar disorder (BIP), several phenotypic variables have been suggested as targets for phenotypic dissection. Premorbid adjustment (PMA) has joined the list of phenotypes that may delineate specific biological subtypes (Schmael et al. 2007). There is consistent evidence that PMA is worse in individuals developing SCZ than in controls. For BIP, research into PMA is scarce and inconclusive.

Objective and Methods

We compared the level of PMA in individuals who later in life develop BIP with healthy controls and investigated whether levels of PMA in BIP patients are associated with specific phenotypic features (see Table 1).Study Sample

  •  Patienten344 BIP type I patients
    182 (53%) female, 162 (47%) male
    mean age 45.1±12.8 years
  • Kontrollgruppe137 healthy controls
    80 (58%) female, 57 (42%) male
    mean age 45.9±14.5 years

PMA Assessment

PMA was assessed using the Premorbid Adjustment Scale (PAS) by Cannon-Spoor (1982).  To increase the comparability of our study with previous studies, we re-analyzed our previously published data set on PMA in SCZ (Schmael et al. 2007) and compared PMA between BIP and SCZ patients.


Bipolar patients performed significantly better than healthy controls during early and late adolescence and had better PAS scores in the domains “sociability and withdrawal” , “adaptation to school” as well as a better overall score. For no life period of PAS domain did controls show better scores than patients. The re-analysis of our SCZ data revealed that BIP patients had significantly lower PAS scores than SCZ patients for all scales.

Figure 1

Figure 1: Median PAS scores for BIP and SCZ patients and healthy controls