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IntroductionThe Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV diagnostic category “Psychotic disorder not otherwise specified” (PNOS) is seldom investigated, and we lack knowledge about long-term outcomes. We examined long-term symptom severity, global functioning, remission/recovery rates, and diagnostic stability after the first treatment for PNOS.MethodsParticipants with first-treatment PNOS (n = 32) were reassessed with structured interviews after 7 to 10 years. The sample also included narrow schizophrenia spectrum disorders (SSD, n = 94) and psychotic bipolar disorders (PBD, n = 54). Symptomatic remission was defined based on the Remission in Schizophrenia Working Group criteria. Clinical recovery was defined as meeting the criteria for symptomatic remission and having adequate functioning for the last 12 months.ResultsParticipants with baseline PNOS or PBD had lower symptom severity and better global functioning at follow-up than those with SSD. More participants with PNOS and PBD were in symptomatic remission and clinical recovery compared to participants with SSD. Seventeen (53%) PNOS participants retained the diagnosis, while 15 participants were diagnosed with either SSD (22%), affective disorders (19%), or substance-induced psychotic disorders (6%). Those rediagnosed with SSD did not differ from the other PNOS participants regarding baseline clinical characteristics.ConclusionsLong-term outcomes are more favorable in PNOS and PBD than in SSD. Our findings confirm diagnostic instability but also stability for a subgroup of participants with PNOS. However, it is challenging to predict diagnostic outcomes of PNOS based on clinical characteristics at first treatment.

Background Recovery is the ultimate goal of psychosis treatment . Basic self-disturbances (BSDs) are non-psychotic phenomena associated with clinical outcome, present in prodromal, psychotic and residual phases of psychotic disorders. Aim To investigate the relationship between BSDs and recovery seven years after first treatment in patients with psychotic disorders. Method Prospective longitudinal study of 56 patients recruited during first adequate treatment for schizophrenia (n = 35) and other psychotic disorders (n = 21) (psychotic bipolar disorder, delusional disorder, psychotic disorder NOS). At baseline and follow-up BSDs were assessed using the Examination of Anomalous Self-Experience (EASE) manual, while standard clinical instruments were used to ascertained diagnosis, clinical symptom severity, and functioning. Recovery was defined as absence of psychotic symptoms and regaining of functioning that persisted the last two years before follow-up. Results At follow up, 34% achieved recovery (5 (14%) with schizophrenia and 14 (67%) with other psychoses at baseline). Recovery was predicted by an absence of a schizophrenia diagnosis, low baseline level of BSDs and further reductions in BSDs from baseline to follow-up. Change in BSDs was the strongest predictor, also after adjusting for premorbid adjustment and duration of untreated psychosis, and was not confounded by diagnosis. Conclusion Low baseline levels of basic self-disturbances and further reductions over time independently predict recovery seven years later in first treated psychosis patients. This work was supported by Innlandet Hospital Trust, Norway (Grant Nos. 150281 and 150338), and Eastern Norway Health Authority (Grants no. 2006258-2011085-2014102). BN was supported by an NHMRC Senior Research Fellowship (Grant no. 1137687).

This study aimed to investigate what characterizes individuals with schizophrenia who experience more or less subjective executive dysfunction in everyday life compared to objective executive performance on neuropsychological tests. Sixty-six participants with broad schizophrenia spectrum disorders completed a comprehensive assessment of executive function. Discrepancies between performance on neuropsychological tests (objective) and an extensive self-report questionnaire (subjective) of central executive functions (inhibition, shifting and working memory) were calculated. Higher level of self-efficacy was the best predictor of experiencing fewer subjective cognitive complaints compared to objective performance, followed by higher levels of disorganized symptoms. Depressive symptoms did not predict discrepancy between subjective and objective executive function. Higher estimated IQ predicted greater subjective working memory difficulties in everyday life despite better objective performance. Results may aid clinicians in the assessment and remediation of cognitive impairment. Low self-efficacy may identify individuals who are not able to utilize their potential executive functions in daily life. Interventions aimed at fostering self-efficacy ought to be included in cognitive remediation for these individuals. Disorganized symptoms could prove useful in identifying individuals who are in need of cognitive remediation for executive dysfunction, despite that they overestimate their skills. These individuals may benefit from efforts to increase insight into cognitive dysfunction. Keywords: Cognition; Cognitive impairment; Executive function; Psychosis; Schizophrenia; Self-efficacy; Subjective assessment. © 2021 The Authors.

Background: Patients with outpatient commitment have a decision on coercive treatment from the specialist health services even if they are in their own home and receive municipal health services. Objective: The aim of this study is to gain more knowledge about how the outpatient commitment system works in the municipal health service and specialist health services, and how they collaborate with patients and across service levels from the perspectives of healthcare professionals. Methods: This is a qualitative study collecting data through focus group interviews with health personnel from the municipal health service and specialist health services. Results: The results describe the health personnel’s experiences with follow-up and interactions with the patients with outpatient commitment decisions, and their experiences with collaboration between service levels. Conclusion: The study show that outpatient commitment makes a difference in the way patients with this decision are followed up. The legislative amendment with new requirements for consent competence was challenging. Collaboration between services levels was also challenging.

Background People with mental health problems are mostly treated within the community. The law allows for the use of compulsory mental health care both in hospital and in the community. Various forms of outpatient commitment (OC) have been adopted in much European legislation. To be subjected to OC is a serious intervention in a person's life. Aim The purpose of this study is to gain knowledge about patients who undergo OC. The study explores the incidence and prevalence of OC in a geographical area, the central characteristics of the sample, and how the framework for follow-up treatment for patients to resolve OC works. Methods The data were collected from a review of electronic patient records. The statistical methods used in this study were descriptive analysis, with frequency analysis and cross-tabulation analysis. Results The main finding in the present study is that the use of OC has increased. An important finding is that most of the patients have a decision made for OC that is justified by the treatment criterion. The present study shows that there is insufficient documentation on statutory responsibilities for follow-up treatment of patients with an OC. Conclusions This study shows that the use of OC has increased. It should be considered whether implemented measures to reduce the use of coercion have the desired effect.

Background Basic self-disturbances (BSDs) are considered core features of schizophrenia spectrum disorders, and are present in the prodromal, early psychotic and chronic phases. Considerable levels of BSDs are also present at first treatment in some patients with psychotic disorders outside the schizophrenia spectrum. There is limited knowledge about the stability of self-disturbances over time. Aim To explore the stability of BSDs in a seven-year follow-up of first treatment patients, and the association between baseline levels and changes in BSDs and diagnostic changes at follow-up. Method Longitudinal study of 56 patients (35 schizophrenia and 21 non-schizophrenia) recruited at their first treatment for a psychotic disorder. BSDs were assessed using the Examination of Anomalous Self-Experience (EASE), while diagnostic categories, clinical symptom severity, and functioning were assessed with standard clinical instruments. Results The schizophrenia group had significantly lower levels of BSDs at follow-up compared to baseline. The EASE domain “Cognition and stream of consciousness” was the most stable. There were no diagnostic changes into or out of schizophrenia spectrum. Patients with schizophrenia had significantly higher levels of BSDs both at baseline and at follow up than patients with psychotic disorders outside the schizophrenia spectrum, who showed stable low levels. Conclusion We found a decrease and thus less stability in BSDs in schizophrenia than expected. This might indicate that BSDs tent to weaken over time, and that unknown individual characteristics may influence the development of BSDs. Diagnostic stability from baseline to follow-up may be due to long DUP before service entry.

Background Anomalous self-experiences (ASEs) are viewed as core features of schizophrenia. Childhood trauma (CT) has been postulated as a risk factor for developing schizophrenia. Aim The aim of this study is to investigate the relationships between CT, depression and ASEs in schizophrenia. Method ASEs were assessed in 55 patients in the early treated phases of schizophrenia using the Examination of Anomalous Self-Experience (EASE) instrument. Data on CT were collected using the Childhood Trauma Questionnaire, short form (CTQ-SF). This consists of 5 subscales: physical abuse, sexual abuse, emotional abuse, emotional neglect, and physical neglect. Assessment of depression was based on the Calgary Depression Scale for Schizophrenia (CDSS). Results We found significant associations between EASE total score and CTQ total score and between EASE total score and emotional neglect subscore in women, but not men. We also found significant associations between CDSS total score and CTQ total score and between CDSS total score and emotional abuse, emotional neglect, and physical neglect subscores in women, but not men. In men we did not find any significant associations between EASE total score, CDSS total score and any CTQ scores. Conclusion CT was significantly associated with higher levels of ASEs in women in the early treated phases of schizophrenia, but not in men. This again associated with an increase in depressive symptoms.

This study aimed to investigate the knowledge about dental erosion (DE) among children and adolescents 13 – 20 years. The study was based on a questionnaire regarding knowledge of DE, oral symptoms, soft drink consumption and oral hygiene habits, and was implemented at three different schools in Troms county: one occupational school (n=42) and one study specialized school (n=64) both in Sør-Troms 16-20 yrs, and one “youth-school” in Tromsø 13 yrs (n=116). The analyzes were done in SPSS using crosstabs and frequencies tables. In total 222 (n) questionnaires were answered at the three different schools. 51.8 % (n=115) of the students were boys and 48.2 % (n=107) were girls. Children and adolescents have in general little knowledge about DE. There were no significant differences when we compared age, sex and education level. The school that had most knowledge was the “study specialized school”, and the school with the poorest knowledge was the “occupational school”, although the “study specialized school” was the school that had the least amount of knowledge about etiology of DE. There were no significant differences regarding sex in our results. We found a positive correlation between consumption of soft drinks and age, with older boys having the highest consumption, and a negative correlation between oral hygiene and age.

Background About 85% of patients with schizophrenia have cognitive impairments, executive functions being particularly affected. Executive dysfunctions are important predictors of functional outcomes. Unlike psychotic symptoms, cognitive deficits do not improve during periods of remission and change only minimally with antipsychotic medications. Thus, effective interventions aimed at improving executive functions in this population are needed. One of the most validated interventions for executive dysfunction is Goal Management Training (GMT). GMT is a compensatory intervention that relies on metacognitive strategies for improving participants’ ability to organize and achieve goals in everyday life. GMT has received empirical support in studies of other populations, such as people with neurological conditions and in healthy elderly. To our knowledge no previous studies have investigated the effect of group-based GMT in patients with schizophrenia spectrum disorders or with high risk of schizophrenia. Thus, this is the main objective of the study. Baseline characteristis and preliminary results from the first patients will be presented. Methods Participants (16–67 years, males and females, IQ >70) with executive dysfunction, will be recruited among patients referred for treatment at Innlandet Hospital Trust in Norway from 2017 to 2020. The study aims to include patients treated for psychotic disorder for less than 5 years and new patients who either have symptoms that meet the DSM-IV criteria for a diagnosis of broad schizophrenia spectrum disorder or who are considered at high risk of psychosis. We aim to recruit one hundred participants for the current randomized controlled trial (RCT), with efficacy of GMT (n = 50) being compared with results of subjects in a wait-list condition (WL, n = 50). Measurements include self-report of executive function, emotional health, and social- and everyday function. Informant reports of executive function will also be collected. Furthermore, neuropsychological tests designed specifically to measure areas of executive function will be utilized, as well as role-playing tasks thought to have good ecological validity. Symptoms of psychosis will also be assessed. GMT will be administered in 9 (twice weekly) x 2 hour sessions in accordance with the GMT research protocol. A general linear model with repeated measures analysis of variance (RM ANOVA) will be used to examine differential group treatment effects. A 2 x 3 mixed-design will be applied, with Group (GMT, WL) as between-subjects factor, and Session (baseline [T1], post-intervention [T2], and 6 months follow-up [T3]) as within-subjects factor. Interpretation of the strength of experimental effects will be provided with effect size statistics. Results Baseline characteristics and preliminary results from the first participants will be presented. Discussion Based on findings from previous GMT-studies, we hypothesize that post-intervention changes will be reflected in improved scores on self-reported and/or objective measures of executive functions (particularly in the areas of planning and attentional control) compared to patients in WL. We also expect that GMT participants will improve their goal attainment in everyday life and social functioning after the intervention. Additionally, we expect post-intervention changes to be reflected in improved scores on measures of emotional health.

Aim To investigate self-reported psychiatric and somatic symptoms and health service use at age 16 in persons who later developed a psychotic disorder compared with a control group from the same geographical areas. Method Responses concerning psychiatric or somatic health and health service use from Norwegian youth studies in a cohort of 15- and 16-year-olds in three Norwegian counties (N = 11 101, 90% response rate) were gathered. The questionnaire responses from persons later identified with a lifetime diagnosis of DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) psychotic disorders (n = 30) (confirmed psychosis, CP) were compared with responses from the rest of the group (population control, PC) (n = 11 067). Follow-up analyses were made for cases with a confirmed onset of a psychotic disorder after the time of the survey (n = 21). Results The main significant differences between the CP and PC groups were more self-reported anxiety, depression and 'feeling in need of treatment for eating disorders' at age 16 in the CP group. The rate of self-reported eating disorder symptoms alone reached the level of statistical significance in the follow-up analyses. The CP group did not use available health services to a markedly greater extent than the control group. Conclusion We found that, in comparison with others, youths who were later identified with a psychotic disorder reported more symptoms at age 16.

Converging evidence indicates that self-disorders (SDs) selectively aggregate in schizophrenia spectrum conditions. The aim of this study was to test the discriminatory power of SDs with respect to schizophrenia and nonschizophrenia spectrum psychosis at first treatment contact. SDs were assessed in 91 patients referred for first treatment through the Examination of Anomalous Self-experience (EASE) instrument. Diagnoses, symptoms severity, and function were assessed using the Structural Clinical Interview for the DSM-IV, Structured Clinical Interview for the Positive and Negative Syndrome Scale, Calgary Depression Scale for Schizophrenia, Young Mania Rating Scale, and Global Assessment of Functioning-Split Version. Most patients found it highly relevant to talk about SDs. EASE total score critically discriminated between schizophrenia, bipolar psychosis, and other psychoses. The EASE total score was the only clinical measure that showed a significant and robust association with the diagnosis of schizophrenia. Systematic exploration of anomalous self-experiences could improve differential diagnosis in first-treatment patients.

Background: The growing research focus on early detection of schizophrenia has fostered an increasing interest in the nonpsychotic experiential anomalies that may antedate schizophrenia spectrum disorders and assist early differential diagnosis. The Examination of Anomalous Self-Experience (EASE) is a phenomenologically inspired checklist, specifically designed to support the comprehensive assessment of these characteristic subjective experiences. Aim: To assess the interrater reliability of the EASE. Sampling and Methods: Twenty-five first-episode psychosis (FEP) patients were interviewed with the EASE. Videotaped interviews were blindly reevaluated. Internal consistency, overall interrater correlation and item interrater agreement (Cohen’s kappa) were estimated. Results: The EASE showed good to excellent internal consistency across the two raters (Cronbach’s alpha above 0.87) and an overall inter-rater correlation above 0.80 (Spearman’s rho, p < 0.001). The average kappa of the EASE was 0.65, ranging from 0.51 to 0.73 over the 5 domains; kappa values at an item level were very good in 9 items, good in 20 items, moderate in 11 items and fair in 4 items. Conclusion: The EASE provides a reliable and internally consistent clinical tool for the assessment of subjective experience in FEP patients, suggesting that this instrument could usefully supplement standard clinical assessments during the onset phase of psychosis.

Background Self-disturbances are considered core features of schizophrenia spectrum disorders, and are present in the prodromal, the early psychotic and in the chronic phase. Self-disturbances are also present at first treatment in some patients with psychotic disorders outside of the schizophrenia spectrum. There is limited knowledge about the stability of self-disturbances over time. The aim is to explore the stability of self-disturbances in a seven year follow-up of first episode patients and to examine the association between self-disturbances at start of treatment and diagnostic changes at follow-up. Methods Longitudinal study of 56 patients recruited at their first treatment for an affective or non-affective psychotic disorder. Self-disturbances were assessed by the Examination of Anomalous Self-Experience (EASE), while diagnostic categories, symptom severity, and functioning were assessed with standard clinical instruments. At baseline we registered life-time experiences of self-disturbances. At follow-up we focused on self-disturbances experienced the last two years Results At follow-up 35 patients were diagnosed with schizophrenia or a schizoaffective disorder (schizophrenia) and 21 with a bipolar, psychotic disorder or delusional disorder (non-schizophrenia). The level of self-disturbances was significant lower at follow-up than at baseline in patients with schizophrenia. Patients with schizophrenia had significantly higher levels of self-disturbances both at baseline and at follow up than patients in the non-schizophrenia group, who showed stable low levels of self-disturbances. In the schizophrenia group the EASE domain “Cognition and stream of consciousness”, was the most stable. There were no changes into or out of the schizophrenia group. The four patients in the non-schizophrenia group with relatively high EASE total scores at baseline (≥ 15) did not convert to schizophrenia at follow-up, as hypothesized. No patients in the non-schizophrenia group who increased their EASE score from baseline to follow-up converted to the schizophrenia group. Discussion EASE domain “Cognition and stream of consciousness”, have previously been described as some of the first self-disturbances appearing in the prodromal phase and are also found to be the most predictive of transition to full-threshold psychosis in an Ultra High Risk group. The results from the present study show that these phenomena are also the most stable over time. We did not find that patients outside the schizophrenia group, converted to schizophrenia, neither among those who had high level of self-disturbances at baseline nor those who had increased levels of self-disturbances at follow-up. The current study was conducted in rural areas with considerable distances to the specialized psychiatric health services, and consequently with long duration of untreated psychosis. The observed diagnostic stability is thus to be expected if symptomatic developments relevant for diagnosis take place early in the first episode, in this case before the first treatment contact.

To investigate the relationship between anomalous self-experiences and duration of untreated psychosis in a sample of patients with first-episode schizophrenia spectrum disorders.Anomalous self-experiences were assessed by means of the Examination of Anomalous Self-Experience manual in 55 patients referred to their first adequate treatment for schizophrenia. Diagnoses, symptom severity, functioning and childhood trauma were assessed using the Structured Clinical Interview for the Positive and Negative Syndrome Scale, Premorbid Adjustment Scale, Social Functioning Scale and Childhood Trauma Questionnaire. Substance misuse was measured with the Drug Use Disorder Identification Test, and alcohol use was measured with the Alcohol Use Disorder Identification Test. Duration of untreated psychosis was measured in accordance with a standardized procedure.High levels of anomalous self-experiences are significantly associated with longer duration of untreated psychosis, an association which held after correcting for other variables associated with long duration of untreated psychosis.The field of early detection in psychosis is in need of additional clinical perspectives to make further progress. Improved understanding and assessment of anomalous self-experiences may help clinicians to detect these important phenomena and provide earlier help, and thus reduce treatment delay.

Background Psychotic disorders are associated with significant social dysfunction. Anomalous self-experiences (ASE) present in psychotic disorders could contribute to social dysfunction. Aim To investigate if ASE contribute to social dysfunction in the early phases of psychotic disorders after controlling for factors related to social functioning including diagnoses. Methods ASE were assessed by means of the EASE (Examination of Anomalous Self-Experience) in 76 patients referred to their first adequate treatment for schizophrenia or psychotic bipolar disorder. Diagnoses, symptom severity, and functioning were assessed using the Structured Clinical Interview for the Positive and Negative Syndrome Scale, Calgary Depression Scale for Schizophrenia, Premorbid Adjustment Scale, Global Assessment of Functioning—Split Version, and Social Functioning Scale. Neurocognitive assessments included measures of psychomotor speed, working memory, executive and memory functions. Duration of untreated psychosis was also assessed. Results High levels of ASE were significantly associated with poorer social functioning in the early phases of schizophrenia and psychotic bipolar disorder also after correcting for diagnosis. Conclusion This study demonstrates the significance of ASE for social dysfunction in patients with psychotic disorders, and contributes to the understanding of the complexity of illness-related factors that affect social functioning.

Etiologies of psychotic disorders (schizophrenia and bipolar disorder) are conceptualized as interplay between genetic and environmental factors. The adolescent period is characterized by changes in social roles and expectations that may interact with biological changes or psychosocial stressors. Few studies focus on the adolescents’ own reports of perceived risk factors. To assess differences at age 16 between persons who later develop psychotic disorders (“Confirmed Psychosis”, CP) and their class-mates (“Population Controls”, PC) we collected information on: (1) Social support factors (size of social network and expectancies of social support from friends), (2) Cognitive functioning (concentrating in the classroom, actual grades and expectancies of own academic achievements) and (3) Problems and stressors in families (illness or loss of work for parents), and in relationship with others (exposure to bullying, violence or sexual violation). Self-reported data from students at 15–16 years of age were linked to the case-registers from the “Thematically Organized Psychosis (TOP) Study”. The CP group reported more economic problems in their families, smaller social network and lower academic expectation than the PC group. The results support the notion that long-term socioeconomic stressors in adolescence may serve as risk factors for the development of psychotic disorders

To investigate self-reported psychiatric and somatic symptoms and health service use at age 16 in persons who later developed a psychotic disorder compared with a control group from the same geographical areas.Responses concerning psychiatric or somatic health and health service use from Norwegian youth studies in a cohort of 15- and 16-year-olds in three Norwegian counties (N = 11 101, 90% response rate) were gathered. The questionnaire responses from persons later identified with a lifetime diagnosis of DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) psychotic disorders (n = 30) (confirmed psychosis, CP) were compared with responses from the rest of the group (population control, PC) (n = 11 067). Follow-up analyses were made for cases with a confirmed onset of a psychotic disorder after the time of the survey (n = 21).The main significant differences between the CP and PC groups were more self-reported anxiety, depression and 'feeling in need of treatment for eating disorders' at age 16 in the CP group. The rate of self-reported eating disorder symptoms alone reached the level of statistical significance in the follow-up analyses. The CP group did not use available health services to a markedly greater extent than the control group.We found that, in comparison with others, youths who were later identified with a psychotic disorder reported more symptoms at age 16.

Background A recent hypothesis is that suicidality in schizophrenia may be linked to the patients' altered basic self-awareness or sense of self, termed self-disorders (SDs). Aim The aim of the study was to investigate whether SDs in first-episode schizophrenia spectrum disorders are related to suicidality and whether this relationship is independent of or mediated by depression or other standard clinical measures. Method Self-disorders were assessed in 49 patients with first-episode schizophrenia by means of the Examination of Anomalous Self-Experience (EASE) instrument. Symptoms severity and functioning were assessed using the Structured Clinical Interview for the Positive and Negative Syndrome Scale, Calgary Depression Scale for Schizophrenia, and Global Assessment of Functioning-Split Version. Suicidality was measured by the Calgary Depression Scale for Schizophrenia item 8. Results Analyses detected a significant association between current suicidality, current depression, and SDs as measured by the EASE. The effect of SDs on suicidal ideation appeared to be mediated by depression. Conclusion The interaction between anomalous self-experiences and depression could be a rational clinical target for the prevention of suicidality in the early phases of schizophrenia and supports the rationale for including assessment of SDs in early intervention efforts.

Background Neurocognitive deficits and self-disorders (i.e. altered basic self-awareness or — sense of self) have both been suggested as fundamental trait features of schizophrenia. However, no study until now has investigated the relationship between these two core features. Aim To investigate the relationship between self-disorders and neurocognitive performance in patients with schizophrenia. Method Self-disorders were assessed in 57 patients in the early phase of schizophrenia by means of the Examination of Anomalous Self-Experience (EASE) instrument. The neurocognitive assessments included measures of psychomotor speed, working memory, executive- and memory functions. Results There were few associations between self-disorders and neurocognitive impairments. However, high levels of SDs were significantly associated with impaired verbal memory. Conclusion The reason for the general lack of associations between self-disorders and neurocognition could be that they represent different basic features of the illness. Verbal memory may however be linked to deficits in the patients' ability to comprehend, direct, remember and reason about their thoughts, functions that are intimately related to the basic sense of self.

Background Low levels of self-esteem have been implicated as both a cause and a consequence of severe mental disorders. The main aims of the study were to examine whether premorbid adjustment has an impact on the subject's self-esteem, and whether lowered self-esteem contributes to the development of delusions and hallucinations. Method A total of 113 patients from the Thematically Organized Psychosis research study (TOP) were included at first treatment. The Positive and Negative Syndrome Scale (PANSS) was used to assess present symptoms. Premorbid adjustment was measured with the Premorbid Adjustment Scale (PAS) and self-esteem by the Rosenberg Self-Esteem Scale (RSES). Results Premorbid social adjustment was significantly related to lower self-esteem and explained a significant proportion of the variance in self-esteem. Self-esteem was significantly associated with the levels of persecutory delusions and hallucinations experienced by the patient and explained a significant proportion of the variance even after adjusting for premorbid functioning and depression. Conclusion There are reasons to suspect that premorbid functioning is an important aspect in the development of self- esteem, and, furthermore, that self-esteem is associated with the development of delusions and hallucinations.