the Camberwell Collaborative Psychosis Study Premorbid social underachievement in schizophrenia. Results from

P.B.JONES, P.BEBBINGTON, A.FOERSTER, S.W. LEWIS,R.M.MURRAY, A.RUSSELL,P.C.SHAM,B.K.TOONE andS.WILKINSInaninvestigationofthetimingandprecursorsofsocialdeclineinschizophreniaandaffectivepsychosis,195 subjectsfromthe CamberwellCollaborativePsychosisStudywere currentlyof lowersocialclassthanweretheirfathers.A comparisonbetweenfather'soccupationandproband'sbestpremorbidoccupationallevelindicatedunderachievementconfinedtoDSM-lllschizophrenia,therebeingnosucheffectinaffectivepsychosis.Declineinsocialstatusfollowingonsetof psychosis,analysedbycomparingbestpremorbidoccupationwith currentoccupation, was markedin both schizophreniaandaffective psychosis,indicatinganon-specificeffect. Schizophrenicpatientswho failedto achievetheirfathers' socialstatushadpoorereducationalqualificationsthanthosewhoequalledorbetteredtheirpaternalsocialclass,despitesimilarpremorbidlQ(NART)scoresandageatonsetofpsychosis.Theseresultsindicatethatschizophreniamaybemanifestbeforetheonsetofpsychosis,andlendweighttothenotionofadevelopmentalorigintothisdisorder.This paper is the first report from the CamberwellCollaborative Psychosis Study. This study wasdesigned to investigate the relationship between theclinical characteristics of schizophrenia and a rangeof potential aetiological factors. These factorsinclude family history of psychosis, pregnancy andbirth complications, abnormal developmental history,neurological and radiological abnormalities, andpsychosocial stress. The present paper gives thediagnostic and sociodemographic characteristics ofthe subjects, and tests the hypothesis that socialunderachievement beginning before the onset of psychosisis specific to schizophrenia among the psychoses.A link between social class and mental disorderswas established by Farms& Dunham (1939), whodemonstrated that new cases of schizophrenia inChicago were concentrated in ‘?hobohemia',thedilapidated slum districts in the centre of the city,and that incident cases decreased towards the moreaffluent, peripheral districts. An increased prevalenceof schizophrenia in socially deprived areas has sincebeen found repeatedly (Clark, 1948; Hare, 1956),although only for urban populations (Kohn, 1973).The finding has been extended by examining occupational status (Hollingshead & Redlich, 1958;Turner et al, 1967; Wiersma et al, 1983), and thereis now little doubt that schizophrenia is concentratedin occupations of the lowest status.It has proved difficult to establish the directionof causality between social class and schizophrenia.Firstly, it is not clear whether the phenomenon is