Social impairment is a long-recognized core feature of schizophrenia and is common in other psychotic disorders. Still, to date the long-term trajectories of social impairment in psychotic disorders have rarely been studied systematically.

Data came from the Suffolk County Mental Health Project, a 20-year prospective study of first-admission patients with psychotic disorders. A never-psychotic comparison group was also assessed. Latent class growth analysis was applied to longitudinal data on social functioning from 485 respondents with schizophrenia spectrum disorders and psychotic mood disorders, and associations of the empirically derived trajectories with premorbid social adjustment, diagnosis, and 20-year outcomes were examined.

Four mostly stable trajectories of preserved (N=82; 59th percentile of comparison group sample distribution), moderately impaired (N=148; 17th percentile), severely impaired (N=181; 3rd percentile), and profoundly impaired (N=74; 1st percentile) functioning best described the 20-year course of social functioning across diagnoses. The outcome in the group with preserved functioning did not differ from that of never-psychotic individuals at 20 years, but the other groups functioned significantly worse. Differences among trajectories were already evident in childhood. The two most impaired trajectories started to diverge in early adolescence. Poorer social functioning trajectories were strongly associated with other real-world outcomes at 20 years. Multiple trajectories were represented within each disorder. However, more participants with schizophrenia spectrum disorders had impaired trajectories, and more with mood disorders had better functioning trajectories.

The results highlight substantial variability of social outcomes within diagnoses—albeit overall worse social outcomes in schizophrenia spectrum disorders—and show remarkably stable long-term impairments in social functioning after illness onset across all diagnoses.

社会障碍是精神分裂症的一个公认的核心特征，在其他精神病性疾病中很常见。但是，迄今为止，很少系统地研究精神病性疾病中社会损害的长期趋势。

数据来自萨福克郡精神卫生项目，该项目为首次入院的精神病患者进行了为期20年的前瞻性研究。还评估了一个从不精神病的对照组。对485名患有精神分裂症谱系障碍和精神病性情绪障碍的受访者的社会功能纵向数据进行了潜伏类增长分析，并检验了经验得出的轨迹与病前社会适应，诊断和20年结局的相关性。

保留的四个最稳定的轨迹（N = 82；比较组样本分布的第59个百分点），中度受损（N = 148；第17个百分点），严重受损（N = 181；第3个百分点）和严重受损（N = 74； 73％）。 1％的功能最能描述诊断过程中社会功能的20年历程。保留功能的组的预后与20岁时从未患有精神病的患者的预后没有差异，但其他组的功能明显较差。在儿童时期，轨迹之间的差异已经很明显。两条最受损的轨迹在青春期初期开始出现分歧。20年以来，较差的社会功能发展轨迹与其他现实世界的结果密切相关。每种障碍都表现出多种轨迹。然而，

结果突出显示了诊断过程中社会结果的显着差异（尽管精神分裂症谱系疾病总体上社会结果较差），并且在所有诊断中均显示出疾病发作后社会功能的长期稳定异常显着。