Premorbid educational attainment in schizophrenia: Association with symptoms, functioning, and neurobehavioral measures

Background: The purpose of this study was to examine the association of educational attainment with phenomenology and neurobehavioral measures assessing brain structure and function in schizophrenia. Methods: One hundred sixty-two patients with schizophrenia were divided into two groups on the basis of educational attainment: greater than or equal to 13 years of education was the cutoff between the high and low groups. The two education groups were compared on symptomatology, functioning, and subsamples on neuropsychological profile, brain volume by magnetic resonance imaging, and brain metabolism by fluorodeoxyglucose positron-emission tomography. Results: The patients with more education had lower levels of psychotic symptomatology than their counterparts with less education. This was most evident for affective flattening alogia, avolition, and bizarre behavior. The higher education group also had better ratings on premorbid adjustment, and the engagement and vocational factors of the Quality of Life Scale. Patients in the high education group also performed better on the neuropsychological battery. There were no brain volume differences or differences in brain metabolism between the two education groups. Conclusions: Education is an important indicator of premorbid function and is related to the clinical presentation of schizophrenia. Biol Psychiatry 1998;44: 739-747 (C) 1998 Society of Biological Psychiatry.