The extent and origin of discordance between self- and observer-rated depression in patients with psychosis

Self- and observer ratings of capacity limitations in patients with neurological conditions

OBJECTIVE

The purpose of this study was to compare the self- and observer ratings of capacity limitations in patients with neurological conditions. Research on this topic is relevant for assessing the patients' ability to participate in work and social life and improving collaborative patient-clinician relationships.

METHOD

The self- and observer ratings of capacity limitations in a sample of N = 245 patients with neurological conditions from a rehabilitation facility were compared and assessed using the short rating of activity limitations and participation restrictions in mental disorders according to the International Classification of Functioning, Disability and Health (Mini-ICF-APP) and the equivalent self-rating questionnaire (Mini-ICF-APP-S).

RESULTS

Paired-samples t-tests revealed significant differences between the self- and observer ratings for six out of 13 capacity dimensions. On average, the patients rated the capacity dimensions adherence to regulations, planning and structuring of tasks, professional competency and endurance as significantly less limited, in comparison to the observers (small to medium effect sizes). The self-ratings for limitation of contact with others and self-care were only marginally higher than the observer ratings.

CONCLUSIONS

The findings show that psychological capacity limitations occur in patients with neurological conditions. In clinical practice, limitations in each capacity dimension and discrepancies in patient- and clinician-ratings should be thoroughly assessed. This is especially relevant in patients with neurological conditions who have a potential tendency to underestimate or deny their disability.

Measurement of negative and depressive symptoms: Discriminatory relevance of affect and expression

There is conceptual overlap between negative and depressive symptoms: Mainly the ‘avolition’ factor of negative symptoms also encompasses main symptoms of depression. However, whereas in depression mood is low, mainly anticipatory anhedonia can be found in negative symptoms. Moreover, patients with schizophrenia (SCZ) show greater expressive deficits than those with Major Depressive Episode (MDE). We investigated if measures of depressive and negative symptoms differentiate SCZ subjects, subjects with MDE, and healthy controls (HC). 21 SCZ, 22 MDE, and 25 HC subjects were examined with a rater assessment and a self-rating for negative symptoms (Clinical Assessment Interview for Negative Symptoms (CAINS); Motivation and Pleasure – Self-Report (MAP-SR)) and depressive symptoms (Hamilton Rating Scale for Depression (HAMD-17); Beck Depression Inventory (BDI)). All measures differentiated the psychiatric samples from HC (all p’s < 0.01). The ratings of depressive symptoms (HAMD-17, BDI) and rater assessment of negative symptoms (CAINS) – specifically its sub scale measuring expressive deficits – managed to discriminate between subjects with schizophrenia and those with MDE (SCZ > MDE > HC for negative, MDE > SCZ > HC for depressive symptoms, all p’s < 0.05). The self-rating of negative symptoms (MAP-SR) did not. To differentiate negative symptoms and depression clinicians might look for (self-)reported low mood and observer-rated reduction in speech as well as in gestures and facial expression. Reduced expression and moderate levels of depression point towards a negative syndrome, whereas mostly unimpaired expression and high scores of self-reported depressive symptoms are more likely to indicate a depressive syndrome.

An Investigation of Module-Specific Effects of Metacognitive Training for Psychosis

Abstract. Metacognitive training for psychosis (MCT) is a group training program that targets cognitive biases, which play a role in the pathogenesis of delusions. It remains unclear to what extent individual MCT modules lead to within- or between-session changes in positive symptoms, sadness, cognitive biases, or theory of mind (ToM) distortions. A one-armed open-label intervention study was conducted with 176 psychiatric inpatients with psychotic symptoms. Patients were asked to fill out a questionnaire on cognitive biases, symptoms, and ToM distortions before and after each session. Multilevel (ML) modeling was used to assess associations between participation in a respective module and subsequent changes in self-reported symptoms. ML analyses indicated an overall improvement in all outcomes as well as within-session decreases in positive symptoms for a module addressing ToM distortions with a small effect. Two MCT modules addressing cognitive biases (jumping to conclusions, a bias against disconfirmatory evidence) were associated with reductions in the module-specific bias with a small and small to medium effect, respectively. The study provides initial evidence regarding module-specific associations with positive symptoms, cognitive biases, and ToM distortions in MCT.

Embracing Psychosis: A Cognitive Insight Intervention Improves Personal Narratives and Meaning-Making in Patients With Schizophrenia

Schizophrenia is a complex psychiatric disorder with unknown and presumably heterogeneous etiology. While the disorder can have various outcomes, research is predominantly "deficit-oriented" emphasizing the hardship that the disorder inflicts on sufferers as well as their families and society. Beyond symptom reduction, imparting patients with hope and meaning in life is increasingly considered an important treatment target, which may raise self-esteem, and reduce self-stigma and suicidal ideation. The present study compared a psychotherapeutic treatment aimed at improving cognitive insight, individualized metacognitive intervention (MCT+), with an active control in order to elucidate if personal meaning-making and hope can be improved in patients with psychosis across time. A total of 92 patients were randomized to either individualized metacognitive therapy (MCT+) or CogPack (neuropsychological training) and followed up for up to 6 months. The "Subjective Sense in Psychosis Questionnaire" (SUSE) was administered which covers different salutogenetic vs pathogenetic views of the disorder, valence of symptom experiences and the consequences of psychosis. Patients in the MCT+ group showed a significant positive shift in attitudes towards the consequences of their illness over time relative to patients in the active control condition. There was some evidence that MCT+ also enhanced meaning-making. The perceived negative consequences of psychosis were highly correlated with depression and low self-esteem, as well as suicidality. The study shows that a cognitive insight training can improve meaning-making in patients and help them come to terms with their diagnosis.

Investigating the roles of loneliness and clinician- and self-rated depressive symptoms in predicting the subjective quality of life among people with psychosis

PURPOSE

To examine the roles of loneliness and clinician- and self-rated depressive symptoms as predictors of the subjective quality of life (QoL) in psychosis.

METHODS

This cross-sectional study was conducted on a sample of 207 patients diagnosed with psychotic disorders. They were assessed with self-reported measures of QoL, loneliness and depression and with clinician-rated measures of depression and overall psychopathology. Multiple indicators multiple causes (MIMIC) modeling was used to analyze the data.

RESULTS

Both loneliness and depression turned out to be independent predictors of impaired QoL. However, once loneliness was accounted for, the effect of depression on QoL was markedly reduced and the effect of loneliness proved to be visibly larger. Self-rated depression was found to be more strongly associated with QoL than clinician-rated depression. Each type of depression measure explained a unique amount of variance in QoL. Depression moderated the relationship between loneliness and QoL in such a way that the negative effect of loneliness on QoL weakened with the increasing intensity of depressive symptoms.

CONCLUSIONS

Therapeutic programs aiming to enhance the QoL of people with psychotic disorders should incorporate interventions targeting both loneliness and depression and need to be tailored to the clinical status of patients. The emphasis on alleviating loneliness should be placed first of all in the case of those with low levels of depression, among whom the negative impact of loneliness on QoL is especially strong. Researchers should be aware that the method chosen for assessing depressive symptoms in models predicting QoL in psychosis matters.

Correlations between self-rating and observer-rating of psychopathology in at-risk mental state and first-episode psychosis patients: influence of disease stage and gender

AIM

Research findings on the correlations between self-rating and observer-rating of schizophrenic psychopathology are inconsistent and have rarely considered first-episode psychosis (FEP) and at-risk mental state (ARMS) for psychosis patients. This study investigates these correlations in ARMS and FEP patients and how they are moderated by disease stage and gender.

METHODS

In the Basel Früherkennung von Psychosen (FePsy) study, positive and negative psychotic and affective symptoms were rated in 126 ARMS and 94 FEP patients using two observer- and three self-rating scales. The agreement between self-rating and observer-rating and the moderating influence of disease stage and gender was quantified using Pearson correlation and multiple regression models.

RESULTS

Correlations between self- and observer-rated subscales covering the same symptom dimension were low and mostly non-significant except for one correlation of positive and one of negative symptoms. There was no moderating influence of disease stage and gender on the correlations between self-rating and observer-rating except for one higher association in positive symptoms in FEP compared to ARMS and in women compared to men. However, these significant interaction effects did not withstand correction for multiple testing.

CONCLUSIONS

This study suggests that the agreement between self-rating and observer-rating in FEP and ARMS patients is rather low, similar across symptom dimensions, and only partially dependent on disease stage and gender. However, low correlations between self-rating and observer-rating do not necessarily indicate that these patients have difficulties reporting their symptoms. They could also have occurred because the scales did not exactly cover the same symptom dimensions.

Concordance of self- and observer-rated motivation and pleasure in patients with negative symptoms and healthy controls

This study examined the validity of using a self-rating scale for assessing the motivation and pleasure domain of negative symptoms in the general population by examining the concordance of self- and observer-rated negative symptoms in a healthy sample and by comparing it with a patient sample. The motivation and pleasure domain of negative symptoms was assessed using the observer-rated Clinical Assessment Interview for Negative Symptoms (CAINS) and the self-rated Motivation and Pleasure Scale-Self-Report (MAP-SR). We found 52.9% of the healthy individuals and 46% of the patients to have relatively equal self- and observer-ratings. Despite the absence of extreme discrepancies, 31.4% of the healthy individuals and 14% of the patients rated their negative symptoms as more severe, whereas 15.7% of the healthy individuals and 40% of the patients rated them as less severe than the observers. By using self-ratings in combination with observer-ratings, possible discrepancies can be uncovered, which may be relevant for the successful treatment of negative symptoms.

Motivation and Pleasure Scale-Self-Report (MAP-SR): Validation of the German version of a self-report measure for screening negative symptoms in schizophrenia

OBJECTIVES

Validated self-report instruments could provide a time efficient screening method for negative symptoms in people with schizophrenia. The aim of this study was to examine the psychometric properties of a German version of the Motivation and Pleasure Scale-Self-Report (MAP-SR) which is based on the Clinical Assessment Interview for Negative Symptoms (CAINS).

METHODS

In- and outpatients (N=50) with schizophrenia or schizoaffective disorder were assessed with standardized interviews and questionnaires on negative and positive symptoms and general psychopathology in schizophrenia, depression, and global functioning.

RESULTS

The German version of the MAP-SR showed high internal consistency. Convergent validity was supported by significant correlations between the MAP-SR with the experience sub-scale of the CAINS and the negative symptom sub-scale of the Positive and Negative Syndrome Scale. The MAP-SR also exhibited discriminant validity indicated by its non-significant correlations with positive symptoms and general psychopathology, which is in line with the findings for the original version of the MAP-SR. However, the MAP-SR correlated moderately with depression.

CONCLUSION

The German MAP-SR appears to be a valid and suitable diagnostic tool for the identification of negative symptoms in schizophrenia.

Can we trust the internet to measure psychotic symptoms?

Online studies are increasingly utilized in applied research. However, lack of external diagnostic verification in many of these investigations is seen as a threat to the reliability of the data. The present study examined the robustness of internet studies on psychosis against simulation. We compared the psychometric properties of the Community Assessment of Psychic Experiences scale (CAPE), a self-report instrument measuring psychotic symptoms, across three independent samples: (1) participants with a confirmed diagnosis of schizophrenia, (2) participants with self-reported schizophrenia who were recruited over the internet, and (3) clinical experts on schizophrenia as well as students who were asked to simulate a person with schizophrenia when completing the CAPE. The CAPE was complemented by a newly developed 4-item psychosis lie scale. Results demonstrate that experts asked to simulate schizophrenia symptoms could be distinguished from real patients: simulators overreported positive symptoms and showed elevated scores on the psychosis lie scale. The present study suggests that simulated answers in online studies on psychosis can be distinguished from authentic responses. Researchers conducting clinical online studies are advised to adopt a number of methodological precautions and to compare the psychometric properties of online studies to established clinical indices to assert the validity of their results.