Clinical predictors of discrepancy between self-ratings and examiner ratings for negative symptoms

Self-assessment scale of auditory verbal hallucinations (SAVH): A novel tool for patients with schizophrenia

BACKGROUND

A scale for self-assessment of auditory verbal hallucinations (SAVH) was developed for patients, and this study aimed to validate the scale by investigating its psychometric properties.

METHODS

Forty one patients with schizophrenia or schizoaffective disorders (DSM-5) self-assessed their hallucinations using nine SAVH questions. Each question was scored from 0 to 5, indicating the severity of the symptoms. Patients were also evaluated with the Brief Psychiatric Rating Scale (BPRS), Auditory Hallucination Rating Scale (AHRS), and Birchwood Insight Scale (BIS). The psychometric properties of the SAVH were assessed by the face, internal consistency, construct, convergent and discriminant validities.

RESULTS

SAVH scores were used to examine the psychometric properties. Cronbach's α and Guttman's Lambda-6 were 0.67 and 0.73 respectively. Significant correlations were observed between SAVH and AHRS total scores, as well as BPRS hallucinatory behavior subscores. No significant correlations were found between total SAVH scores and (i) levels of insight or (ii) negative BPRS subscores. Factor analysis on SAVH revealed three factors accounting for 59.3 % of the variance. Most patients found the questions clear, appropriate, and of adequate length.

CONCLUSIONS

SAVH demonstrated good psychometric properties, suggesting its utility in assessing auditory verbal hallucinations (AVH). This self-assessment could be valuable in evaluating AVH treatment efficacy, monitoring AVH, and empowering patients.

Exploring negative symptoms heterogeneity in patients diagnosed with schizophrenia and schizoaffective disorder using cluster analysis

BACKGROUND

Dissecting the heterogeneity of schizophrenia may help foster progress in understanding its etiology and lay the groundwork for the development of new treatment options for primary or enduring negative symptoms (NS). In this regard, the present study aimed to: (1) to use cluster analysis to identify subgroups of Lebanese patients diagnosed with either schizophrenia or schizoaffective disorder based on NS clusters, and (2) to relate the statistically-derived subgroups to clinically relevant external validators (including measures if state and trait depression, stigma, insight, loneliness, social support).

METHOD

A total of 202 adult long-stay, chronic, and clinically remitted patients (166 diagnosed with schizophrenia and 36 with schizoaffective disorder) were enrolled. A cluster analysis approach was adopted to classify patients based on the five NS domains social withdrawal, emotional withdrawal, alogia, avolition and anhedonia.

RESULTS

A three-cluster solution was obtained based on unique NS profiles, and divided patients into (1) low NS (LNS; 42.6%) which characterized by the lowest mean scores in all NS domains, (2) moderate NS (MNS; 25.7%), and (3) high NS (HNS; 31.7%). Post-hoc comparisons showed that depression (state and trait), loneliness and social support could accurately distinguish the schizophrenia subgroups. Additionally, individuals in the HNS cluster had longer duration of illness, longer duration of hospitalization, and were given higher dosages of antipsychotic medication compared to those in the other clusters, but these differences did not achieve the statistical significance.

CONCLUSION

Findings provide additional support to the categorical model of schizophrenia by confirming the existence of three alternate subtypes based on NS. The determination of distinct NS subgroups within the broad heterogeneous population of people diagnosed with schizophrenia may imply that each subgroup possibly has unique underlying mechanisms and necessitates different treatment approaches.

Bridge centrality network structure of negative symptoms in people with schizophrenia

Negative symptoms are complex psychopathology. Although evidence generally supported the NIMH five consensus domains, research seldom examined measurement invariance of this model, and domain-specific correspondence across multiple scales. This study aimed to examine the interrelationship between negative symptom domains captured by different rating scales, and to examine the domain-specific correspondence across multiple scales. We administered the Brief Negative Symptom Scale (BNSS), the Self-evaluation of Negative Symptoms (SNS), and the Scale for Assessment of Negative Symptoms (SANS) to 204 individuals with schizophrenia. We used network analysis to examine the interrelationship between negative symptom domains. Besides regularized partial correlation network, we estimated bridge centrality indices to investigate domain-specific correspondence, while taking each scale as an independent community. The regularized partial correlation network showed that the SNS nodes clustered together, whereas the SANS and the BNSS nodes intermingled together. The SANS attention domain lied at the periphery of the network according to the Fruchterman-Reingold algorithm. The SANS anhedonia-asociality (strength = 1.48; EI = 1.48) and the SANS affective flattening (strength = 1.06; EI = 1.06) had the highest node strength and EI. Moreover, the five nodes of the BNSS bridged the nodes of the SANS and the SNS. BNSS blunted affect (strength = 0.76; EI = 0.76) and SANS anhedonia-asociality (strength = 0.76; EI = 0.74) showed the highest bridge strength and bridge EI. The BNSS captures negative symptoms and bridges the symptom domains measured by the SANS and the SNS. The three scales showed domain-specific correspondence.

Validation of the Turkish version of the self-evaluation of negative symptoms scale (SNS)

OBJECTIVES

The Self-Evaluation of Negative Symptoms Scale (SNS) is a self-report scale that evaluates a patient's subjective experience on all five domains of the negative symptoms. This study aimed to present the adaptation and validation study of the Turkish version of SNS(SNS-TR).

METHODS

Seventy-five patients and 50 controls were recruited for this study. After the approval of the translation, participants were asked to fill out SNS-TR by themselves. They were interviewed with the Brief Negative Symptoms Scale (BNSS), Positive and Negative Syndrome Scale (PANSS), and Calgary Depression Scale for Schizophrenia (CDSS).

RESULTS

SNS-TR showed good internal consistency in the reliability analysis with Cronbach's alpha= 0.873. Subscale-total score correlation coefficients were significant (p < 0.01). In the validity analyses, the total and subscale scores of SNS-TR showed positive correlations with the total and subscales of BNSS, with only one exception of BNSS lack of distress subscales. The total score of SNS-TR demonstrated a significant correlation with PANSS-total, PANSS-negative subscale, PANSS-general subscale, and CDSS scores. Confirmatory factor analysis showed acceptable values for the five-factor structure, similar to the original version.

CONCLUSION

To conclude, our study indicates that SNS-TR is an easily applicable self-evaluation tool with good psychometric properties for assessing negative symptoms. KEY POINTSSNS is a novel and easily applicable self-report scale for examining negative symptoms in schizophrenia patients, allowing them to evaluate their subjective experience on all five domains of the negative symptoms.It shows good internal consistency (α= 0.873) which is similar to the original version (α = 0.867).Confirmatory factor analysis scores were found in acceptable ranges and SNS-TR confirm the five-factor structure.Using this scale in clinical practice would empower both the physician's examinations and patient participation through treatment and follow-up course.

Psychopathology in psychotic disorders: Congruency between self-reported and observer-rated measures highest for affective symptoms and lowest for negative symptoms

Considering that both observer ratings and patient self-reports on severity of psychopathological symptoms are being used in research and clinical settings, this paper aims to explore the degree of congruence between these two sources. Eighty-two adult outpatients diagnosed with psychotic disorders rated their symptoms using the Brief Symptom Inventory (BSI). Observers assessed patients' functioning using the Brief Psychiatry Rating Scale (BPRS). Self-ratings (overall BSI) were strongly correlated to observers' evaluations (overall BPRS). Anxiety/depression symptoms dimension of the BPRS were significantly associated with all nine symptom dimensions of the BSI, while positive symptoms dimension and unusual and withdrawal behavior in the BPRS showed a significant relationship to seven symptom dimensions as measured with the BSI. Mania/activation in the BPRS was significantly and negatively related only to phobic anxiety in BSI. Eight symptom dimensions of the BSI (interpersonal sensitivity was an exception), as well as unusual and withdrawal behavior and positive symptoms in the BPRS were rated as more severe in unemployed study participants. Self-rated paranoid ideation was higher in less educated participants. No sex or marital status differences were found in the BSI and BPRS dimensions. The obtained pattern of correlations implied that congruence was highest in regards to affective symptomatology, followed by positive symptoms, and lowest for disorganization and withdrawal behavior.

European Validation of the Self-Evaluation of Negative Symptoms (SNS): A Large Multinational and Multicenter Study

BACKGROUND

Negative symptoms are usually evaluated with scales based on observer ratings and up to now self-assessments have been overlooked. The aim of this paper was to validate the Self-evaluation of Negative Symptoms (SNS) in a large European sample coming from 12 countries. We wanted to demonstrate: (1) good convergent and divergent validities; (2) relationships between SNS scores and patients' functional outcome; (3) the capacity of the SNS compared to the Brief Negative Symptom Scale (BNSS) to detect negative symptoms; and (4) a five-domain construct in relation to the 5 consensus domains (social withdrawal, anhedonia, alogia, avolition, blunted affect) as the best latent structure of SNS.

METHODS

Two hundred forty-five subjects with a DSM-IV diagnosis of schizophrenia completed the SNS, the Positive and Negative Syndrome Scale (PANSS), the BNSS, the Calgary Depression Scale for Schizophrenia (CDSS), and the Personal and Social Performance (PSP) scale. Spearman's Rho correlations, confirmatory factor analysis investigating 4 models of the latent structure of SNS and stepwise multiple regression were performed.

RESULTS

Significant positive correlations were observed between the total score of the SNS and the total scores of the PANSS negative subscale (r = 0.37; P < 0.0001) and the BNSS (r = 0.43; p < 0.0001). SNS scores did not correlate with the level of insight, parkinsonism, or the total score of the PANSS positive subscale. A positive correlation was found between SNS and CDSS (r = 0.35; p < 0.0001). Among the 5 SNS subscores, only avolition subscores entered the regression equation explaining a lower functional outcome. The 1-factor and 2-factor models provided poor fit, while the 5-factor model and the hierarchical model provided the best fit, with a small advantage of the 5-factor model. The frequency of each negative dimension was systematically higher using the BNSS and the SNS vs. the PANSS and was higher for alogia and avolition using SNS vs. BNSS.

CONCLUSION

In a large European multicentric sample, this study demonstrated that the SNS has: (1) good psychometric properties with good convergent and divergent validities; (2) a five-factor latent structure; (3) an association with patients' functional outcome; and (4) the capacity to identify subjects with negative symptoms that is close to the BNSS and superior to the PANSS negative subscale.

Validity and reliability of a Persian version of the self- evaluation of negative symptoms (SNS)

AIM

The Self-evaluation of Negative Symptoms (SNS) has been developed to allow schizophrenia patients to evaluate themselves in five dimensions of negative symptoms. The present study aimed to examine psychometric properties of the Persian version of SNS.

METHODS

A group of 50 patients with schizophrenia and a group of 50 healthy controls received the Persian-SNS. Severity of negative symptoms were evaluated by the Scale for Assessment of Negative symptoms (SANS) and the Brief Psychiatric Rating Scale (BPRS).

RESULTS

The results showed that the Cronbach's alpha for the Persian SNS was 0.95. The Persian-SNS and its subscales showed significant positive correlations with the total SANS score and SANS subscales as well as BPRS negative subscale, thus confirming the validity of the scale. Finally, the Persian-SNS showed the ability to discriminate patients with schizophrenia from healthy controls.

CONCLUSION

The acceptable properties of the Persian version of SNS demonstrated that it is a practical tool for screening negative symptoms in Persian-speaking schizophrenia patients.

Development and Validation of a Computerized Adaptive Assessment Tool for Discrimination and Measurement of Psychotic Symptoms

OBJECTIVE

Time constraints limit the use of measurement-based approaches in research and routine clinical management of psychosis. Computerized adaptive testing (CAT) can reduce administration time, thus increasing measurement efficiency. This study aimed to develop and test the capacity of the CAT-Psychosis battery, both self-administered and rater-administered, to measure the severity of psychotic symptoms and discriminate psychosis from healthy controls.

METHODS

An item bank was developed and calibrated. Two raters administered CAT-Psychosis for inter-rater reliability (IRR). Subjects rated themselves and were retested within 7 days for test-retest reliability. The Brief Psychiatric Rating Scale (BPRS) was administered for convergent validity and chart diagnosis, and the Structured Clinical Interview (SCID) was used to test psychosis discriminant validity.

RESULTS

Development and calibration study included 649 psychotic patients. Simulations revealed a correlation of r = .92 with the total 73-item bank score, using an average of 12 items. Validation study included 160 additional patients and 40 healthy controls. CAT-Psychosis showed convergent validity (clinician: r = 0.690; 95% confidence interval [95% CI]: 0.610-0.757; self-report: r = .690; 95% CI: 0.609-0.756), IRR (intraclass correlation coefficient [ICC] = 0.733; 95% CI: 0.611-0.828), and test-retest reliability (clinician ICC = 0.862; 95% CI: 0.767-0.922; self-report ICC = 0.815; 95%CI: 0.741-0.871). CAT-Psychosis could discriminate psychosis from healthy controls (clinician: area under the receiver operating characteristic curve [AUC] = 0.965, 95% CI: 0.945-0.984; self-report AUC = 0.850, 95% CI: 0.807-0.894). The median length of the clinician-administered assessment was 5 minutes (interquartile range [IQR]: 3:23-8:29 min) and 1 minute, 20 seconds (IQR: 0:57-2:09 min) for the self-report.

CONCLUSION

CAT-Psychosis can quickly and reliably assess the severity of psychosis and discriminate psychotic patients from healthy controls, creating an opportunity for frequent remote assessment and patient/population-level follow-up.

Factor Structure, Convergent, and Divergent Validity of the Prodromal Questionnaire-Negative Symptom Subscale

Negative symptoms such as anhedonia are associated with psychosis risk and poorer outcomes. The Prodromal Questionnaire (PQ) is a self-report questionnaire used to screen for psychosis spectrum symptoms. However, the convergent and divergent validity and underlying factor structure of the PQ-negative symptom subscale (PQ-N) have yet to be examined. Undergraduates (N = 1,556) completed the PQ, Temporal Experience of Pleasure Scale, and measures assessing anxiety, depression, and motivation. An exploratory factor analysis conducted on the PQ-N yielded a two-factor solution, reflecting subdimensions of social expression and dissociative-depressive experiences, contrary to previous research examining the factor structure of negative symptoms. Associations between the PQ-N, its two factors, and measures of negative symptoms and other psychopathology were examined. Results indicated that the PQ-N and its factors were more strongly correlated with measures of depression and anxiety than with measures of negative symptoms relating to motivation and pleasure, suggesting poor convergent and divergent validity.

Differences between self-reported and clinician-rated evaluations of 1-year changes in auditory verbal hallucinations among schizophrenia patients

Auditory verbal hallucinations (AVHs) constitute a frequent and distressing symptom of schizophrenia, associated with physical, emotional, and cognitive challenges. Despite their clinical importance, changes in the multiple dimensions of AVHs during treatment have rarely been examined, and subjective views thereof have received minimal attention. Here, we evaluated 87 patients with schizophrenia-related AVHs using the Hamilton Program for Schizophrenia Voices Questionnaire (HPSVQ; a self-report questionnaire) and the Psychotic Symptom Rating Scales-Auditory Hallucination Subscale (PSYRATS-AH; a clinician-rated scale) at baseline and after 6 months and 1 year of treatment. We explored dimensions that changed from the perspectives of both clinicians and patients and the relationships between these perceptions over the year. The test-retest reliabilities of the HPSVQ and PSYRATS-AH were generally fair. Improvements in AVHs were evident over the first 6 months; the PSYRATS-AH revealed a broader range of symptom improvement than did the HPSVQ. The "interference with life" dimension on the HPSVQ was not reduced, but the "disruption to life" score on the PSYRATS-AH was. At both baseline and 6 months, the physical characteristics of AVHs (frequency, duration, and loudness) were significantly correlated with both distress and life interference/disruption; all correlations except that for frequency were reduced at 1 year. The clinician-rated and self-reported personal perspectives on AVHs exhibited both differences and similarities; physical AVH components and subjective distressful experiences changed in different ways in those with chronic, persistent AVHs. The HPSVQ and PSYRATS-AH data were complementary, improving our understanding of the clinical implications of AVHs and subjective patient distress.

The role of resources in the face of psychopathology

OBJECTIVES

The current study compared resource realization and psychological distress in patients with different psychiatric diagnoses and healthy individuals and examined the moderating effect of intrapersonal resources (personal strengths) and interpersonal resources (relationships) on the association between incongruence (unsatisfactory realization of personal goals) and psychological distress.

METHOD

In total, 218 participants (45.87% female, mean age = 39.83 years) completed standardized questionnaires at one measurement point.

RESULTS

Healthy individuals (n = 56) reported the most resources, followed by patients with psychotic (n = 53), substance use (n = 53), and depressive disorders (n = 56). While patients with psychotic disorders benefited from intra- and interpersonal resources, patients with depression only benefitted from intrapersonal resources. Patients with substance use disorders did not benefit from resources at all.

CONCLUSIONS

Depending on the diagnosis, patients evaluated their level of resources differently and benefitted in different ways. The results suggest that within psychotherapy, it might be useful to strengthen resources, especially for patients with depressive and substance use disorders.

Self-assessment of negative symptoms - Critical appraisal of the motivation and pleasure - Self-report's (MAP-SR) validity and reliability

OBJECTIVE

The negative symptom domain remains a major challenge concerning treatment. A valid self-report measure could assist clinicians and researchers in identifying patients with a relevant subjective burden. The Motivation and Pleasure - Self Report (MAP-SR) derives from the CAINS and is supposed to reflect the "amotivation" factor of negative symptoms. We evaluated different aspects of the scale's reliability and validity. This is the first factorial analysis as well as the first analysis of test-retest reliability.

METHODS

We assessed three samples of subjects with schizophrenia or schizoaffective disorder (n = 93) and a broad spectrum of related domains.

RESULTS

We explored a 3-, 2- and 1-factor solution (explaining 50.93, 44.85 and 36.18% of variance, respectively). The factor "pleasure and hedonic activity" consists of eight items and was most robust; the factors "social motivation" and "motivation for work" were problematic. Test-retest reliability of the scale was adequate (r_S = 0.63, p = .005). Neither the MAP-SR nor the "pleasure and hedonic activities" factor are associated with the PANSS negative symptom scale. There are significant associations with the observer-rated CAINS-MAP scale, experiences of pleasure, and social cognition but none with functional outcome. Discriminant validity could not be established with regards to depression and extrapyramidal symptoms.

CONCLUSIONS

We found that the MAP-SR is adequate to assess anhedonia but is less suitable when assessing motivation. Therefore, we propose using the "pleasure and hedonic activity scale" to cover the "anhedonia" subdomain. We think the "motivation" part of the instrument requires reconstruction.

Dimensional symptom severity and global cognitive function predict subjective quality of life in patients with schizophrenia and healthy adults

Over the last several decades Quality of Life (QoL) has become increasingly important as an indicator of treatment outcomes; particularly in schizophrenia spectrum disorders because of its close association with functional disability. Numerous studies seeking to elucidate the factors that contribute to QoL in this population have implicated both symptom severity and cognition in determining QoL but the findings have been mixed. The critical factors that appear to impede the lack of consensus in the extant literature examining determinants of QoL include the heterogeneity of the samples and measures examined as well as medication effects across different studies. Thus, the present study sought to address some of these issues by examining the relationship between subjective QoL and both symptom severity and cognitive function in a relatively homogeneous patient sample of patients and a community control sample assessed for dimensional symptom severity. Our results suggest that both global cognitive function and psychiatric symptoms have a significant impact on the subjective QoL of both people with schizophrenia spectrum disorders and psychiatrically healthy adults. Specifically, we found that a global index of cognition as well as self-reported avolitional and depressive symptoms were significantly predictive of QoL in both samples. These findings highlight the importance of addressing cognitive, depressive and avolitional symptoms in the treatment of patients with schizophrenia spectrum disorders and suggest that improvements in these domains may have a meaningful impact on their overall QoL.

Current developments and challenges in the assessment of negative symptoms

Reliable and valid assessment of negative symptoms is crucial to further develop etiological models and improve treatments. Our understanding of the concept of negative symptoms has undergone significant advances since the introduction of quantitative assessments of negative symptoms in the 1980s. These include the conceptualization of cognitive dysfunction as separate from negative symptoms and the distinction of two main negative symptom factors (avolition and diminished expression). In this review we provide an overview of existing negative symptom scales, focusing on both observer-rated and self-rated measurement of negative symptoms. We also distinguish between measures that assess negative symptoms as part of a broader assessment of schizophrenia symptoms, those specifically developed for negative symptoms and those that assess specific domains of negative symptoms within and beyond the context of psychotic disorders. We critically discuss strengths and limitations of these measures in the light of some existing challenges, i.e. observed and subjective symptom experiences, the challenge of distinguishing between primary and secondary negative symptoms, and the overlap between negative symptoms and related factors (e.g. personality traits and premorbid functioning). This review is aimed to inform the ongoing development of negative symptom scales.

Self-Evaluation of Negative Symptoms: A Novel Tool to Assess Negative Symptoms

Many patients with schizophrenia have negative symptoms, but their evaluation is a challenge. Thus, standardized assessments are needed to facilitate identification of these symptoms. Many tools have been developed, but most are based on observer ratings. Self-evaluation can provide an additional outcome measure and allow patients to be more engaged in their treatment. The aim of this study was to present a novel tool, Self-evaluation of Negative Symptoms (SNS), and demonstrate its validity. Forty-nine patients with schizophrenia and schizoaffective disorders according to DSM-5 were evaluated. Cronbach's coefficient (α = 0.867) showed good internal consistency. Factor analysis extracted 2 factors (apathy and emotional) that accounted for 75.2% of the variance. The SNS significantly correlated with the Scale of Assessment of Negative Symptoms (r= 0.628) and the Clinician Global Impression on the severity of negative symptoms (r= 0.599), supporting good convergent validity. SNS scores did not correlate with level of insight (r= 0.008), Parkinsonism (r= 0.175) or Brief Psychiatric Rating Scale positive subscores (r= 0.253), which indicates good discriminant validity. The intrasubject reliability of the SNS revealed excellent intraclass correlation coefficients (ICC = 0.942). Taken together, the results show that the SNS has good psychometric properties and satisfactory acceptance by patients. The study also demonstrates the ability of patients with schizophrenia to accurately report their own experiences. Self-assessments of negative symptoms should be more widely employed in clinical practice because they may allow patients with schizophrenia to develop appropriate coping strategies.

Different Perspectives of Clinicians and Patients with Severe Mental Illness on Motivation for Treatment

The present study assessed motivation for engaging in treatment as rated by clinicians (n = 57) and patients with severe mental illness (SMI, n = 294) using measures based on three different motivation theories. Questionnaires were derived from self-determination theory, the transtheoretical model and the integral model of treatment motivation. It was investigated to which extent clinicians of patients with SMI were able to estimate their patient's perspective on motivation for engaging in treatment, to which extent they agreed on the patient's motivation and which factors were associated with estimation and agreement on treatment motivation. It was found that clinicians were poorly to moderately capable of estimating their patient's type of motivation and readiness for change. Further, agreement on the level of motivation between patients and clinicians was moderate. These findings were consistent across diagnostic groups (psychotic and personality disorders). A higher quality therapeutic relationship was generally associated with higher clinician-rated motivation. The patient's ethnicity and socially desirable responding were factors that differentiated between scales of different motivation theories. It is concluded that patients with SMI and their clinicians have different perceptions on the patient's motivation for engaging in psychiatric treatment, regardless of the theoretical framework that is used to measure motivation. The findings imply that a negotiated approach is needed where both perceptions of clinicians and patients on motivation for treatment are considered to ensure effective mental health interventions. Copyright © 2015 John Wiley & Sons, Ltd.

KEY PRACTITIONER MESSAGE

Clinicians show poor to moderate capability in estimating how patients perceive their motivation for engaging in treatment, especially so when the patient's motives revolve around feelings of shame and guilt. Clinicians generally give higher motivation ratings for patients where they experience a higher quality therapeutic relationships with, whereas-depending on the scale that is used to measure motivation-they give lower ratings to patients who respond in socially desirable ways and to ethnic minority patients. As patients with SMI and their clinicians have different perceptions on the patient's motivation for engaging in psychiatric treatment (regardless of the theoretical framework that is used to assess motivation), this implies that a negotiated approach is needed where both perceptions of clinicians and patients on motivation for treatment are considered to ensure effective mental health interventions.

Screening for negative symptoms: preliminary results from the self-report version of the Clinical Assessment Interview for Negative Symptoms

Though negative symptoms in schizophrenia are associated with a host of deleterious outcomes (e.g., White et al., 2009), not all individuals with schizophrenia suffer from negative symptoms (e.g., Blanchard et al., 2005). Thus, methods to quickly screen and identify patients for more intensive clinical interview assessments may have significant clinical and research utility. The present study is a preliminary examination of the reliability and validity of a self-report version of the newly developed Clinical Assessment Interview for Negative Symptoms (CAINS; Blanchard et al., 2011; Forbes et al., 2010; Horan et al., 2011). The CAINS-SR is a 30-item self-report measure that assesses Experiential (avolition, anhedonia, asociality) and Expressive (blunted affect, alogia) domains of negative symptoms. Participants (N = 69) completed the CAINS-SR questionnaire and were evaluated with symptom interviews using the CAINS and other non-negative symptom interviews that assessed psychotic, affective, and other symptoms. The Experience subscale of the CAINS-SR demonstrated good internal consistency, convergent validity, and discriminant validity, while the poorer psychometric properties of the Expression subscale suggest that self-report of negative symptoms should focus on the experiential domain. Overall, preliminary findings indicate that the CAINS-SR (addressing experiential deficits) may be a useful complement to the clinician-rated interview measure. Future research on the sensitivity and specificity of the CAINS-SR will determine its suitability as a screening measure.

The usefulness of a self-report questionnaire measuring auditory verbal hallucinations

A self-report measure of psychotic symptoms has been considered to be unsuitable due to the possible denial of symptoms in the patients with schizophrenia. However, a self-report questionnaire would be an efficient tool for the evaluation of subjective aspects of auditory verbal hallucination (AVH), which requires further clarification. In this study, a total of 87 patients with schizophrenia took baseline evaluations for Hamilton Program for Schizophrenia Voices Questionnaire (HPSVQ), a self-report questionnaire for AVH, and Psychotic Symptom Rating Scales-Auditory Hallucination Subscale (PSYRATS-AH) and an item measuring hallucinations (P3) on Positive and Negative Syndrome Scale for Schizophrenia (PANSS), both interviewer-rated scales for AVH. At 1 week and at 6 months post-baseline, 39 and 68 patients repeated HPSVQ and PSYRATS-AH, respectively. Total scores on HPSVQ showed good agreement with those on PSYRATS-AH and PANSS, Item P3, and HPSVQ showed good test-retest reliability and internal consistency. In addition, the changes in total scores of HPSVQ during 6-month follow-up were also highly correlated to those of PSYRATS-AH. The findings of factor analysis and hierarchical cluster analysis suggested that the items addressing emotional characteristics of AVH constituted one factor and that the remaining items, primarily concerning the physical characteristics, combined to form another factor. Taken together, the HPSVQ, a self-report questionnaire measuring AVH, was characterized by good psychometric properties, which suggests the appropriateness of a self-report scale for examining the internal structure of AVH in patients with schizophrenia.

Can delusions be self-assessed? Concordance between self- and observer-rated delusions in schizophrenia

Several multi-dimensional self-report scales have been developed to assess delusional ideation in the general population. However, self-ratings of positive symptoms in patients with psychosis are often considered unreliable due to neuro-cognitive disturbance and lack of insight. This study tested associations of self- and observer-rated delusions as well as factors associated with discrepancies. Observer-rated delusions were assessed in 80 in- and outpatients with schizophrenia spectrum disorders by trained raters with the Positive and Negative Syndrome Scale. Self-rated delusions were assessed with the Peters et al. Delusions Inventory and the Paranoia Checklist. Correlations between self- and observer-rated overall delusions ranged from 0.49 to 0.57. Associations between specific delusions of persecution and grandiosity were moderate but unique. Good concordance of ratings was not restricted to outpatients or patients with fewer positive symptoms. Patients with lower self- than observer ratings of delusions were characterised by fewer years of education, lower functioning, more negative symptoms and less insight. The results indicate that patients can reliably provide information with regard to the presence and type of delusional beliefs. Thus, patient ratings are a valid additional source of diagnostic information.

A symptom self-rating scale for schizophrenia (4S): psychometric properties, reliability and validity

The objective of the study was to validate a self-administrated symptom rating scale for use in patients with schizophrenia spectrum disorders by item analysis, exploration of factor structure, and analyses of reliability and validity. Data on 151 patients, initially treated by risperidone, obtained within the framework of a naturalistic Phase IV longitudinal study, were analysed by comparing patient and clinician ratings of symptoms, side-effects and global indices of illness. The Symptom Self-rating Scale for Schizophrenia (4S) is psychometrically adequate (item analysis, internal consistency, factor structure). Side-effect ratings were reliable. Symptom ratings displayed consistent associations with clinicians' ratings of corresponding symptom dimensions, suggesting construct validity. Patients had most difficulties assessing negative symptom items. Patients were well able to assess their own symptoms and drug side-effects. The factor structure of symptom ratings differs between patients and clinicians as well as how they construe global indices of illness. Clinicians focus on psychotic, patients on affective symptoms. Use of symptom self-ratings is one way to improve communication and thereby strengthen the therapeutic alliance and increase treatment adherence.

Are self-reports valid for schizophrenia patients with poor insight? Relationship of unawareness of illness to psychological self-report instruments

This investigation aimed to determine whether impaired insight influences the validity of self-report test scores in schizophrenia and schizoaffective disorder. 274 outpatients enrolled in work rehabilitation completed the Beck Depression Inventory (BDI), Eysenck Personality Questionnaire (EPQ), Bell Object Relations and Reality Testing Inventory (BORRTI), and NEO-Five Factor Inventory (NEO-FFI). Self-report scores were compared to clinician's ratings on comparable personality and symptom dimensions on the Positive and Negative Syndrome Scale (PANSS), the Work Behavior Inventory (WBI), and the Quality of Life Scale (QLS). The influence of insight was determined using the Scale for Unawareness of Mental Disorder (SUMD). In the first analysis, clinician SUMD ratings of patient insight were associated with self-report accuracy. In a second analysis, patients were categorized into good and poor insight groups based on SUMD ratings and compared on self-report and clinician report variables. Results suggest that poor insight patients accurately report less Neuroticism and Agreeableness, and more Psychoticism than good insight patients, but individuals with poor insight wish to present themselves as more extraverted than they actually are, and they are likely to be more certain of their perceptions than they should be. It appears that self-report measures may be valid for most personality and symptom domains.

Self-reported empathic abilities in schizophrenia

BACKGROUND

Increasing evidence indicates impairments of empathic abilities in schizophrenia that may impact outcome and course of the disease. While there is consensus on the presence of deficits in 'theory of mind' in this disorder, i.e. cognitive aspects of mental state attribution, the ability to infer emotional experiences of others, i.e. affective empathy, has not been investigated so far.

METHODS

We assessed multiple dimensions of empathy in 45 schizophrenic patients and 45 healthy controls, matched for age and gender, with a self-rating instrument, the Interpersonal Reactivity Index (IRI). To control for modulating effects of cognitive deficits, a neuropsychological test battery was employed.

RESULTS

Schizophrenic patients showed significantly lower scores in cognitive empathy ('perspective taking': F=12.176, df=1, p=0.001) but more self-related aversive feelings in response to the distress of others ('personal distress: F=16.477, df=1, p<0.001). Self-ratings of affective empathy, i.e. concern for others, did not differ between groups. Results in the domains of empathy were not explained by symptoms or neurocognition as revealed by regression analysis. However, lower scores in 'perspective taking' were found with advancing duration of illness (r=-0.453, p=0.002).

CONCLUSIONS

Results indicate reductions of cognitive empathy but relatively preserved emotional empathic abilities in schizophrenia. Although previous studies observed deficits in emotion perception and expression, our findings support the concept of differentially disturbed abilities in cognitive and emotional empathy in schizophrenia.

The Positive and Negative Symptoms Questionnaire: a self-report scale in schizophrenia

The assessment of various symptoms in schizophrenia has received much interest, although few studies have compared evaluations by clinicians to those of their patients. Self-report tools may improve service delivery, data collection, and possibly also treatment adherence. We constructed the Positive and Negative Symptoms Questionnaire (PNS-Q), a self-report measure, after items from the Scale for Assessment of Positive Symptoms (SAPS) and the Scale for Assessment of Negative Symptoms (SANS). The PNS-Q contained 68 items and was administered to 61 schizophrenic inpatients. We examined its psychometric properties and utility as a self-report tool in schizophrenia. The PNS-Q exhibited high internal consistency for both its positive and negative subscales. External validity with the SAPS and SANS was low. The positive symptoms subscale correlated significantly with the SAPS ( r = .341, P < .01), whereas the negative symptoms subscale did not correlate at all with the SANS ( r = -0.086, P > .1). The correlation between patients' insight and scores of the PNS-Q was mixed. A partial correlation analysis failed to confirm a relationship between the rating of the patients' level of insight (measured by the Amador Scale to Assess Unawareness of Mental Disorders [SUMD]) and the disparity between the PNS-Q and the SAPS and SANS. However, the PNS-Q correlated highly with McEvoy's Vignettes, a measure of self-perception of symptoms. The results of this study are discussed in light of current research and methodologic issues. The PNS-Q reflects schizophrenics' self-perception, an important, yet neglected, aspect of schizophrenia. Using this new measure, we believe that clinicians and researchers will be able to gain insight to the inner world of these patients and improve their condition, as well as enhance patients' involvement in treatment planning.

The brief symptom inventory and the positive and negative syndrome scale: discriminate validity between a self-reported and observational measure of psychopathology

Concern within the literature has emerged from time to time arguing the poor validity of self-reported measures in psychopathology, namely, the reporting of psychotic experience. Although it is commonly believed that patients who have had a psychotic episode cannot accurately self-report their experience, very few studies have been conducted to measure the concordance between self-reported and observational measures of psychopathology using multivariate statistical techniques. Sixty-nine patients presenting their first psychotic episode were interviewed and assessed on the Positive and Negative Syndrome Scale (PANSS) and were asked to complete the Brief Symptom Inventory (BSI). By clustering symptom dimensions from the BSI into discriminate functions, the research demonstrated that these symptom dimensions could adequately classify high versus low scores on the PANSS subscales and total score. When the same clusters were entered into multivariate analysis of variance (MANOVA) models, they also demonstrated significant differences between high versus low observed symptomatology on the PANSS Positive and General Subscale Groups and Total Score Groups. The current findings shed some doubt on the supposition that those who experience psychosis are unable to report symptom dimensions that concord with those who observe the psychosis. It appears that models, operational definitions, and the language used in measuring psychopathology may differ significantly from those who experience the psychotic experience and those who observe it. Techniques such as multitrait multimethod are discussed as ways of overcoming these concerns.

Insight in schizophrenia: a meta-analysis

There has been an increase in the study of insight in schizophrenia in the last 20 years. Insight is operationally defined according to five dimensions which include: the patient's awareness of mental disorder, awareness of the social consequences of disorder, awareness of the need for treatment, awareness of symptoms and attribution of symptoms to disorder. Despite the development of psychometrically sound measurement tools, the results from previous studies have been inconclusive regarding the nature of the relationship between insight and symptomatology. A meta-analysis of 40 published English-language studies was conducted to determine the magnitude and direction of the relationship, or effect size, between insight and symptom domains in schizophrenia and to determine moderator variables that were associated with the variations in effect sizes across studies. Results indicated that there was a small negative relationship between insight and global, positive and negative symptoms. There was also a small positive relationship between insight and depressive symptoms in schizophrenia. Acute patient status and mean age of onset of the disorder moderated the relationship between insight and symptom clusters. The possible reasons for the effect sizes being modest, the examination of the role of moderator variables and directions for future research are provided.