The validity of using patient self-report to assess psychotic symptoms in schizophrenia

Department of Psychiatry and Biobehavioural Sciences, University of California, Los Angeles, Los Ángeles, California, United States
Schizophrenia Research (Impact Factor: 3.92). 03/2007; 90(1-3):245-50. DOI: 10.1016/j.schres.2006.11.011
Source: PubMed

ABSTRACT Brief, reliable and valid measures of psychosis can be very useful in both clinical practice and research, and for identifying unmet treatment needs in persons with schizophrenia. This study examines the concurrent validity and receiver operating characteristics of the psychosis scale of the Revised Behavior and Symptom Identification Scale (BASIS-R). The study was conducted with 71 adults with schizophrenia who were randomly sampled from a large mental health clinic. Study participants at the West Los Angeles Veterans Healthcare Center were assessed using the BASIS-R, a subjective, self-report measure, and the UCLA Brief Psychiatric Rating Scale (BPRS), a clinician-rated measure administered by highly trained research staff. The psychosis scale of the BASIS-R shows good concurrent validity with the psychosis items on the BPRS. Using the BPRS as the gold standard for measuring psychosis, receiver operating characteristics suggest that both the weighted and unweighted versions of the BASIS-R psychosis scale adequately identify psychosis that is moderate or greater or severe. The performance of the two versions was similar. Unweighted scores are easier to calculate, and we therefore recommend cutoff scores based on the unweighted BASIS-R. We identified a cutoff score of 0.5 to best detect moderate or greater psychosis, and a cutoff score of 1.0 to best detect severe or extremely severe psychosis. The BASIS-R has potential as an assessment tool and screening instrument in schizophrenia.

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    • "Depressive symptoms in individuals with schizophrenia are most commonly assessed using measures such as the Hamilton Rating Scale for Depression, the Calgary Depression Scale for Schizophrenia, or the Beck Depression Inventory, which have been shown to be highly correlated and reported to have good validity and test–retest reliability (Niv et al., 2007). However, these measures are retrospective in nature, asking participants to recall experiences from the past week or two weeks, thus vulnerable to longterm memory impairments and biases. "
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    ABSTRACT: Depressed mood is prevalent among individuals with schizophrenia, leading to difficulties in functioning. Typically, depressed mood is evaluated using retrospective assessments during which individuals are asked to recall their mood during the past week or month. However, as individuals with schizophrenia may display memory difficulties, the results of such assessments may be biased, potentially leading to inaccurate clinical characterizations and/or suboptimal treatment. Our aim was to assess the potential impact of long-term memory on depressed mood in individuals with schizophrenia. Employing an Experience Sampling Method (ESM) approach, 51 individuals with schizophrenia and 22 healthy controls rated their momentary emotions up to 10 times/day over a two-day period, along with retrospective measures of depressed mood, long-term memory, quality of life, social functioning, and symptoms. ESM assessment of real-time depressed mood demonstrated discriminant and convergent validity. Among the schizophrenia group, there was a significant correlation between the real-time and retrospective measures of depressed mood. However, once variance due to long-term memory was controlled, the relationship between the real-time and retrospective measure was no longer significant. The findings suggest that a real-time measure of depressed mood may allow overcoming some of the limitations associated with long-term memory difficulties common among individuals with schizophrenia. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Psychiatry Research 06/2015; 227(2-3):318-323. DOI:10.1016/j.psychres.2015.03.008 · 2.47 Impact Factor
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    • "Additionally, the CTQ has been used in previous studies as an assessment of childhood trauma amongst psychotic disorder patients [6] [17] [19] and prior research has demonstrated the validity of self-report measures in individuals with serious mental illness [25] [26] [27] and of reports of abuse in patients with psychosis [28] [29] [30]. "
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    ABSTRACT: Previous studies point to an association between childhood sexual abuse (CSA) and auditory hallucinations (AH). However, methodological issues limit the strength of these results. Here we compared childhood abuse between psychotic disorder patients and healthy control subjects using a reliable measure of abuse, and assessed the relationship between CSA and AH. 114 psychotic disorder patients and 81 healthy control subjects were administered the Structured Clinical Interview of the DSM-IV (SCID) and the Childhood Trauma Questionnaire (CTQ). We compared the severity of abuse between groups, and tested the relationship between different types of childhood abuse and specific psychotic symptoms. Psychotic patients reported more childhood abuse than controls (p<.001). Psychotic patients with a history of AH reported significantly more sexual, emotional, and physical abuse than patients without a history of AH (p<.05). Emotional and physical abuse, in the absence of sexual abuse, did not lead to a higher rate of AH. Finally, reports of childhood abuse did not increase the risk of any form of hallucination other than AH or of any form of delusion. These results suggest that childhood abuse, especially childhood sexual abuse, shapes the phenotype of psychotic disorders by conferring a specific risk for AH.
    Comprehensive psychiatry 06/2013; 54(7). DOI:10.1016/j.comppsych.2013.05.013 · 2.25 Impact Factor
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    • "Developing concise screening methods has been a growing interest in recent years, as self-report measures have already been found to be appropriate for evaluating both positive symptoms (Niv et al., 2007; Kim et al., 2010; Lincoln et al., 2010) and prodromal psychotic symptoms (Kobayashi et al., 2008; Kelleher et al., 2011). Due to deficits in self-awareness in schizophrenia (Amador et al., 1994), there is concern that lack of insight in patients may undermine valid appraisal of symptoms on self-report measures (Liraud et al., 2004). "
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    ABSTRACT: 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.
    Schizophrenia Research 03/2012; 135(1-3):139-43. DOI:10.1016/j.schres.2011.12.007 · 3.92 Impact Factor
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