Awareness of illness moderates self-assessment of psychotic symptoms

Abstract

Objective: Self-reports or patient-reported outcome measures are seldom used in psychosis due to concerns about the ability of patients to accurately report their symptomatology, particularly in cases of low awareness of illness. The aim of this study was to assess the effect of insight on the accuracy of self-reported psychotic symptoms using a computerized adaptive testing tool (CAT-Psychosis). Methods: A secondary analysis of data drawn from the CAT-Psychosis development and validation study was performed. The Brief Psychiatric Rating Scale and the Scale of Unawareness of Mental Disorders were administered by clinicians. Patients completed the self-reported version of the CAT-Psychosis. Patients were median-split regarding their insight level to compare the correlation between the two psychosis severity measures. A subgroup sensitivity analysis was performed only on patients with schizophrenia spectrum disorders. Results: A total of 159 patients with a psychotic disorder who completed both CAT-Psychosis and Scale of Unawareness of Mental Disorders were included. For the whole sample, CAT-Psychosis scores showed convergent validity with Brief Psychiatric Rating Scale ratings ( r = 0.517, 95% confidence interval = [0.392, 0.622], p < 0.001). Insight was found to moderate this correlation (β = –0.511, p = 0.005), yet agreement between both measures remained statistically significant for both high ( r = 0.621, 95% confidence interval = [0.476, 0.733], p < 0.001) and low insight patients ( r = 0.408, 95% confidence interval = [0.187, 0.589], p < 0.001), while psychosis severity was comparable between these groups (for Brief Psychiatric Rating Scale: U = 3057, z = –0.129, p = 0.897; disorganization: U = 2986.5, z = –0.274, p = 0.784 and for CAT-Psychosis: U = 2800.5, z = –1.022, p = 0.307). Subgroup of patients with schizophrenia spectrum disorders showed very similar results. Conclusions: Insight moderates the correlation between self-reported and clinician-rated severity of psychosis, yet CAT-Psychosis remains valid in patients with both high and low awareness of illness.

Training guidelines and competencies for serious mental illness (SMI) psychology.

“…SMI Psychologists are required to not only have familiarity with and knowledge of assessment tools but also demonstrate flexibility and resourcefulness in adapting the assessment process to meet the individualized needs of those with whom they work. For example, the validity of some self-report measures may be impacted by limited insight (Bell et al, 2007; Martinez Agulleiro et al, 2022), anticipated stigma (Rüsch et al, 2014), mistrust, paranoia, or within-person variations related to acclimation to illness (Awad & Voruganti, 2016). Thus, incorporating multiple data sources (e.g., caregiver and/or clinician ratings) may be beneficial, though SMI Psychologists must also be aware of potential challenges to this method, such as a lack of access to family contacts or discrepancies between raters (e.g., Kline et al, 2013; Liraud et al, 2004).…”