Respondent and informant accounts of psychiatric symptoms in a sample of patients with learning disability

Abstract

This paper investigates differences in the nature and frequency of psychiatric symptoms reported by patients with learning disability and key informants. The study involved psychiatric assessment of 100 patients with learning disabilities and key informants using the Psychiatric Assessment Schedule for Adults with a Developmental Disability (PAS-ADD), a semi-structured psychiatric interview developed specifically for people who have a learning disability. There was considerable disagreement between respondent and informant interviews: only 40.7% of cases were detected by both interviews. Respondents were more likely to report on autonomic symptoms and certain psychotic phenomena. Other anxiety and depression symptoms were more frequently reported by informants. The results indicate that it is crucial for sensitive case detection to complete both interviews where possible. If the respondent cannot be interviewed, panic disorder or phobias may be particularly difficult to detect.

A Review and Analysis of Three Measures for Diagnosis of Mental Illness in Individuals With Intellectual Disabilities

“…The 1993 study reported good reliability on informantreport (mean kappa for all items = .72). However, in a second study, Moss, Prosser, Ibbotson, and Goldberg (1996) reported poor inter-rater reliability for respondent and informant versions of the scale (i.e., in only 40% of cases did both versions yield a diagnosis). These data are consistent with published informant and self-report data on the PIMRA from over a decade earlier in that self-report when compared to informant data was generally a more accurate rating method (Matson et al, 1984).…”

The PAS‐ADD assessments and their continuing conceptual development

“…In contrast, the core symptoms of psychosis, hallucinations and delusions, are highly abstract, and cannot be inferred from external behaviour with any degree of certainty. Moss et al (1996b) found the only first-rank symptom which could be detected with any frequency in their verbally competent sample was auditory hallucinations. Almost none of the respondents or informants was able to give an account of thought disorder or passivity delusions which was sufficiently unequivocal to fulfill the SCAN algorithm.…”

“…Important findings were made at this time about schizophrenia and its probable over-diagnosis (Moss et al, 1996a), and about the relationships between patient and informant accounts (Moss et al, 1996b). Overall, it became clear how useful it is to get a patient account, and how difficult it can be to get one.…”

Early-Onset Schizophrenia in Children With Mental Retardation: Diagnostic Reliability and Stability of Clinical Features

“…Clinical interviewing is of limited usefulness, so assessment must rely heavily on information from caregivers, and treatment records, as well as observation. Diagnosis in the absence of a full verbal account by the patient does, however, pose validity problems (Moss et al, 1996b). To maximize diagnostic validity, multiple perspectives on the individual's behavior must be coupled with carefully structured methods for recording symptoms, encompassing all the variables that influence an individual's behavior (e.g., biomedical, psychological, interactional, environmental) (Gardner and Sovner, 1994;Griffiths, 1995;Moss and Lee, 2001).…”