Lack of concordance between subjective improvement and symptom change in psychotic episodes.
OBJECTIVE
Subjective, self-rated improvement in patients with schizophrenia spectrum disorders can carry significance as a first-person account of treatment outcome, and can be of importance for the individual patient's acceptance of further treatment, including psychological treatments. This study assessed the concordance between post-treatment subjective improvement and the observed symptom change after a psychotic episode.


METHODS
Longitudinal study based on daily symptom ratings.


METHODS
The study sample consisted of 43 younger, primarily first- or second-episode patients. Observed symptom change was calculated as both pre-post differences and symptom trajectories. Subjective improvement was assessed at the end of treatment by using the 'Emotional and Behavioural Changes in Psychotherapy Questionnaire' (VEV), a retrospective measure of subjective change.


RESULTS
The findings indicated no significant concordance between pre-post differences in symptoms and self-rated improvement, nor were final levels of symptoms related to subjective improvement. Higher initial and mean symptom levels for positive symptoms were related to a lower degree of subjective improvement. A shorter duration of an initial trend-like improvement in psychosis was shown to be associated with greater subjective improvement.


CONCLUSIONS
Subjective assessment of improvement may differ markedly from symptom change. In psychotic episodes, more severe initial positive symptoms as well as a delayed improvement of positive symptoms may be related to a reduced subjective experience of improvement for the duration of the entire episode. The treatment of psychosis should take a possible discordance between subjective and objective change into account.
Kupper
Zeno
Z
Department of Psychotherapy, University Hospital of Psychiatry, University of Bern, Bern, Switzerland. zeno.kupper@spk.unibe.ch
Tschacher
Wolfgang
W
D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001294:Attitude to Health; D003131:Combined Modality Therapy; D005260:Female; D006304:Health Status; D006801:Humans; D038801:International Classification of Diseases / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008297:Male; D008884:Milieu Therapy; D008960:Models, Psychological; D010342:Patient Acceptance of Health Care; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data*; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy*; D011788:Quality of Life; D012189:Retrospective Studies; D012559:Schizophrenia / Q000175:diagnosis / Q000628:therapy; D012565:Schizophrenic Psychology; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
D014150:Antipsychotic Agents