Premium
Lack of concordance between subjective improvement and symptom change in psychotic episodes
Author(s) -
Kupper Zeno.,
Tschacher Wolfgang.
Publication year - 2008
Publication title -
british journal of clinical psychology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.479
H-Index - 92
eISSN - 2044-8260
pISSN - 0144-6657
DOI - 10.1348/014466507x246780
Subject(s) - concordance , psychology , psychosis , schizophrenia (object oriented programming) , psychiatry , clinical psychology , medicine
Objectives 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. Design Longitudinal study based on daily symptom ratings. Method 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.