The concordance between symptom information gathered from remitted schizophrenic patients and their relatives

Abstract

The concordance between symptom information gathered from remitted schizophrenic out-patients and the relatives with whom they live was assessed for different schizophrenic symptom clusters. It was hypothesized that the positive symptoms would show the greatest patient-relative concordance. Patients and relatives were also compared for levels of overall symptom reporting. It was hypothesized that long-term memory problems, anosognosia, and underreporting in order to appear healthy, would cause patients to report fewer symptoms than their relatives. An alternative hypothesis was that relatives would underreport symptoms to avoid “blame” for their relatives' illness, and because they did not have direct experience of the symptomatology. The 24-item version of the Brief Psychiatric Rating Scale (BPRS) was administered to 41 schizophrenic patients (chart diagnoses were validated by a DSM-III-R diagnostic checklist). Fourteen of the BPRS items were then used to glean information about patients' symptomatology from 41 relatives of the patients. Interviews with patients revealed significantly more symptomatology than interviews with patients' relatives for total and non-positive symptoms (both p-values < .01), but not positive symptoms. Intraclass correlations (ICC) between patients' and relatives' assessments were moderate for positive symptoms (ICC = .54, p < .01), low for total symptoms (ICC = .26, p = .05) and negligible for non-positive symptoms (.13, ns). Despite the potential for underreporting due to factors like anosognosia and long-term memory problems, patients are still the best source of information for schizophrenic symptomatology.