[Description and validation of a new scale for assessment of autonomy in patients with schizophrenia].

OBJECTIVE

During the last years there is a clear shift of interest from acute to non-acute stages of schizophrenia: psychopathology and quality of remission, social functioning, and quality of life of patients. Authors think that in addition to that, a separate object of research should be the ability of patient to independent existence, or phenomenon of autonomy. For systematic research of autonomy in patients with schizophrenia a specialized assessment scale was constructed.

MATERIAL AND METHODS

On the basis of preliminary clinical data, we realized that for description of autonomy it is necessary to consider consistency of patients at least in the following areas of life: to possess sufficient level of physical and psychic power; to be able to form specific and realistic goals at least in the nearest future and structure behavior correspondingly to goal achievement; to be able to use support from the social environment in case of deficit of personal resources; to use efficiently and on regular basis contacts with a doctor and other medical resources; to be able to manage everyday needs from hygiene to self-sufficiency, including ability to support compliance. Scale comprises five items. Each of them is assessed on basis of semi-structured interview and other sources of information: medical records, reports from relatives and/or care-givers, medical stuff. In order to study the validity of the scale 40 patients (13 males and 27 females, age 49.8±9, duration of illness 22±8.6), who were diagnosed as schizophrenia according to ICD-10. They were assessed with the help of the scale of autonomy and well-known scales GAF, PSP, PANSS, NSA and CGI-S, cognitive functioning was assessed by BACS.

RESULTS

Analysis of internal consistency showed high consistency of items - Cronbach's alfa - 0.83. Analysis of convergent validity demonstrated low or moderate correlations of indices with related scales GAF and PSP. Discriminative validity showed low or moderate correlations only with negative subscale of PANSS, CGI-S score, NSA total score, BACS total score.

CONCLUSION

Сompliance of the scale of autonomy to major psychodiagnostic requirements showed that the scale is a new reliable and sensitive psychometric instrument. The study demonstrated that the scale measured specifically ability of patients to be autonomous (self-dependent support of culturally adequate existence in presence of chronic disease) and can't be reduced to existing categories - quality of life, personal or social functioning.