病识感会调节精神病症状的自我评估。

Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY, USA.

Psychiatry Department, Complexo Hospitalario Universitario de Ferrol, Ferrol, Spain.

Aust N Z J Psychiatry. 2022 Oct;56(10):1287-1294. doi: 10.1177/00048674211057480. Epub 2021 Nov 17.

OBJECTIVE

Self-reports or patient-reported outcome measures are seldom used in psychosis due to concerns about the ability of patients to accurately report their symptomatology, particularly in cases of low awareness of illness. The aim of this study was to assess the effect of insight on the accuracy of self-reported psychotic symptoms using a computerized adaptive testing tool (CAT-Psychosis).

METHODS

A secondary analysis of data drawn from the CAT-Psychosis development and validation study was performed. The Brief Psychiatric Rating Scale and the Scale of Unawareness of Mental Disorders were administered by clinicians. Patients completed the self-reported version of the CAT-Psychosis. Patients were median-split regarding their insight level to compare the correlation between the two psychosis severity measures. A subgroup sensitivity analysis was performed only on patients with schizophrenia spectrum disorders.

RESULTS

A total of 159 patients with a psychotic disorder who completed both CAT-Psychosis and Scale of Unawareness of Mental Disorders were included. For the whole sample, CAT-Psychosis scores showed convergent validity with Brief Psychiatric Rating Scale ratings ( = 0.517, 95% confidence interval = [0.392, 0.622], < 0.001). Insight was found to moderate this correlation (β = -0.511, = 0.005), yet agreement between both measures remained statistically significant for both high ( = 0.621, 95% confidence interval = [0.476, 0.733], < 0.001) and low insight patients ( = 0.408, 95% confidence interval = [0.187, 0.589], < 0.001), while psychosis severity was comparable between these groups (for Brief Psychiatric Rating Scale: = 3057, = -0.129, = 0.897; disorganization: = 2986.5, = -0.274, = 0.784 and for CAT-Psychosis: = 2800.5, = -1.022, = 0.307). Subgroup of patients with schizophrenia spectrum disorders showed very similar results.

CONCLUSIONS

Insight moderates the correlation between self-reported and clinician-rated severity of psychosis, yet CAT-Psychosis remains valid in patients with both high and low awareness of illness.

目的

由于担心患者准确报告其症状的能力，尤其是在疾病意识低下的情况下，自我报告或患者报告的结果测量很少用于精神病学。本研究的目的是使用计算机自适应测试工具（CAT-精神病学）评估洞察力对自我报告的精神病症状准确性的影响。

方法

对 CAT-精神病学开发和验证研究的数据进行了二次分析。由临床医生对简明精神病评定量表和精神障碍意识量表进行评估。患者完成了 CAT-精神病学的自我报告版本。根据他们的洞察力水平对患者进行中位数分割，以比较两种精神病严重程度测量之间的相关性。仅对精神分裂症谱系障碍患者进行了亚组敏感性分析。

结果

共有 159 名完成 CAT-精神病学和精神障碍意识量表的精神病患者被纳入研究。对于整个样本，CAT-精神病学评分与简明精神病评定量表评分呈收敛效度（ = 0.517，95%置信区间[0.392, 0.622]， < 0.001）。洞察力被发现可以调节这种相关性（β = -0.511， = 0.005），但对于高洞察力（ = 0.621，95%置信区间[0.476, 0.733]， < 0.001）和低洞察力患者（ = 0.408，95%置信区间[0.187, 0.589]， < 0.001），这两种测量方法之间的一致性仍然具有统计学意义，而这两组患者的精神病严重程度相当（对于简明精神病评定量表： = 3057， = -0.129， = 0.897；紊乱： = 2986.5， = -0.274， = 0.784；CAT-精神病学： = 2800.5， = -1.022， = 0.307）。精神分裂症谱系障碍患者的亚组显示出非常相似的结果。