In Patients Diagnosed with Schizophrenia, Depression Linked to More Accurate Assessments

Participants diagnosed with schizophrenia with higher levels of self-reported depression have more accurate assessments of abilities

Bernalyn Ruiz
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A study recently published in Schizophrenia Bulletin explored the impact of self-reported depression levels on the client’s perception of functioning abilities within persons identified as having schizophrenia or schizoaffective disorder.

Previous research has shown that individuals identified as having depression more accurately self-assess their abilities than those who report no depression. Moreover, results from a large-scale study found that severity of depression was associated with “clinical insight,” suggesting that depression is related to increased awareness of functional limitations. Researchers for the present study were interested in exploring this relationship within individuals who have received a schizophrenia diagnosis.

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Data were extracted from the Validation of Everyday Real-World Outcomes (VALERO) study across three geographical areas. All participants were receiving outpatient services and had been diagnosed with schizophrenia or schizoaffective disorder. Participants completed measures of performance-based functional capacity, cognitive performance, real-world functioning, self-reported depression, and symptom severity.

Real-world functioning was measured using the Specific Levels of Functioning (SLOF) tool which is composed of three domains: interpersonal functioning, everyday activities, and vocational functioning. Interpersonal functioning refers to the degree of initiating, accepting, maintaining social contacts, and effectively communicating. The daily activities domain aims to provide a measure a person’s involvement in activities such as shopping, using a telephone, paying bills, use of leisure time, and use of public transportation. Lastly, the vocational functioning domain captures the individual’s employable skills, the level of supervision required to complete tasks, ability to stay on task, complete tasks, and punctuality.

The self-reported severity of depressive symptoms was determined with the Beck Depression Inventory (BDI). The severity of positive, negative, and general symptoms associated with schizophrenia was assessed with the Positive and Negative Syndrome Scale (PANSS). Functional capacity was assessed with a performance-based measure (UCSD Performance-based Skills Assessment (UPSA-B).  In this task, participants are asked to do everyday tasks related to communication and finance such as calling to reschedule a doctor’s appointment and paying a utility bill. Cognitive performance was also measured, utilizing the modified version of the MATRICS Consensus Battery (MCCB).

Researchers tested the difference between self-reported functioning and informant-based ratings of functioning. Participant reports of everyday functioning were higher than the ratings from informants (a clinician who had frequent contact with the clients).

When correlations between the difference scores, positive symptoms, negative symptoms, and depressive symptoms were measured, it was found that those with worse depressive symptoms had less overestimation of functioning compared to informant ratings. Those with higher depressive scores overestimated their every day, vocational, and interpersonal functioning to a greater degree than those with lower depressive symptom scores. Neither positive nor negative symptoms were correlated with overestimation across any of the functioning domains.

When participants were split into three groups based on the severity of their self-reported depressive symptoms, the two groups with higher self-reported depression had a more accurate assessment of interpersonal functioning and everyday activities than the group with minimal depression. On vocational functioning, the group with a more severe depression score had a more accurate assessment. From the informant perspective, everyday activities and vocational functioning domain scores were not related to depression scores. On interpersonal functioning, the group with highest self-reported depression was rated as significantly worse on social functioning.

Also, regarding cognition and performance-based skills, there was no relationship between either of the constructs and self-reported depression scores. Lastly, lower depression scores were associated with less severe positive symptom scores while those with higher depression scores had the highest negative symptom scores.

Within this sample of individuals diagnosed with schizophrenia or schizoaffective disorder, self-reported symptoms of depression were correlated with accuracy of self-assessment of everyday functioning. Participants with lower levels of self-reported depression overestimated their daily functioning and those with higher levels of self-reported depression assessed their functioning levels more consistently with the assessments reported by clinicians. Interestingly, regardless of the severity of depressive symptoms, none of the patients underestimated their level of functioning.

A particularly interesting finding of this study was that participants who reported minimal levels of depression and better functioning than observed by clinicians performed similarly on objective measures of cognition and functional capacity as participants who more accurately reported higher levels of functioning impairment. The authors suggest this represents that self-reported levels of depression and functioning are not likely to give an accurate estimation of the client’s present functioning capacity.

The authors conclude:

“Very low levels of subjective depression may signal significant difficulty in self-rating level of everyday functioning and objective abilities. Thus, informant ratings may be required for establishing an accurate level of functional impairment in schizophrenia and other neuropsychiatric conditions.”

 

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Harvey, P. D., Twamley, E. W., Pinkham, A. E., Depp, C. A., & Patterson, T. L. (2017). Depression in schizophrenia: associations with cognition, functional capacity, everyday functioning, and self-assessment. Schizophrenia Bulletin43(3), 575-582. (Abstract)

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Bernalyn Ruiz
MIA Research News Team: Bernalyn Ruiz is a doctoral student at the University of Massachusetts Boston and has a master’s degree in clinical psychology from Columbia University. She is engaged in research on psychosis and stigma from a social justice perspective. She is a proud daughter of Mexican immigrants and hopes to play her small part in improving Latinx mental health.

6 COMMENTS

  1. So they’re saying, “If you’re schizophrenic, you can never underestimate yourself. It can only be worse!” If you don’t like it, you’re not the only one. Studies in “depressive realism” have been conducted in multiple segments of multiple populations, and their validity is often disputed because of inconsistent results. I wouldn’t count on this being the final word…

  2. No offense, but this paper sounds like a bunch of self serving nonsense. First of all, the “gold standard schizophrenia treatment,” the antipsychotics/neuroleptics, can create both the negative and positive symptoms of “schizophrenia,” via neuroleptic induced deficit syndrome and anticholinergic toxidrome.

    https://en.wikipedia.org/wiki/Neuroleptic-Induced_Deficit_Syndrome
    https://en.wikipedia.org/wiki/Toxidrome

    The majority of “mental health care” workers don’t know this because these neuroleptic induced illnesses are not listed in your DSM billing code “bible.”

    As to, “informant ratings may be required for establishing an accurate level of functional impairment in schizophrenia and other neuropsychiatric conditions.” Trust me, doctors do not know more about a person’s well being or activities than the person him/herself.

    My psychiatrist wrote in his medical records, about my taking on the responsibility of managing a 250+ member volunteer organization, “not believed by doctor.” And on my second to last appointment with him, after I confronted him with all the misinformation, and all his delusions written in his medical records, he quite literally declared my entire life a “credible fictional story.” Did he really expect me to believe the town I grew up in and the universities I’d attended were “fictional”? Doctors most definitely do not know more about the patients’ lives, than the patients themselves. That would be, as you “mental health professionals” say, a “delusion of grandeur.”

    The truth of the matter is that the psychiatrists/psychologists have an almost incomprehensible disrespect, especially in a country where “all people are created as equal,” for those they defame with their scientifically invalid DSM “serious mental illnesses.” And the doctors are completely deluded about the adverse effects of their psychiatric “wonder drugs” as well.

    The pharmaceutical companies want the doctors creating and managing “diseases,” not curing people, since this is what is profitable for them. Wake up, take the red pill.

  3. One problem of course that the clinician assessment is taken as ultimate truth. So those who assess closely to clinician they obviously more adequate then those who assess their functioning differently.

    >Interpersonal functioning refers to the degree of initiating, accepting, maintaining social contacts, and >effectively communicating. The daily activities domain aims to provide a measure a person’s >involvement in activities such as shopping, using a telephone, paying bills, use of leisure time, and use >of public transportation. Lastly, the vocational functioning domain captures the individual’s employable > skills, the level of supervision required to complete tasks, ability to stay on task, complete tasks, and punctuality.

    I just don’t see HOW clinician may provide more accurate assessment here.

    There are many ways to speculate about this study. One path – is that clinicians are more pessimistic in their assessments so as depressed people. So both assessments are pessimistique.

    Also What if someone is overly optimistic vegetable? Plus one to discrepancy
    What if highly functioning but overly pessimistique? Guess what, he and clinician will probably provide the same estimate.

    Also in some ways even healthy depressed people don’t overestimate themself. This is probably well-known result from the domain of cognitive psychology.

    The whole study is dumb and waste of money.

  4. Well, psychiatry is dumb and a waste of money–and lives. If psychiatrists must exist there are worse things they can do than perform studies like this.

    Self hatred and pessimism about one’s skills and abilities is a bad thing and unhealthy. Unless you are “severely mentally ill.” Then it’s a good thing, because it shows you have insight. (Yeah, you have to be hospitalized 3 or 4 times a year because of an unaccountable urge to kill yourself. Oh well. Must be your sick brain at fault.)

  5. Highly amusing.

    On another note I now understand my diagnosis of schizophrenia. My neurotransmitters are firing differently which causes psychosis symptoms.

    There is in fact a biological component making it an illness but also provides mechanism to get in contact with the universal concept of divinity.

    Hey what do you think? I came up with this a couple years ago while staring at the moon on my back porch. This is what I believe.

    THANK YOU For THE ARTICLES BERNALYN.