Accuracy of self-assessment of real-life functioning in schizophrenia

A consensus has not yet been reached regarding the accuracy of people with schizophrenia in self-reporting their real-life functioning. In a large ( n = 618) cohort of stable, community-dwelling schizophrenia patients we sought to: (1) examine the concordance of patients’ reports of their real-life functioning with the reports of their key caregiver; (2) identify which patient characteristics are associated to the differences between patients and informants. Patient-caregiver concordance of the ratings in three Specific Level of Functioning Scale (SLOF) domains (interpersonal relationships, everyday life skills, work skills) was evaluated with matched-pair t tests, the Lin’s concordance correlation, Somers’ D , and Bland–Altman plots with limits of agreement (LOA). Predictors of the patient-caregiver differences in SLOF ratings were assessed with a linear regression with multivariable fractional polynomials. Patients’ self-evaluation of functioning was higher than caregivers’ in all the evaluated domains of the SLOF and 17.6% of the patients exceeded the LOA, thus providing a self-evaluation discordant from their key caregivers. The strongest predictors of patient-caregiver discrepancies were caregivers’ ratings in each SLOF domain. In clinically stable outpatients with a moderate degree of functional impairment, self-evaluation with the SLOF scale can become a useful, informative and reliable clinical tool to design a tailored rehabilitation program.

I cooked a two inch ribeye steak to medium rare on the first try last night. Put a beautiful crust on the outside and kept it pink on the inside. Most neurotypicals can’t do that.

I function well enough by my own standards, thank you.

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My disagreement with Psychiatry, is that they tend to put all emphasis on how it looks from the outside, when they are not living it on the inside.

There is a tendency to disempower the patient, by telling them that they are only valid through outside opinion.

I agree, when your brain is scrambled as it is at the outset of schizophrenia, you are not able to self-analyze. But if you are stable and functioning, chances are you have much more insight into your condition than anyone could ever have from the outside looking in.

I have had extremely negative experiences with psychiatrists.

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I’ve been a caregiver for Phil, physical reasons. To me it seems more important.