Agreement Between Client- and Clinician-Rated Symptoms in First-Episode Psychosis Treatment

Alyssa Williamson, BA

Beth Israel Deaconess Medical Center
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Scientific Abstract

Background: In first-episode psychosis (FEP) treatment, self-report measures can provide information about a client’s perception of their illness. Despite lower levels of insight often seen in psychotic disorders, clients with psychosis have been found to report their symptoms fairly accurately when compared to clinician reports. For cases where client and clinician ratings differ, however, this discrepancy may have important clinical implications. FEP clients who report higher therapeutic alliance with their treatment providers may have improved quality of life and symptom-level outcomes. Thus, this analysis sought to assess the similarity of clinician and client ratings of symptomology across FEP clinics in Massachusetts, and to test the association of this agreement (or lack thereof) with clients’ alliance with their treaters.

Methods: Eight FEP clinics reported routine clinical assessment data from youth receiving treatment at their program, with assessments completed at patient intake and at six-month intervals following intake. We report results from 47 participants with baseline data on the Colorado Symptom Index (CSI) and Clinician-Rated Dimensions of Psychopathology (CRDP). Clients’ perceptions of therapeutic alliance with treaters was measured using the Autonomy Support Scale. We conducted Pearson correlations comparing the CSI to the CRDP and the level of agreement to the AS. Individual symptom domains were compared using Wilcoxon Signed Rank tests.

Results: There was a small but significant correlation between client and clinician reports of symptomology (r=0.32, p=0.007). The level of disagreement between a client and their clinician did not correlate significantly with clients’ perceived alliance with the treatment team (r= 0.14, p=0.3).

Conclusions: FEP clients’ symptom self-ratings were weakly related clinicians’ symptom ratings. A stronger therapeutic alliance did not predict better agreement regarding symptom severity. Therefore, it stands to reason that understanding both the client and clinician’s formulation of the client’s illness are vital for the client’s recovery.

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research Areas


Alyssa N. Williamson, BA, Kelsey A. Johnson, MPH, Beshaun Davis, PhD, Emily Kline, PhD, Matcheri Keshavan, MD

Principal Investigator

Emily Kline, PhD, and Matcheri Keshavan, MD

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