Comparison of self- and clinician's ratings of Personal and Social Performance in patients with schizophrenia: the role of insight.

BACKGROUND: Patients with schizophrenia are often markedly impaired in their social functioning, partly independent of symptom severity. Few studies have examined patients' self-reporting of their social functioning, how a patient's self-perspective differs from third-party ratings, and whether or not the patients' self-rating of social functioning is influenced by their awareness of illness. SAMPLING AND METHODS: Based on the Personal and Social Performance (PSP) scale as a clinician-administered scale, a PSP self-rating scale for patients was developed. The study included 42 inpatients with schizophrenia. Instruments were the PSP scale, the PSP self-rating scale, the Clinical Global Impression-Severity Scale, and the Scale to Assess Unawareness of Mental Disorder.
RESULTS: A significant correlation was found between PSP self- and clinician's rating for 'socially useful activities', whereas the other PSP subdimensions as well as the total score were not significantly correlated. For patients with high insight, a significantly positive association emerged with 'disturbing and aggressive behaviour', while there was no significant correlation between PSP self- and clinician's ratings for the patients with poor insight into their disorder.
CONCLUSIONS: Patients and clinicians only marginally converge on their judgments concerning the patients' psychosocial functioning. Patients' insight may have a moderating role on the approximation of agreement between self- and third-party ratings. Results are discussed in line with the present literature regarding the accuracy of self-awareness in schizophrenia.