Listening to the subjective experiences of patients with first-episode psychosis. Relationship of self-rated and clinician-rated psychopathology with subjective quality of life and needs

Backgroung: Psychotic disorders are the most disabling of all mental illnesses. Professionals and service users display divergent opinions and prioritize different aspects of care. Patients are more focused on aspects related to social integration in the community and their psychosocial performance, whereas staff on the illness, its management and deficits associated with diagnosis and treatment. When clinicians and patients agree about the care process, it is easier to obtain better clinical outcomes. The study compared clinician-rated and patient-rated psychopathology and analyzed their relationship with subjective quality of life and need for care in a sample of first episode psychotic patients. Methods: In the context of the multi-center GET UP study, 92 patients were assessed for both clinician and self rated psychopathology (by using respectively PANSS scale and PSYRATS scale), and asked to report their subjective quality of life (by using the WHO QoL Bref scale) and need for care (by using CAN). Assessment were performed at baseline and at 9 months follow up. In order to explore the associations between psychopathology and subjective quality of life, bivariate correlations were preformed. Results: Different levels of agreement between staff and patient evaluation of symptoms’ seriousness are present. For auditory hallucination a good or moderate agreement between patients and clinicians is found, while for delusional beliefs a moderate or low agreement between patients and clinicians is detected. The staff-patient agreement on symptoms’ seriousness seems to not to have a great impact on the quality of life area, with the exception of some specific domains (physical domain and satisfaction with information). As concern the effect of staff-patient agreement on symptoms’ seriousness and need for care, this study highlighted that when a poor agreement between staff and patient assessment of auditory hallucination is present, patients have an higher number of unmet need. For delusional beliefs, instead, when a poor agreement between patient and clinician rated delusion and unusual thought content is present, patients declare to have more needs towards services. Patients with a moderate agreement with clinician about the evaluation of delusional symptoms, seem to have an improvement of basic met needs and social needs. Conclusion: A great challenge to mental health services is to develop better methods of increasing consensus between staff and patients not only in evaluating the psychopathological status, but also in share the treatment decision and planning. Staff may increase consensus by obtaining more feedback from users about the extent to which services are meeting their needs. Subjective quality of life and needs represent some promising measures of both process and outcome in FEP subjects. Measurement of these factors has important implications for treatment planning and delivery, particularly from the point of view of potential generalizability to broader treatment goals such as recovery and staying well.