Advancing Measurement Based Care in Schizophrenia - Development of a Self-Reported Measurement of Function

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Presenting Author(s): Dr. Zahinoor Ismail, MD, FRCPC

Co-Author(s): Andrea Bardell

Date and time: 23 Mar 2019 from 15:00 to 15:30

Location: Hawthorn A  Floor Map

Objectives

  1. To review approaches to measurement based care in schizophrenia;
  2. To discuss the importance of function as an outcome measure in psychotic disorders; and
  3. To assess the role and utility of the recently developed Canadian Self Report Functional Rating Scale in Schizophrenia.

Literature References

  1. Douglas W. Heinrichs, Thomas E. Hanlon, William T. Carpenter; The Quality of Life Scale: An Instrument for Rating the
    Schizophrenic Deficit Syndrome, Schizophrenia Bulletin, Volume 10, Issue 3, 1 January 1984, Pages 388–398,
    https://doi.org/10.1093/schbul/10.3.388
  2. Donald Addington, MD, Sabina Abidi, MD, Iliana Garcia-Ortega, MD, William G. Honer, MD, Zahinoor Ismail, MD Canadian
    Guidelines for the Assessment and Diagnosis of Patients with Schizophrenia Spectrum and Other Psychotic Disorders Canadian
    Journal of Psychiatry 2017
  3. Christopher R. Bowie , Ph.D., Abraham Reichenberg , Ph.D., Thomas L. Patterson , Ph.D., Robert K. Heaton , Ph.D., and Philip D.
    Harvey , Ph.D. Determinants of Real-World Functional Performance in Schizophrenia Subjects: Correlations With Cognition, Functional
    Capacity, and Symptoms, American Journal of Psychiatry 2006; https://doi.org/10.1176/appi.ajp.163.3.418

Abstract

Measurement based care (MBC) in psychiatry is well established as an approach to monitor change in symptom burden and optimize
outcomes. In mood and anxiety disorders, both clinician-rated scales and self-report measures are valid, reliable, easy to use, and
simple to implement for community dwelling outpatients. In schizophrenia, however, anosognosia or poor insight, and inaccurate
symptom reporting, undermine the utility of self-reported measures. Clinician-rating scales such as the Positive and Negative Symptom
Scale (PANSS) and the Brief Psychiatric Rating Scale (BPRS) are valid and reliable, but slightly more time consuming than their mood
and anxiety disorder equivalents, require more intensive rater training, and thus are less likely to be used in routine practice. Newer
schizophrenia guidelines and changing treatment paradigms are moving beyond the unidimensional approach to treating only symptoms
in schizophrenia. Relapse prevention and functional recovery are now important 21st century outcomes, and are more consistent with
patient-reported goals for treatment of their illness. Moreover, functional status may be more reliably reported than positive psychotic
symptoms, and can be an area of focus for the development of meaningful outcome measures for those with psychotic disorders.
We present here the development of a self-report rating scale in schizophrenia for functional outcomes. Important component domains
include productivity, self-care, leisure, and quality of life, all of which are important to patients, and are related to medication adherence
and efficacy. We also present the validation protocol, to be implemented in partner sites across Canada.



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