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.

1.
Burns T, Patrick D: Social functioning as an outcome measure in schizophrenia studies. Acta Psychiatr Scand 2007;116:403–418.
2.
Ginsberg DL, Schooler NR, Buckley PF, Harvey PD, Weider PJ: Optimizing treatment of schizophrenia. Enhancing affective/cognitive and depressive functioning. CNS Spectr 2005;10:1–13.
3.
Nasrallah H, Morosini P, Gagnon DD: Reliability, validity and ability to detect change of the Personal and Social Performance scale in patients with stable schizophrenia. Psychiatry Res 2008;161:213–224.
4.
Bell M, Fiszdon J, Richardson R, Lysaker P, Bryson G: Are self-reports valid for schizophrenia patients with poor insight? Relationship of unawareness of illness to psychological self-report instruments. Psychiatry Res 2007;151:37–46.
5.
Niv N, Cohen AN, Mintz J, Ventura J, Young AS: The validity of using patient self-report to assess psychotic symptoms in schizophrenia. Schizophr Res 2007;90:245–250.
6.
Huppert JD, Smith TE, Apfeldorf WJ: Use of self-report measures of anxiety and depression in outpatients with schizophrenia: reliability and validity. J Psychopathol Behav Assess 2002;24:275–283.
7.
Dickerson FB, Ringel NB, Parente F: Ratings of social functioning in outpatients with schizophrenia: patient self-report versus caregiver assessment. Eval Program Plann 1997;20:415–420.
8.
Birchwood M, Smith J, Cochrane R, Wetton S, Copestake S: The Social Functioning Scale. The development and validation of a new scale of social adjustment for use in family intervention programmes with schizophrenic patients. Br J Psychiatry 1990;157:853–859.
9.
Becchi A, Rucci P, Placentino A, Neri G, de Girolamo G: Quality of life in patients with schizophrenia – comparison of self-report and proxy assessments. Soc Psychiatry Psychiatr Epidemiol 2004;39:397–401.
10.
Bowie CR, Twamley EW, Anderson H, Halpern B, Patterson TL, Harvey PD: Self-assessment of functional status in schizophrenia. J Psychiatr Res 2007;41:1012–1018.
11.
Lysaker PH, Roe D, Yanos PT: Toward understanding the insight paradox: internalized stigma moderates the association between insight and social functioning, hope, and self-esteem among people with schizophrenia spectrum disorders. Schizophr Bull 2007;33:192–199.
12.
Lysaker PH, Bell M, Milstein R, Bryson G, Beam-Goulet J: Insight and psychosocial treatment compliance in schizophrenia. Psychiatry 1994;57:307–315.
13.
Lysaker PH, Bryson GJ, Bell MD: Insight and work performance in schizophrenia. J Nerv Ment Dis 2002;190:142–146.
14.
Lysaker PH, Buck KD, Salvatore G, Popolo R, Dimaggio G: Lack of awareness of illness in schizophrenia: conceptualizations, correlates and treatment approaches. Expert Rev Neurother 2009;9:1035–1043.
15.
Morosini PL, Magliano L, Brambilla L, Ugolini S, Pioli R: Development, reliability and acceptability of a new version of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS) to assess routine social functioning. Acta Psychiatr Scand 2000;1001:323–329.
16.
Schaub D, Juckel G: PSP Scale: German version of the Personal and Social Performance Scale: valid instrument for the assessment of psychosocial functioning in the treatment of schizophrenia. Nervenarzt 2010, E-pub ahead of print.
17.
Juckel G, Schaub D, Fuchs N, Naumann U, Uhl I, Witthaus H, Hargarter L, Bierhoff HW, Brüne M: Validation of the Personal and Social Performance (PSP) Scale in a German sample of acutely ill patients with schizophrenia. Schizophr Res 2008;104:287–293.
18.
Schaub D, Abdel-Hamid M, Brüne M: Schizophrenia and social functioning: the role of impaired metacognition; in Dimaggio G, Lysaker PH (eds): Metacognition and Severe Adult Mental Disorders. From Research to Treatment (chapter 5). New York, Routledge, 2010, pp 83–94.
19.
Guy W: Clinical global impressions; in Guy W (ed): ECDEU Assessment Manual for Psychopharmacology. Rockville, National Institute for Mental Health, 1976, pp 218–220.
20.
Amador XF, Strauss DH, Yale SA, Flaum MM, Endicott J, Gorman JM: The assessment of insight in psychoses. Am J Psychiatry 1993;150:873–879.
21.
Lambert M, Naber D: Current issues in schizophrenia: overview of patient acceptability, functioning capacity and quality of life. CNS Drugs 2004;18:5–17.
22.
Eichenberger A, Rössler W: Comparison of self-ratings and therapist ratings of outpatients’ psychosocial status. J Nerv Ment Dis 2000;188:297–300.
23.
Drake RJ, Pickles A, Bentall RP, Kinderman P, Haddock G, Tarrier N, Lewis SW: The evolution of insight, paranoia and depression during early schizophrenia. Psychol Med 2004;34:285–292.
24.
Crumlish N, Whitty P, Kamali M, Clarke M, Browne S, McTique O, Lane A, Kinsella A, Larkin C, O’Callaghan E: Early insight predicts depression and attempted suicide after 4 years in first-episode schizophrenia and schizophreniform disorder. Acta Psychiatr Scand 2005;112:449–455.
25.
Langdon R, Ward P: Taking the perspective of the other contributes to the awareness of illness in schizophrenia. Schizophr Bull 2009;35:1003–1011.
26.
Brüne M, Abdel-Hamid M, Lehmkämper C, Sonntag C: Mental state attribution, neurocognitive functioning, and psychopathology: what predicts poor social competence in schizophrenia best? Schizophr Res 2007;92:151–159.
27.
Lysaker PH, Carcione A, Dimaggio G, Johannesen JK, Nicoló G, Procacci M, Semerari A: Metacognition amidst narratives of self and illness in schizophrenia: associations with neurocognition, symptoms, insight and quality of life. Acta Psychiatr Scand 2005;112:64–71.
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