Measuring negative symptom change in schizophrenia: considering alternatives to self-report

Abstract

Treatment of negative symptoms in schizophrenia is a priority, but is approaching stagnation, due in part to the methods used to assess change in these symptoms. Traditional methods for assessing negative symptoms employ subjective self-report and/or clinician-rated scales, both of which are contaminated by considerable measurement error. The purpose of this article is to highlight the limitations in current assessment measures for negative symptoms and discuss the advantages of quantitative objective measurement, particularly in the context of clinical trial research. Recent research from psychology, neuroscience and computer technology has produced objective quantitative measures such as facial analysis and virtual reality that are more precise and sensitive to change; these objective measures are poised to revolutionize the measurement of this critical symptom.

Keywords::

• clinical trials
• negative symptoms
• objective assessment
• psychometrics
• schizophrenia

Financial & competing interests disclosure

CR Bowie has served as a consultant for Lundbeck, Otsaka and Abbvie. CR Bowie has also received grant support from Pfizer and Lundbeck. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Negative symptoms remain the most prominent and treatment-resistant feature of schizophrenia to date, incurring immense personal burden and societal costs.

• Traditional clinician-rated assessment tools contain considerable measurement errors and have inherent limitations for assessment and analysis.

• Objective quantitative measures such as facial analysis and virtual reality are more precise and sensitive to change, and with advances and cost reductions in technology these objective measures are well poised to revolutionize the measurement of negative symptoms.

• Subjective rating scales are limited by error in clinical judgment as well as memory deficits, lack of insight and social desirability biases in self-report.

• Subjective rating scales increase the potential for noise in data, whereas quantitative measures provide objective measurement that may be more sensitive to behavioral change and produce more reliable assessment of change during clinical trials.

• The use of objective assessment methods can capture more proximal mechanisms of change and are less biased by the need for concomitant change in real-world functioning that is confounded by extraneous factors.

• The next 5 years of clinical trial research have the potential to revolutionize the treatment of negative symptoms in schizophrenia.

Notes