Symptom dimensions of the psychotic symptom rating scales in psychosis: a multisite study

Todd S Woodward, Kwanghee Jung, Heungsun Hwang, John Yin, Laura Taylor, Mahesh Menon, Emmanuelle Peters, Elizabeth Kuipers, Flavie Waters, Tania Lecomte, Iris E Sommer, Kirstin Daalman, Remko van Lutterveld, Daniela Hubl, Jochen Kindler, Philipp Homan, Johanna C Badcock, Saruchi Chhabra, Matteo Cella, Sarah Keedy, Paul Allen, Andrea Mechelli, Antonio Preti, Sara Siddi, David Erickson, Todd S Woodward, Kwanghee Jung, Heungsun Hwang, John Yin, Laura Taylor, Mahesh Menon, Emmanuelle Peters, Elizabeth Kuipers, Flavie Waters, Tania Lecomte, Iris E Sommer, Kirstin Daalman, Remko van Lutterveld, Daniela Hubl, Jochen Kindler, Philipp Homan, Johanna C Badcock, Saruchi Chhabra, Matteo Cella, Sarah Keedy, Paul Allen, Andrea Mechelli, Antonio Preti, Sara Siddi, David Erickson

Abstract

The Psychotic Symptom Rating Scales (PSYRATS) is an instrument designed to quantify the severity of delusions and hallucinations and is typically used in research studies and clinical settings focusing on people with psychosis and schizophrenia. It is comprised of the auditory hallucinations (AHS) and delusions subscales (DS), but these subscales do not necessarily reflect the psychological constructs causing intercorrelation between clusters of scale items. Identification of these constructs is important in some clinical and research contexts because item clustering may be caused by underlying etiological processes of interest. Previous attempts to identify these constructs have produced conflicting results. In this study, we compiled PSYRATS data from 12 sites in 7 countries, comprising 711 participants for AHS and 520 for DS. We compared previously proposed and novel models of underlying constructs using structural equation modeling. For the AHS, a novel 4-dimensional model provided the best fit, with latent variables labeled Distress (negative content, distress, and control), Frequency (frequency, duration, and disruption), Attribution (location and origin of voices), and Loudness (loudness item only). For the DS, a 2-dimensional solution was confirmed, with latent variables labeled Distress (amount/intensity) and Frequency (preoccupation, conviction, and disruption). The within-AHS and within-DS dimension intercorrelations were higher than those between subscales, with the exception of the AHS and DS Distress dimensions, which produced a correlation that approached the range of the within-scale correlations. Recommendations are provided for integrating these underlying constructs into research and clinical applications of the PSYRATS.

Keywords: delusions; hallucinations; principal component analysis; psychosis; schizophrenia; structural equation modeling; symptom rating scales.

© The Author 2014. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center.

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