OBJECTIVES: To assess discordance between psychiatrists and their patients with Schizophrenia in relation to disease severity and treatment outcomes.

METHODS: A cross-sectional survey of psychiatrists and their patients with schizophrenia was conducted across the US, France, Spain, Japan and China between July and December 2019. Participating psychiatrists completed a patient record form (PRF) for their next 10 consulting adult patients with schizophrenia, with the same patients voluntarily completing a patient self-completion form (PSC). Both PRF and PSC surveyed on patients’ clinical characteristics, severity of illness and treatment outcomes. Kappa analysis was used to calculate agreement between psychiatrists and patients.

RESULTS: A total of 456 psychiatrists provided data on 4189 patients, of which 2275 completed a PSC. Results were derived from matched PRF and PSC pairs. Discordance was observed between psychiatrists and their patients with Schizophrenia on patient’s severity of illness (kappa = 0.1744) and level of improvement on treatment (kappa = 0.2035) using Clinical Global Impression (CGI) scale. Compared to patients, psychiatrists tended to underrate patients’ severity of illness (16.6% of patients considered markedly/severely/extremely ill by psychiatrists, compared to 30.3% by patients themselves) and overrate the patients’ level of improvement on treatment, (72.0% of patients considered much/very improved by psychiatrists, compared to 46.9% by patients themselves). Where patients were not always compliant with schizophrenia treatment, psychiatrists tended to underestimate “taking medication is inconvenient” (6% psychiatrist reported vs 22% patient reported; kappa = 0.0909) and “do not see improvement on medication” (20% psychiatrist reported vs 49% patient reported; kappa = 0.0033) as key reasons for non-compliance.

CONCLUSIONS: A disconnect was observed between psychiatrists and their patients with Schizophrenia on their respective perception of severity of illness, level of improvement and reasons for non-compliance with treatment, which could lead to sub-optimal treatment. Future research should investigate factors associated with such discordance.