The cognitive-phenomenological assessment of delusions and hallucinations at the early intervention in psychosis service stage: The results of a quality improvement project.

A quality improvement project reviewed health records of patients in an Early Intervention in Psychosis Service to see which cognitive-phenomenological dimensions of hallucinations and delusions staff assessed. All patients were asked about the content of their hallucinations or delusions, and most were asked about the emotional valence of that content. However, less than half of patients were asked about potential or actual harm from these symptoms, even though patients had experienced psychosis for almost two years on average. Other dimensions were assessed inconsistently. The assessment was incomplete, suggesting a need for guidelines and training to improve thoroughness, which could aid risk assessment and treatment planning.

Study at a glance

Abstract

Clinical assessments are vital for gaining an understanding of a patients' presenting problem. A priority for Early Intervention in Psychosis Service staff is understanding and supporting their patients' experiences of hallucinations and/or delusions. We aimed to identify what cognitive-phenomenology dimensions of hallucinations and delusions EIPS staff were assessing with their patients. We developed a brief checklist of cognitive-phenomenological dimensions of hallucinations and delusions called the Lived Experience Symptom Survey (LESS) based on relevant literature. As part of a Quality Improvement Project, we reviewed the health records of a sub-sample of EIPS patients using the LESS identifying whether each dimension was present or absent. We found that all patients had been asked about the content of their hallucinations and/or delusions, and the majority had been asked about the valence of this content. Despite patients having experienced psychosis for almost 2 years on average, less than half of patients were asked about the potential or actual harm associated with these symptoms. All other cognitive-phenomenological dimensions were assessed inconsistently. The assessment of hallucination and delusions in our EIPS was inconsistent and incomprehensive. These findings require replication in other EIPS' but may point to a need for guidelines and training around how to conduct a thorough assessment of hallucinations and delusions for current and future EIPS staff. Improved assessment of these symptoms will aid the development of risk assessments and treatment plans.