Psychiatric Rating Scales
Psychiatric Rating Scales
Psychiatric Rating Scales
1
Young Mania Rating Scale
Depressed Mood Time occupied by obsessive thoughts
This scale is used to assess disease
severity in patients already diagnosed Unknown. Unknown.
with mania. This 11-item scale is intended 0= Natural mood. 0= None.
to be administered by a trained clinician
who assigns a severity rating for each 1= When it is doubtful whether the 1= Mild.
item based on a personal interview (Table 3).3 patient is more despondent or sad
2= Moderate.
than usual. Eg the patient vaguely
indicates to be more depressed 3= Severe.
1. Elevated mood than usual.
4= Extreme.
2. Increased motor activity and energy 2= When the patient is more clearly
concerned with unpleasant Table 5. Item 1 of the Y-BOCS
3. Sexual interest experiences, although he/she is
4. Sleep still without helplessness Positive and Negative Syndrome
or hopelessness. Scale (PANSS)
5. Irritability
3= The patient shows clear non- The PANSS was developed as a more
6. Speech (rate and amount) verbal signs of depression rigorously and objective method for
7. Language and thought disorder and/or hopelessness. evaluating positive, negative and other
8. Content 4= The patient remarks on symptom dimensions in schizophrenia.
despondency and helplessness or The PANSS assessment is derived from
9. Disruptive-aggressive behaviour the patient cannot be distracted behavioural information collected from a
10. Appearance from non-verbal signs of depression number of sources including: observations
that dominate the interview. during the interview; a clinical interview;
11. Insight. and reports by primary care or hospital
Table 4. Item 6 of the HAM-A rating scale staff or family members.6
Table 3. Items evaluated in the
Young Mania rating scale The ratings provide summary scores on a
Yale–Brown Obsessive– 7-item positive scale (Table 6), a 7-item
Compulsive Scale (Y-BOCS) negative scale and a 16-item general
Hamilton Anxiety Rating
(HAM-A) Scale This is a 10-item balanced scale designed psychopathology scale. The PANSS ratings
to rate both the severity and type of should be based on all the information
This scale consists of 14 items, each symptoms in patients with OCD. The relating to a specified period, normally
defined by a series of symptoms. The scale includes assessments of time identified as the previous week. If the
HAM-A was one of the first rating scales occupied, interference with ordinary item is absent it is scored as 1, increased
developed to measure the severity of social activities, degree of distress, levels of psychpathology are assigned
anxiety symptomatology. The scale was resistance and control. This scale was scores from 2 (minimal) to 7 (extreme).
introduced by Max Hamilton in 1959 and designed to measure symptoms, on a The rater must determine the symptom
measures the severity of symptoms such scale from 0 to 4, without being severity by reference to the particular
as anxiety, tension, depressed mood. influenced by the type of obsessions criteria for the anchoring points and
palpitations, breathing difficulties, sleep or compulsions (Table 5).5 assign the highest applicable rating point.
disturbances, restlessness and other
physical symptoms (Table 4).4 This is a
widely used scale and an accepted
outcome measure in clinical trials.
2
P1 Delusions. 1. Somatic concern. Hopelessness
P2 Conceptual disorganisation. 2. Anxiety: psychic. Unknown.
P3 Hallucinatory behaviour. 3. Emotional withdrawal. 0= Absent.
P4 Excitement. 4. Conceptual disorganisation 1= Mild.
(incoherence).
P5 Grandiosity. 2= Moderate.
5. Self-depreciation and guilt feelings.
P6 Suspiciousness/persecution. 3= Severe.
6. Anxiety: somatic.
P7 Hostility.
Table 8. Item 2 of the CDSS
7. Specific movement disturbances.
Table 6. Postive scale (P) items evaluated in
8. Exaggerated self-esteem.
the PANSS Global Assessment of
9. Depressive mood. Functioning (GAF) Scale
Brief Psychiatric Rating Scale 10. Hostility. The GAF, a modified version of the Global
(BPRS) Assessment Scale (GAS), first appeared in
11. Suspiciousness.
The BPRS is probably the most widely DSM-III-R in 1994.9 Overall function on
used rating scale in psychiatry. 12. Hallucinations. Axis V of the DSM-IV is assessed using
It comprises 16 items rated from 0 13. Motor retardation. the GAF scale. This scale may be
(not present) to 6 (extremely severe) particularly useful when the clinical
and includes symptoms such as somatic 14. Uncooperativeness. progress of a patient needs to be assessed
concern, anxiety, depressive mood, 15. Unusual thought content. in global terms, using a single measure.
hostility and hallucinations (Table 7).7 The GAF scale is rated with respect to
16. Blunted or inappropriate affect. psychological and occupational
The scale was developed essentially for
schizophrenia states but also includes functioning only. Interpretation of total
Table 7. Items evaluated on the BPRS scores is as follows:
symptoms of depression. Interpretation
of the total scores is: 0–9, not a
schizoaffective case; 10–20, possible Calgary Depression Scale for Total score 91–100
schizoaffective case; 21 or more, Schizophrenia (CDSS) Superior functioning in a wide range of
definite schizoaffective case. Many of the frequently used depression activities, life’s problems never seem to
For schizophrenia states, the 10 scales were designed to assess depression get out of hand, is sought out by others
schizophrenia items on the BPRS in nonpsychotic patients. These scales because of his or her many positive
should be summed. contain items which do not distinguish qualities. No symptoms.
The scale is quantitative; it was depressed from nondepressed psychotic
patients. The CDSS was designed to Total score 81–90
constructed for the sole purpose of rating
the current clinical picture. It is not a assess symptoms of depression in the Absent or minimal symptoms (eg, mild
diagnostic tool. When the scale is used in presence of schizophrenia. It measures anxiety before an exam), good
repeated (weekly) ratings, each the severity of symptoms such as functioning in all areas, interested and
assessment must be made independently, depressed mood, hopelessness, guilt, involved in a wide range of activities,
without reference to previous interviews. insomnia and suicide (Table 8).8 socially effective, generally satisfied
3
with life, no more than everyday References Further reading
problems or concerns (eg, an occasional
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depression. J Neurol Neurosurg Diagnostic and Statistical Manual of
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Washington, DC: American
If symptoms are present, they are 2. Montgomery SA, Åsberg M. A new
Psychiatric Association; 1994.
transient and expectable reactions to depression scale designed to be
psychosocial stressors (eg, difficulty sensitive to change. Br J Psychiatry Åsberg M, Montgomery SA, Perris C, et al.
concentrating after family argument); no 1979;134:382–389. A comprehensive psychopathological
more than slight impairment in social, rating scale. Acta Psychiatr Scand
3. Young RC, Biggs JT, Ziegler VE, Meyer
occupational, or school functioning (eg, 1978;(Suppl. 271):5–27.
DA. A rating scale for mania: reliability,
temporarily falling behind in schoolwork). validity and sensitivity. Br J Psychiatry Gorham DR, Overall JE. Dimensions of
1978;133:429–435. change in psychiatric symptomatology.
Clinical Global Impression (CGI) Dis Nerv Syst 1961;22:576–880.
4. Hamilton M. The assessment of
Scale anxiety states by rating. Br J Med Gorham DR, Overall JE. Drug action
The CGI scale refers to the global Psychol 1959;32:50–55. profiles based upon an abbreviated
impression of the patient and requires psychiatric rating scale. J Nerv Ment Dis
5. Goodman WK, Price LH, Rasmussen
clinical experience with the syndrome 1960;132:528–535.
SA, et al. The Yale–Brown
under assessment.10 The CGI Obsessive–Compulsive Scale. I. Hamilton M. Development of a rating
improvement scale can be completed Development, use, and reliability. scale for primary depressive illness. Br J
only following or during treatment. The Arch Gen Psychiatry Soc Clin Psychol 1967;6:278–296.
concept of improvement refers to the 1989;46:1006–1011.
clinical distance between the individual’s Montgomery S, Åsberg M, Jörnestedt L et
current condition and that prior to the 6. Kay SR, Fiszbein A, Opler LA. The al. Reliability of the CPRS between the
start of treatment. The scale has a single positive and negative syndrome scale disciplines of psychiatry, general practice,
item measured on a 7 point scale from 1 (PANSS) for schizophrenia. nursing and psychology in depressed
(‘normal’, not ill) to 7 (extremely ill). Schizophr Bull 1987;13:261–276. patients. Acta Psychiatr Scand
1978;(Suppl. 271):29–32.
7. Overall JE, Gorham DR. The Brief
Psychiatric Rating Scale. Psychol Rep
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8. Addington D, Addington J,
Maticka-Tyndale E. Assessing
depression in schizophrenia: the
Calgary Depression Scale. Br J
Psychiatry Suppl 1993;22:39–44.
9. American Psychiatric Association.
Diagnostic and Statistical Manual of
Mental Disorders, third edition revised.
Washington, DC: American Psychiatric
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10. Guy W. ECDEU Assessment manual for
psychopharmacology. Rockville, MD:
US Department of Health and
Human Services publication (ADM)
1976; pp 218–22.