Neuropsych Lec 8 Psych Rating Scales

Lecture 8 - Psychiatric Rating Scales (Rating Instruments) Dr. Abcede PSYCHIATRY II - USTMED 2008 Source: Kaplan Psychiatric Rating Scales (Rating Instruments)

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provide a way to quantify aspects of a patient's psyche, behavior and relationships with individuals and society

CHARACTERISTICS OF RATING SCALES 1. can be specific or comprehensive 2. can measure internally experienced variable (eg. mood) 3. can measure externally observable variable (eg. behavior) 4. assess classic items from the mental status examination 5. assessment of adverse effects from psychotherapeutic drugs; social adjustments and psychoanalytic concepts OTHER CHARACTERISTICS 1. time covered 2. level of judgement required 3. method of recording answers a. dichotomous variable (eg. true or false, present or absent) b. continuos variable (eg. severity, frequency) PSYCHIATRIC RATING SCALES A. Rating scales used for Schizophrenia of Psychosis B. Rating scales used for Mood disorders C. Rating scales used for Anxiety disorders D. Others: 1. Child/adolescent patients 2. Adverse effects of drugs 3. Quality of life 4. Dissociative disorders RATING SCALES USED FOR SCHIZOPHRENIA AND PSYCHOSIS 1. Brief Psychiatric Rating Scale (BPRS) 2. Schedule for Affective Disorders and Schizophrenia (SADS) 3. Scale for the Assessment of Negative Symptoms (SANS) 4. Scale for the Assessment of Thought, Language and Communication (TLC) 5. Thought Disorder Index (TDI) 6. Quality of Life Scale (QLS) 7. Chestnut Lodge Prognostic Scale for Chronic Schizophrenia RATING SCALES USED FOR MOOD DISORDERS 1. Backs Depression Inventory 2. Standard Assessment of Depressive Disorder (SADD) 3. Zung Self-rating Scale for Depression 4. Caroll Rating Scale for Depression 5. Montgomery-Asbug Scale 6. Raskin Depression Rating Scale 7. Inventory to Diagnose Depression 8. Manic Rating Scale 9. Mania State Rating Scale 10. Hamilton Rating Scale for Depression RATING SCALES USED FOR ANXIETY DISORDERS 1. Brief Outpatient Psychopathology Scale 2. Physician's Questionnaire 3. Covi Anxiety Scale 4. Anxiety States Inventory 5. Fear Questionnaire 6. Mobility Inventory For Agoraphobia 7. Social Avoidance and Distress Scale 8. Acute Panic Inventory 9. Leyton Obsessional Inventory 10. Fear Thermometer 11. Impact of Events Scale PANSS RATING MANUAL Instructions: For each item below (P1, P2, etc.) enter the code that best describes the patient’s psychopathology. POSITIVE SCALE P1 DELUSIONS: Beliefs which are unfounded, unrealistic, and idiosyncratic. Basis for rating: thought content expressed in the interview and its influence on social relations and behavior. 1 = Absent – Definition does not apply. 2 = Minimal – Questionable pathology; may be at the upper extreme of normal limits 3 = Mild – Presence of one or two delusions which are vague, uncrystallized and not tenaciously held. Delusions do not interfere with thinking, social relations or behavior. 4 = Moderate – Presence of either a kaleidoscopic array of poorly formed, unstable delusions or a few well-formed delusions that occasionally interfere with thinking, social relations or behavior

5 = Moderate Severe – Presence of numerous well-formed delusions that are tenaciously held and occasionally interfere with thinking, social relations or behavior. 6 = Severe – Presence of stable set of delusions which are crystallized, possibly systematized, tenaciously held, and clearly interfere with thinking, social relations and behavior 7 = Extreme – Presence of stable set of delusions which are either highly systematized or very numerous and which dominate major facets of the patient’s life. This frequently results in inappropriate and irresponsible action, which may even jeopardize the safety of the patient or others. P2 CONCEPTUAL DISORGANIZATION: Disorganized process of thinking characterized by the disruption of goal-directed sequencing, (e.g., circumstantiality, tangentiality, loose associations, non sequiturs, gross illogicality, or thought block). Basis for rating: cognitive-verbal processes observed during the course of the interview. 1 = Absent – Definition does not apply. 2 = Minimal – Questionable pathology; may be at the the upper extreme of normal limits. 3 = Mild – Thinking is circumstantial, tangential, or paralogical. There is some difficulty in directing thoughts toward a goal, and some loosening of associations may be evidenced under pressure. 4 = Moderate – Able to focus thoughts when communications are brief and structured, but becomes loose or irrelevant when dealing with more complex communications or when under minimal pressure. 5 = Moderate Severe – Generally has difficulty in organizing thoughts, as evidence by frequent irrelevancies, disconnectedness, or loosening of associations when not under pressure. 6 = Severe – Thinking is seriously derailed and internally inconsistent, resulting in gross irrelevancies and disruption of thought processes, which occur almost constantly. 7 = Extreme – Thoughts are disrupted to the point where the patient is incoherent. There is marked loosening of associations, which results in total failure of communication, (e.g. “word salad”) or mutism. HAMILTON RATING SCALE FOR DEPRESSION Instructions: For each item select the “cue” which best describes the patient. 1: Depressed Mood (Sadness, hopeless, helpless, worthless)

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0 = Absent 1 = These feelings states indicated only on questioning 2 = These feeling states spontaneously reported verbally 3 = Communicates feeling states nonverbally—ie, through facial expression, posture, voice, and tendency to weep

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4 = Patient reports VIRTUALLY ONLY these feeling states in his spontaneous verbal and nonverbal communication 2: Feelings of Guilt

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0 = Absent

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3 = Present illness is a punishment. Delusions of guilt

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0 = Absent

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3 = Suicide ideas or gesture

1 = Self-reproach, feels he has let people down 2 = Ideas of guilt or rumination over past errors or sinful deeds

4 = Hears accusatory or denunciatory voices and/or experiences threatening visual hallucinations 3: Suicide 1 = Feels life is not worth living 2 = Wishes he were dead or any thoughts of possible death to self

4 = Attempts at suicide (any serious attempt rates 4) 4: Insomnia early

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0 = No difficulty falling asleep 1 = Complains of occasional difficulty falling asleep – ie, more than ¼ hour

- 2 = Complains of nightly difficulty falling asleep 5: Insomnia middle -

0 = No difficulty

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2 = Waking during the night—any getting out of bed rates 2 (except for purpose of voiding)

1 = Patient complains of being restless and disturbed during the night

HAMILTON ANXIETY RATING SCALE Instructions: This checklist is to assist the physician or psychiatrist in evaluating each patient as to his degree of anxiety and patholigical condition. Please fill in the appropriate rating: NONE = 0 MILD = 1 MODERATE = 2 SEVERE = 3 SEVERE, GROSSLY DISABLING = 4 ITEM Anxious Worries, anticipation of the worst, fearful anticipation, irritability Tension Feelings of tension, fatigability, startle response, moved to tears easily , trembling, feelings of restlessness, inability to relax Fears Of dark, of strangers, of being left alone, of animals, of traffic, of crowds Insomnia Difficulty in falling asleep, broken sleep, unsatisfying sleep and fatigue on waking, dreams, nightmares, night-terrors Intellectual (cognitive) poor memory

Difficulty in concentration,

Depressed Mood Loss of interest, lack of pleasure in hobbies, depression, early waking, diurnal swing Somatic (muscular) Pains and aches, twitching, stiffness, myoclonic jerks, grinding of teeth, unsteady voice, increased muscular tone Somatic (sensory) Tinnitus, blurring of vision, hot and cold flushes, feelings of weakness, picking sensation Cardiovascular Symptoms Tachycardia, palpitations, pain in chest, throbbing of vessels, fainting feelings, missing beat Respiratory Symptoms Pressure or constriction in chest, choking feelings, sighing, dyspnea Gastrointestinal Symptoms Difficulty in swallowing, wind, abdominal pain, burning sensations, abdominal fullness, nausea, vomiting, borborygmi, looseness of bowels, loss of weight, constipation Genitourinary Symptoms Frequency of micturition, urgency of micturition, amenorrhea, menorrhagia, development of frigidity, premature ejaculation, loss of libido, impotence Autonomic Symptoms Dry mouth, flushing, pallor, tendency to sweat, giddiness, tension headache, raising of hair Behavior at Interview Fidgeting, restlessness or acing, tremor of hands, furrowed brow, strained face, sighing or rapid respiration, facial pallor, swallowing, belching, brisk tendon jerks, dilated pupils, exophthalmos

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RATING