What is the Severity of Alcohol Dependence Questionnaire?

Introduction

The Severity of Alcohol Dependence Questionnaire (SADQ or SAD-Q) is a 20 item clinical screening tool designed to measure the presence and level of alcohol dependence.

It is divided into five sections:

  • Physical withdrawal symptoms.
  • Affective withdrawal symptoms.
  • Craving and relief drinking.
  • Typical daily consumption.
  • Reinstatement of dependence after a period of abstinence.

Each item is scored on a 4-point scale, giving a possible range of 0 to 60. A score of over 30 indicates severe alcohol dependence.

Some local clinical guidelines use the SADQ to predict the levels of medication needed during alcohol detoxification.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Severity_of_Alcohol_Dependence_Questionnaire >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is the Dissociative Experiences Scale?

Introduction

The Dissociative Experiences Scale (DES) is a psychological self-assessment questionnaire that measures dissociative symptoms.

Background

It contains twenty-eight questions and returns an overall score as well as four sub-scale results.

DES is intended to be a screening test, since only 17% of patients with scores over 30 will be diagnosed with having dissociative identity disorder. Patients with lower scores above normal may have other post-traumatic conditions.

The DES-II contains the same questions but with a different response scale.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Dissociative_Experiences_Scale >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is the CRAFFT Screening Test?

Introduction

The CRAFFT is a short clinical assessment tool designed to screen for substance-related risks and problems in adolescents.

CRAFFT stands for the key words of the 6 items in the second section of the assessment:

  • Car.
  • Relax.
  • Alone.
  • Forget.
  • Friends.
  • Trouble.

As of 2020, updated versions of the CRAFFT known as the “CRAFFT 2.1” and “CRAFFT 2.1+N” have been released.

The older version of the questionnaire contains 9 items in total, answered in a “yes” or “no” format.

  • The first three items (Part A) evaluate alcohol and drug use over the past year; and
  • The other six (Part B) ask about situations in which the respondent used drugs or alcohol and any consequences of the usage.

The CRAFFT 2.1 screening tool begins with past-12-month frequency items (Part A), rather than the previous “yes/no” question for any use over the past year, and the other six (Part B) questions remain the same.

The CRAFFT can function as a self-report questionnaire or an interview to be administered by a clinician. Both employ a skip pattern: those whose Part A score is “0” (no use) answer the Car question only of Part B, while those who report any use in Part A also answer all six Part B CRAFFT questions. Each “yes” answer is scored as “1” point and a CRAFFT total score of two or higher identifies “high risk” for a substance use disorder and warrants further assessment.

Development and Brief History

The CRAFFT Screening Test was developed by John R Knight, MD and colleagues at the Centre for Adolescent Behavioural Health Research (CABHRe), formerly known as the Centre for Adolescent Substance Abuse Research (CeASAR) at Boston Children’s Hospital. Their goal was to develop a screening tool that – like the CAGE questionnaire used for adults – was brief and easy to administer and score. Unlike the CAGE, the CRAFFT was designed to be developmentally appropriate for adolescents and screen conjointly for both alcohol and drug use. Because motor vehicle crashes are a leading cause of death among adolescents, and often associated with alcohol and drug use, the CRAFFT includes a risk item to evaluate whether an adolescent has ever ridden in a car driven by someone (including themselves) who was under the influence of alcohol or other drugs. It has been established as valid and reliable for identifying youth who need further assessment and therapeutic intervention. The CRAFFT was originally designed to screen adolescents at high risk of substance use disorders in primary medical care offices. However, the necessity for a universal adolescent screening measure was made apparent by research findings suggesting that half of high school students drink, a third binge drink, and a fourth use marijuana. For drug use specifically, studies show that more than half of high school seniors have used an illegal drug of any kind and a fourth have used illegal drugs other than marijuana. In addition, more than two-thirds of high school seniors, half of sophomores, and a third of eighth graders have used alcohol in the past year. These findings also contributed to the identification of a need for a tool like the CRAFFT to be developed and widely implemented.

CRAFFT 2.1

This revised version of the CRAFFT screening tool incorporates changes that enhance the sensitivity of the system in terms of identifying adolescents with substance use, and presents new recommended clinician talking points, informed by the latest science and clinician feedback, to guide a brief discussion about substance use with adolescents. The CRAFFT 2.1 provides an updated and revised version of this well-validated and widely utilised adolescent substance use screening protocol. Although the previous version of the CRAFFT will still be available, CABHRe recommends that clinicians transition to using version 2.1.

The CRAFFT 2.1 screening tool begins with past-12-month frequency items, rather than the previous “yes/no” question for any use over the past year. A recent study examining these opening yes/no questions found that they had relatively low sensitivity in identifying youth with any past-12-month alcohol or marijuana use (62% and 72%, respectively). Research also has suggested that yes/no questions may contribute to lower sensitivity on certain measures by inhibiting disclosure of less socially desirable behaviours; i.e. they may be more prone to social desirability bias.

Alternatively, questions that ask “how many” or “how often” implicitly imply an expectation of the behaviour, and may thus mitigate discomfort around disclosure. The instruction, “Say ‘0’ if none” follows each question to convey that non-use is also normative. The CRAFFT 2.1 begins with past-12-month frequency items; i.e. “During the past 12 months, on how many days did you … [drink/use substance name]?”

This new set of frequency questions was tested in a recent study of 708 adolescent primary care patients ages 12-18 that found a sensitivity of 96% and specificity of 81% for detecting past-12-month use of any substance, suggesting better performance in identifying substance use compared to that of the “yes/no” questions found in the prior study.

The CRAFFT 2.1 has been translated into the following languages: Albanian, Arabic, Burmese, Simplified Chinese, Traditional Chinese, Cape Verdean Creole, Haitian Creole, Dutch, French, German, Greek, Hebrew, Hindi, Japanese, Khmer, Korean, Laotian, Lithuanian, Nepali, Portuguese (Brazil), Portuguese (Portugal), Romanian, Russian, Somali, Spanish (Latin Am), Spanish (Spain), Swahili, Telugu, Turkish, Twi, and Vietnamese.

CRAFFT 2.1+N

The CRAFFT 2.1+N expands upon the content from the CRAFFT 2.1 with the inclusion of the Hooked On Nicotine Checklist (HONC), which is a 10-item questionnaire that screens for dependence on tobacco and nicotine. If a teen indicates use of a vaping device containing nicotine and/or flavours or any tobacco products within the frequency questions, they are prompted to answer the HONC questions as well. A positive response to one or more of the items calls for further assessment regarding a serious problem with nicotine.

Psychometrics

Research has shown that CRAFFT has relatively high sensitivity and specificity, internal consistency, and test-retest reliability as a screener for alcohol and substance misuse. The CRAFFT questionnaire has been validated against the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and demonstrates good ability to distinguish between those with and without clinical levels of any DSM-5 substance use disorder. It is supported by many studies as a reliable and valid assessment of substance use and misuse in adolescents and is considered an effective tool for assessing whether further assessment is warranted. It has been well-validated against criterion standard psychological tests and structured psychiatric diagnostic interviews. It has been recommended by the American Academy of Paediatrics’ Committee on Substance Abuse for use with adolescents. Findings suggest that paediatricians should regularly screen for substance use disorders in adolescents using the CRAFFT.

The CRAFFT has been translated into many languages, including Albanian, Arabic, Burmese, Simplified Chinese, Traditional Chinese, Cape Verdean Creole, Haitian Creole, Dutch, French, German, Greek, Hebrew, Hindi, Japanese, Khmer, Korean, Laotian, Lithuanian, Nepali, Portuguese (Brazil), Portuguese (Portugal), Romanian, Russian, Somali, Spanish (Latin Am), Spanish (Spain), Swahili, Telugu, Turkish, Twi, and Vietnamese. Studies attest to its validity and reliability across cultures.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/CRAFFT_Screening_Test >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is the Michigan Alcoholism Screening Test?

Introduction

The Michigan Alcoholism Screening Test (MAST) screening tool was developed in 1971, and is one of the oldest alcoholism-screening tests for identifying dependent drinkers.

Background

Its use is constructed for the general population. There are other versions of the MAST screening tool, all of which can be self-administered or via interview with someone who is trained in the tool being used. All MAST screening tools are scored on a point scale system.

As stated on the Project Cork website (now archived), there are 25 questions to the MAST screening tool. The tool’s length makes administering it inconvenient in many busy primary health care and emergency department settings. The tool also mainly focuses on the patient’s problems throughout their lifetime, rather than the problems currently displayed by the patient. The questions throughout the screening tool operate in the past tense, which means that it is less likely to detect any problems with alcohol in its early stages, according to T. Buddy. The extended questioning is a benefit in a sense that one accomplishes a bit of the assessment section when conducting the screening; furthermore, it allows the individual conducting the screening to achieve better communication and rapport with the client.

The MAST-G screening tool is directed towards screening geriatric clients and has one less question than the MAST tool. There has always been an underlying concern as to the sensitivity and reliability when questioning geriatric clients.

Another related screening tool is the “brief MAST”, which is much shorter than the previous tests at 10 questions. There is also the Short-MAST tool similar to the brief test; it contains 13 questions. Which tool to use is decided by the screener.

Variations

  • MAST.
  • MAST-G.
  • Brief MAST.
  • Short-MAST.
  • Short-MAST-G.

This page is based on the copyrighted Wikipedia article <https://en.wikipedia.org/wiki/Michigan_Alcoholism_Screening_Test >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is the Hospital Anxiety and Depression Scale?

Introduction

Hospital Anxiety and Depression Scale (HADS) was originally developed by Zigmond and Snaith (1983) and is commonly used by doctors to determine the levels of anxiety and depression that a person is experiencing.

The HADS is a fourteen item scale that generates: Seven of the items that relate to anxiety and seven that relate to depression. Zigmond and Snaith created this outcome measure specifically to avoid reliance on aspects of these conditions that are also common somatic symptoms of illness, for example fatigue and insomnia or hypersomnia. This, it was hoped, would create a tool for the detection of anxiety and depression in people with physical health problems.

Items on the Questionnaire

The items on the questionnaire that relate to anxiety are

  • I feel tense or wound up.
  • I get a sort of frightened feeling as if something awful is about to happen.
  • Worrying thoughts go through my mind.
  • I can sit at ease and feel relaxed.
  • I get a sort of frightened feeling like ‘butterflies’ in the stomach.
  • I feel restless as I have to be on the move.
  • I get sudden feelings of panic.

The items that relate to depression are:

  • I still enjoy the things I used to enjoy.
  • I can laugh and see the funny side of things.
  • I feel cheerful.
  • I feel as if I am slowed down.
  • I have lost interest in my appearance.
  • I look forward with enjoyment to things.
  • I can enjoy a good book or radio or TV programme.

Scoring the Questionnaire

Each item on the questionnaire is scored from 0-3 and this means that a person can score between 0 and 21 for either anxiety or depression.

Caseness of Anxiety and Depression

A number of researchers have explored HADS data to establish the cut-off points for caseness of anxiety or depression. Bjelland et al. (2002) through a literature review of a large number of studies identified a cut-off point of 8/21 for anxiety or depression. For anxiety (HADS-A) this gave a specificity of 0.78 and a sensitivity of 0.9. For depression (HADS-D) this gave a specificity of 0.79 and a sensitivity of 0.83.

Factor Structure

There are a large number of studies that have explored the underlying factor structure of the HADS. Many support the two-factor structure but there are others that suggest a three or four factor structure. Some argue that the tool is best used as a unidimensional measure of psychological distress.

Criticisms

The factor structure of the HADS has been questioned. Coyne and Sonderen argue in a letter published in the same issue, that Cosco, et al. provides grounds for abandoning HADS altogether. The HADS has also been criticised for its over reliance on anhedonia as being the core symptom of depression, how single-item measures of depression may have the same predictive value as the HADS scale, as well as its use of British colloquial expressions which can be difficult to translate.

This page is based on the copyrighted Wikipedia article <https://en.wikipedia.org/wiki/Hospital_Anxiety_and_Depression_Scale >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is the Positive and Negative Syndrome Scale?

Introduction

The Positive and Negative Syndrome Scale (PANSS) is a medical scale used for measuring symptom severity of patients with schizophrenia.

It was published in 1987 by Stanley Kay, Lewis Opler, and Abraham Fiszbein. It is widely used in the study of antipsychotic therapy. The scale is known as the “gold standard” that all assessments of psychotic behavioural disorders should follow.

The name refers to the two types of symptoms in schizophrenia, as defined by the American Psychiatric Association:

  • Positive symptoms, which refer to an excess or distortion of normal functions (e.g. hallucinations and delusions); and
  • Negative symptoms, which represent a diminution or loss of normal functions.

Some of these functions which may be lost include normal thoughts, actions, ability to tell fantasies from reality, and the ability to properly express emotions.

The PANSS is a relatively brief interview, requiring 45 to 50 minutes to administer. The interviewer must be trained to a standardised level of reliability.

Interview Items

To assess a patient using PANSS, an approximately 45-minute clinical interview is conducted. The patient is rated from 1 to 7 on 30 different symptoms based on the interview as well as reports of family members or primary care hospital workers.

  • Positive scale:
    • 7 Items, (minimum score = 7, maximum score = 49):
      • Delusions.
      • Conceptual disorganisation.
      • Hallucinations.
      • Excitement.
      • Grandiosity.
      • Suspiciousness/persecution.
      • Hostility.
  • Negative scale:
    • 7 Items, (minimum score = 7, maximum score = 49):
      • Blunted affect.
      • Emotional withdrawal.
      • Poor rapport.
      • Passive/apathetic social withdrawal.
      • Difficulty in abstract thinking.
      • Lack of spontaneity and flow of conversation.
      • Stereotyped thinking.
  • General Psychopathology scale:
    • 16 Items, (minimum score = 16, maximum score = 112):
      • Somatic concern.
      • Anxiety.
      • Guilt feelings.
      • Tension.
      • Mannerisms and posturing.
      • Depression.
      • Motor retardation.
      • Uncooperativeness.
      • Unusual thought content.
      • Disorientation.
      • Poor attention.
      • Lack of judgement and insight.
      • Disturbance of volition.
      • Poor impulse control.
      • Preoccupation.
      • Active social avoidance.

PANSS Total score minimum = 30, maximum = 210

Scoring

As 1 rather than 0 is given as the lowest score for each item, a patient can not score lower than 30 for the total PANSS score. Scores are often given separately for the positive items, negative items, and general psychopathology. In their original publication on the PANSS scale, Stanley Kay and colleagues tested the scale on 101 adult patients (20-68 years-old) with schizophrenia and the mean scores were,

  • Positive scale = 18.20.
  • Negative scale = 21.01.
  • General psychopathology = 37.74.

Based on meta-analytic results, an alternative five-factor solution of the PANSS was proposed with positive symptoms, negative symptoms, disorganisation, excitement, and emotional distress.

This page is based on the copyrighted Wikipedia article <https://en.wikipedia.org/wiki/Positive_and_Negative_Syndrome_Scale&gt;; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is the Subjective Units of Distress Scale?

Introduction

A Subjective Units of Distress Scale (SUDS), also known as the Subjective Units of Disturbance Scale), is a scale ranging from 0 to 10 measuring the subjective intensity of disturbance or distress currently experienced by an individual.

Respondents provide a self report of where they are on the scale. The SUDS may be used as a benchmark for a professional or observer to evaluate the progress of treatment. In desensitisation-based therapies, and the patients’ regular self assessments enable them to guide the clinician repeatedly as part of the therapeutic dialogue.

The SUD-level was developed by Joseph Wolpe in 1969. It has been used in cognitive-behavioural treatments for anxiety disorders (e.g. exposure practices and hierarchy) and for research purposes.

There is no hard and fast rule by which a patient can self assign a SUDS rating to his or her disturbance or distress, hence the name subjective.

Some guidelines are:

  • The intensity recorded must be as it is experienced now.
  • Constriction or congestion or tensing of body parts indicates a higher SUDS than that reported.

The Scale

There a number of version of the scale, and the below is for illustration only:

  • 10 = Feels unbearably bad, beside yourself, out of control as in a nervous breakdown, overwhelmed, at the end of your rope. You may feel so upset that you don’t want to talk because you can’t imagine how anyone could possibly understand your agitation.
  • 9 = Feeling desperate. What most people call a 10 is actually a 9. Feeling extremely freaked out to the point that it almost feels unbearable and you are getting scared of what you might do. Feeling very, very bad, losing control of your emotions.
  • 8 = Freaking out. The beginning of alienation.
  • 7 = Starting to freak out, on the edge of some definitely bad feelings. You can maintain control with difficulty.
  • 6 = Feeling bad to the point that you begin to think something ought to be done about the way you feel.
  • 5 = Moderately upset, uncomfortable. Unpleasant feelings are still manageable with some effort.
  • 4 = Somewhat upset to the point that you cannot easily ignore an unpleasant thought. You can handle it OK but don’t feel good.
  • 3 = Mildly upset. Worried, bothered to the point that you notice it.
  • 2 = A little bit upset, but not noticeable unless you took care to pay attention to your feelings and then realize, “yes” there is something bothering me.
  • 1 = No acute distress and feeling basically good. If you took special effort you might feel something unpleasant but not much.
  • 0 = Peace, serenity, total relief. No more anxiety of any kind about any particular issue.

Utility Does Not Require Precision

In using SUDS in a therapeutic setting, the therapist does not necessarily define the scale, because one of the benefits of asking a patient or client for a SUDS score is that it is simple. Typically, you can ask the client, “On a scale of zero to ten, where zero is the best you can feel and ten is the worst, how do you feel right now?”

The purpose of this question is to enable the patient or client to notice improvements, and the inherent difference between one person’s subjective scale and another person’s is irrelevant to therapy with either individual. Our brains are sophisticated enough that they can usually summarize a large amount of data very quickly, and often accurately.

There is a possibility that in some forms of therapy, the patient will want to see progress and will therefore report progress that isn’t objectively present – a type one error from a statistical point of view. While both type I and type II errors are important in research situations, type one errors can have a therapeutic utility in clinical situations, in which they can provide an indirect opportunity for positive autosuggestion – much like the indirect suggestions employed in Eriksonian hypnosis.

Thus, since the main use of SUDS is for clinical purposes, rather than research purposes, the imprecise nature of the scale is relatively unimportant to its main users: patients and clinicians.

This page is based on the copyrighted Wikipedia article <https://en.wikipedia.org/wiki/Subjective_units_of_distress_scale&gt;; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is the Holmes and Rahe Stress Scale?

Introduction

The Holmes and Rahe stress scale is a list of 43 stressful life events that can contribute to illness.

The test works via a point accumulation score which then gives an assessment of risk. The American Institute of Stress for instance, regards a score of 300 or more as an “80% chance of health breakdown within the next 2 years”. While there is good evidence that chronic stress can lead to ill health, there is not much evidence to support the ranking of stressful life events in this manner.

Brief History

In 1967, psychiatrists Thomas Holmes and Richard Rahe examined the medical records of over 5,000 medical patients as a way to determine whether stressful events might cause illnesses. Patients were asked to tally a list of 43 life events based on a relative score. A positive correlation of 0.118 was found between their life events and their illnesses.

Their results were published as the Social Readjustment Rating Scale (SRRS), known more commonly as the Holmes and Rahe Stress Scale. Subsequent validation has supported the links between stress and illness.

Supporting Research

Rahe carried out a study in 1970 testing the validity of the stress scale as a predictor of illness. The scale was given to 2,500 US sailors and they were asked to rate scores of ‘life events’ over the previous six months. Over the next six months, detailed records were kept of the sailors’ health. There was a +0.118 correlation between stress scale scores and illness, which was sufficient to support the hypothesis of a link between life events and illness.

In conjunction with the Cornell medical index assessing, the stress scale correlated with visits to medical dispensaries, and the H&R stress scale’s scores also correlated independently with individuals dropping out of stressful underwater demolitions training due to medical problems. The scale was also assessed against different populations within the United States (with African, Mexican and White American groups). The scale was also tested cross-culturally, comparing Japanese and Malaysian groups with American populations.

Scale

  • Score of 300+: At risk of illness.
  • Score of 150-299: Risk of illness is moderate (reduced by 30% from the above risk).
  • Score <150: Only have a slight risk of illness.

Adults

The sum of the life change units of the applicable events in the past year of an individual’s life gives a rough estimate of how stress affects health.

Life EventLife Change Units
Death of a Spouse100
Divorce73
Marital Separation65
Imprisonment63
Death of a Close Family Member63
Personal Injury or Illness53
Marriage50
Dismissal from Work47
Marital Reconciliation45
Retirement45
Change in Health of Family Member44
Pregnancy40
Sexual Difficulties39
Gain a New Family Member39
Business Readjustment39
Change in Financial State38
Death of a Close Friend37
Change to Different Line of Work36
Change in Frequency of Arguments35
Major Mortgage32
Foreclosure of Mortgage/Loan30
Change in Responsibilities at Work29
Child Leaving Home29
Trouble with In-Laws29
Outstanding Personal Achievement28
Spouse Starts or Stops Work26
Beginning or End of School26
Change in Living Conditions25
Revision of Personal Habits24
Trouble with Boss23
Change in Working Hours or Conditions20
Change in Residence20
Change in Schools20
Change in Recreation19
Change in Church Activities19
Change in Social Activities18
Minor Mortgage/Loan17
Change in Sleeping Habits16
Change in Number of Family Reunions15
Change in Eating Habits15
Vacation13
Major Holiday12
Minor Violation of Law11

Non-Adults

A modified scale has also been developed for non-adults. Similar to the adult scale, stress points for life events in the past year are added and compared to the rough estimate of how stress affects health.

Life EventLife Change Units
Death of a Parent100
Unplanned Pregnancy/Abortion100
Getting Married95
Divorce of Parents90
Acquiring a Visible Deformity80
Fathering a Child70
Jail Sentence of Parent of Over One Year70
Marital Separation of Parents69
Death of a Brother or Sister68
Change in Acceptance by Peers67
Unplanned Pregnancy of Sister64
Discovery of Being an Adopted Child63
Marriage of Parent to Step-Parent63
Death of a Close Friend63
Having a Visible Congenital Deformity62
Serious Illness Requiring Hospitalisation58
Failure of a Grade in School56
Not Making an Extracurricular Activity55
Hospitalisation of a Parent55
Jail Sentence of Parent for over 30 Days53
Breaking Up with Boyfriend or Girlfriend53
Beginning to Date51
Suspension from School50
Becoming Involved with Drugs/Alcohol50
Birth of a Brother or Sister50
Increase in Arguments between Parents47
Loss of Job by Parent46
Outstanding Personal Achievement46
Change in Parent’s Financial Status45
Accepted at College of Choice43
Being a Senior in High School42
Hospitalisation of a Sibling41
Increased Absence of Parent from Home38
Brother or Sister Leaving Home37
Addition of Third Adult to Family34
Becoming a Full-Fledged Member of a Church31
Decrease in Arguments between Parents27
Decrease in Arguments with Parents26
Mother or Father Beginning Work26

This page is based on the copyrighted Wikipedia article <https://en.wikipedia.org/wiki/Holmes_and_Rahe_stress_scale&gt;; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is the Brief Psychiatric Rating Scale?

Introduction

The Brief Psychiatric Rating Scale (BPRS) is a rating scale which a clinician or researcher may use to measure psychiatric symptoms such as depression, anxiety, hallucinations and unusual behaviour.

The scale is one of the oldest, most widely used scales to measure psychotic symptoms and was first published in 1962.

Brief History

The BPRS was initially developed by John E. Overall and Donald R. Gorham. It was created for the purpose of being able to quickly assess the patient’s psychiatric symptoms prior, during, or following a treatment. The items of the test were generated from conducting factor analysis on the Multidimensional Scale for Rating Psychiatric Patients and the Inpatient Multidimensional Psychiatric Scale. Sixteen factors were found from the analysis, which served as the building blocks for the BPRS. Later research in 1968 added two more factors to the BPRS, which were excitement and disorientation.

Test Format

The BPRS consists of 18 items measuring the following factors:

  1. Anxiety.
  2. Emotional withdrawal.
  3. Conceptual disorganisation.
  4. Guilt feelings.
  5. Tension.
  6. Mannerisms and posturing.
  7. Grandiosity.
  8. Depressive moods.
  9. Hostility.
  10. Suspiciousness.
  11. Hallucinatory behaviour.
  12. Motor hyperactivity.
  13. Uncooperativeness.
  14. Unusual thought content.
  15. Blunted affect.
  16. Somatic concern.
  17. Excitement.
  18. Disorientation.

It uses a seven-item Likert scale with the following values:

  • 1 = “not present”.
  • 2 = “very mild”.
  • 3 = “mild”.
  • 4 = “moderate”.
  • 5 = “moderately severe”.
  • 6 = “severe”.
  • 7 = “extremely severe”.

The test is administered in tandem with a series of interviews conducted by at least two clinicians to ensure interrater reliability of the assessment.

Usage

The BPRS is intended for use on adult psychiatric patients and has been validated for use in elderly populations. A version designed for children called the Brief Psychiatric Rating Scale Children was also developed by Overall and Betty Pfeifferbaum, with different scale structures and factors.

Further Development

An expanded version of the test was created in 1993 by D. Lukoff, Keith H. Nuechterlein, and Joseph Ventura.

This page is based on the copyrighted Wikipedia article <https://en.wikipedia.org/wiki/Brief_Psychiatric_Rating_Scale&gt;; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is the General Behaviour Inventory?

Introduction

The General Behavior Inventory (GBI) is a 73-question psychological self-report assessment tool designed by Richard Depue and colleagues to identify the presence and severity of manic and depressive moods in adults, as well as to assess for cyclothymia.

It is one of the most widely used psychometric tests for measuring the severity of bipolar disorder and the fluctuation of symptoms over time. The GBI is intended to be administered for adult populations; however, it has been adapted into versions that allow for juvenile populations (for parents to rate their offspring), as well as a short version that allows for it to be used as a screening test.

Refer to Hypomania Checklist.

Versions

General Behaviour Inventory (GBI)

The GBI was originally made as a self-report instrument for college students and adults to use to describe their own history of mood symptoms. The original item set included clinical characteristics and associated features in addition to the diagnostic symptoms of manic and depressive states in the current versions of the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association. The first set of 69 items was increased to 73, with the final version having 73 mood items and 6 additional questions to check the validity of responses (but which did not figure in the scale scores). The self report version of the GBI has been used in an extensive programme of research, accruing evidence of many facets of validity. Because of its length and high reading level, there also have been many efforts to develop short forms of the GBI.

7 Up 7 Down Inventory (7U7D)

The 7 Up-7 Down (7U7D) is a 14-item measure of manic and depressive tendencies that was carved from the full length GBI. This version is designed to be applicable for both youths and adults, and to improve separation between both mania and depressive conditions. It was developed via factor analysis from nine separate samples pooled into two age groups, ensuring applicability for use in youth and adults.

A sleep scale also has been carved from the GBI, using the seven items that ask about anything directly related to sleep.

Parent Report on the GBI (P-GBI)

The P-GBI is an adaptation of the GBI, consisting of 73 Likert scale items rated on a scale from 0 (“Never or Hardly Ever”) to 3 (“Very often or Almost Constantly”). It consists of two scales: a depressive symptoms (46 items) and a hypomanic/biphasic (mixed) symptoms (28 items).

Parent Short Forms

Again, due to the length of the full version, several short forms have been built and tested in multiple samples that may be more convenient to use in clinical work. These include 10 item mania, two alternate 10 item depression forms, and the seven item Sleep scale. All have performed as well or better than the self-report version when completed by an adult familiar with the youth’s behaviour (typically a parent).

The PGBI-10M is a brief (10-item) version of the PGBI that was validated for clinical use for patients presenting with a variety of different diagnoses, including frequent comorbid conditions. It is administered to parents for them to rate their children between ages 5-17. The 10 items include symptoms such as elated mood, high energy, irritability and rapid changes in mood and energy as indicators of potential juvenile bipolar disorder. The PhenX Toolkit uses this instrument as its child protocol for Hypomania/Mania Symptoms.

Teacher Report on the GBI

One study had a large sample of teachers complete the GBI to describe the mood and behaviour of youths age 5 to 18 years old. The results indicated that there were many items that teachers did not have an opportunity to observe the behaviour (such as the items asking about sleep), and others that teachers often chose to skip. Even after shortening the item list to those that teachers could report about, the validity results were modest even though the internal consistency reliability was high. The results suggested that it was challenging for teachers to tell the difference between hypomanic symptoms and symptoms attributable to attention-deficit/hyperactivity disorder, which is much more common in the classroom. The results aligned with findings from a large meta-analysis that teacher report had the lowest average validity across all mania scales compared to adolescent or parent report on the same scales. Based on these results, current recommendations are to concentrate on parent and youth report, and not use teacher report as a way of measuring hypomanic symptoms in youths.

Psychometric Properties

The GBI has been used extensively in research, including clinical samples, college students, longitudinal, treatment, and other studies. However, no normative data exist to calibrate scores in the general population.

Reliability

The GBI has exceptionally high internal consistency because it has long scales with a large number of items. The GBI shows high reliability whether completed as a self report or as a caregiver report about youth behaviour.

Retest reliability also is good over a week or two week period, although the GBI’s length makes it tedious to complete frequently.

Interpretation

GBI Scoring

The current GBI questionnaire includes 73 Likert-type items which reflect symptoms of different moods. The original version of the GBI used case scoring where items were given values ranging from 1-4. Symptoms that were rated as 1 or 2 were considered to be absent and symptoms rated as 3 or 4 were considered to be present. However, if each item were to receive one of four scores, the authors of the GBI decided Likert scaling would be a better scoring option. The items on the GBI are now scaled from 0-3 rated as 0 (never or hardly ever present), 1 (sometimes present), 2 (often present), and 3 (very often or almost constantly present).

PGBI-10M

For the PGBI-10M, the scores from each question are added together to form a total score, with higher scores indicating a greater severity of symptoms. Scores range from 0 to 30. Low scores of 5 and below indicate a very low risk of a bipolar diagnosis. High scores of 18 and over indicate a high risk of a diagnosis of bipolar disorder, increasing the likelihood by a factor of seven or greater. Several peer-reviewed research studies support the P-GBI as a reliable and valid measure of bipolar in children and adolescents. It is recommended to be used as part of an assessment battery in the diagnosis of juvenile bipolar disorder.

Limitations

The GBI is free for use clinically and in research. The reading level and length make it challenging for some people to complete. Being a self-report questionnaire, the GBI is not known to have any adverse effects on patients beyond the potential of causing minor distress.

Research

Shorter versions of the GBI have been validated for research and clinical use. For instance, the PGBI-10M is currently being tested as part of a large longitudinal study investigating the course of early symptoms of mania in children[citation needed], with preliminary studies indicating its clinical efficacy in differentiating juvenile bipolar disorder from youth with other diagnoses.