5.3 Psychiatric Rating Scales
227
18.
DISORIENTATION:
Confusion or lack of proper association for person, place or time.
Rate based on observations made during interview .
1
=
Not reported
2
=
Very Mild: e.g., seems somewhat confused
3
=
Mild: e.g., indicated 1982 when, in fact, it is 1983
4
=
Moderate: e.g., indicates 1978
5
=
Moderately Severe: e.g., is unsure where he/she is
6
=
Severe: e.g., has no idea where he/she is
7
=
Very Severe: e.g., does not know who he/she is
8
=
Cannot be assessed adequately because of severe formal thought disorder, uncooperativeness, or marked evasiveness/
guardedness; or Not assessed
19.
SEVERITY OF ILLNESS:
Considering your total clinical experience with this patient population, how mentally ill is the patient at
this time?
1
=
Normal, not at all ill
2
=
Borderline mentally ill
3
=
Mildly ill
4
=
Moderately ill
5
=
Markedly ill
6
=
Severely ill
7
=
Among the most severely ill patients
20.
GLOBAL IMPROVEMENT:
Rate total improvement whether or not, in your judgment, it is due to treatment. At baseline
assessment, mark “Not assessed” for item 20. For assessments up to the start of double-blind medication, rate Global
Improvement compared to baseline. For assessments following the start of double-blind medication, rate Global Improvement
compared to the start of double-blind.
1
=
Very much improved
2
=
Much improved
3
=
Minimally improved
4
=
No change
5
=
Minimally worse
6
=
Much worse
7
=
Very much worse
8
=
Not assessed
a
Ratings based primarily on verbal report.
(From Sadock BJ, Sadock VA, Ruiz P.
Kaplan & Sadock’s Comprehensive Textbook of Psychiatry
. 9
th
ed. Philadelphia: Lippincott Williams & Wilkins;
2009:1043, with permission.)
24-item version in Table 5.3-5, have been used in many studies
as well. The 17-item version does not include some of the symp-
toms for depression in DSM-III and its successors, most nota-
bly the so-called reverse neurovegetative signs (increased sleep,
increased appetite, and psychomotor retardation). The HAM-D
was designed for clinician raters but has been used by trained
lay administrators as well. Ratings are completed by the exam-
iner based on the patient interview and observations. A struc-
tured interview guide has been developed to improve reliability.
The ratings can be completed in 15 to 20 minutes. Reliability
is good to excellent, particularly when the structured interview
version is used. Validity appears good based on correlation with
other depression symptom measures. The HAM-D has been used
extensively to evaluate change in response to pharmacological
and other interventions and, thus, offers the advantage of compa-
rability across a broad range of treatment trials. It is more prob-
lematic in the elderly and the medically ill, in whom the presence
of somatic symptoms may not be indicative of major depression.
Beck Depression Inventory (BDI).
The BDI was devel-
oped in the early 1960s to rate depression severity, with a focus
on behavioral and cognitive dimensions of depression. The cur-
rent version, the Beck-II, has added more coverage of somatic
symptoms and covers the most recent 2 weeks. Earlier versions
are focused on the past week or even shorter intervals, which
may be preferable for monitoring treatment response. The scale
can be completed in 5 to 10 minutes. Internal consistency has
been high in numerous studies. Test–retest reliability is not con-
sistently high, but this may reflect changes in underlying symp-
toms. Validity is supported by correlation with other depression
Table 5.3-2
Brief Psychiatric Rating Scale (
continued
)
DEPARTMENT OF HEALTH AND HUMAN SERVICES
PUBLIC HEALTH SERVICE
PATIENT NUMBER
- - - -
DATA GROUP
bprs
EVALUATION DATE
–– –– ––
M D Y
Alcohol, Drug Abuse, and Mental Health Administration
NIMH Treatment Strategies in Schizophrenia Society
PATIENT NAME
RATER NUMBER
BRIEF PSYCHIATRIC RATING SCALE - Anchored Overall and Gorham
RATER NUMBER
EVALUATION TYPE (
Circle
)
– – –
1 Baseline
4 Start double-blind 7 Start open meds
10 Early termination
2
5 Major evaluation 8 During open meds 11 Study completion
3 4-week minor 6 Other
9 Stop open minds
