Kaplan + Sadock's Synopsis of Psychiatry, 11e

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5.3 Psychiatric Rating Scales

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

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.)

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

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-