Lecture 8 - Psychiatric Rating Scales (Rating Instruments) 5 = Moderate Severe – Presence of numerous well-formed delusions

Dr. Abcede that are tenaciously held and occasionally interfere with thinking,
PSYCHIATRY II - USTMED 2008 social relations or behavior.
Source: Kaplan 6 = Severe – Presence of stable set of delusions which are
crystallized, possibly systematized, tenaciously held, and clearly
Psychiatric Rating Scales (Rating Instruments) interfere with thinking, social relations and behavior
- provide a way to quantify aspects of a patient's psyche, 7 = Extreme – Presence of stable set of delusions which are either
highly systematized or very numerous and which dominate major
behavior and relationships with individuals and society
facets of the patient’s life. This frequently results in inappropriate
and irresponsible action, which may even jeopardize the safety of
CHARACTERISTICS OF RATING SCALES
the patient or others.
1. can be specific or comprehensive
2. can measure internally experienced variable (eg. mood)
P2 CONCEPTUAL DISORGANIZATION: Disorganized process of
3. can measure externally observable variable (eg. behavior)
thinking characterized by the disruption of goal-directed
4. assess classic items from the mental status examination
sequencing, (e.g., circumstantiality, tangentiality, loose
5. assessment of adverse effects from psychotherapeutic drugs;
associations, non sequiturs, gross illogicality, or thought block).
social adjustments and psychoanalytic concepts
Basis for rating: cognitive-verbal processes observed during the
course of the interview.
OTHER CHARACTERISTICS
1. time covered
1 = Absent – Definition does not apply.
2. level of judgement required
2 = Minimal – Questionable pathology; may be at the the upper
3. method of recording answers
extreme of normal limits.
a. dichotomous variable (eg. true or false, present or
3 = Mild – Thinking is circumstantial, tangential, or paralogical.
absent)
There is some difficulty in directing thoughts toward a goal, and
b. continuos variable (eg. severity, frequency)
some loosening of associations may be evidenced under pressure.
4 = Moderate – Able to focus thoughts when communications are
PSYCHIATRIC RATING SCALES
brief and structured, but becomes loose or irrelevant when dealing
A. Rating scales used for Schizophrenia of Psychosis
with more complex communications or when under minimal
B. Rating scales used for Mood disorders
pressure.
C. Rating scales used for Anxiety disorders
5 = Moderate Severe – Generally has difficulty in organizing
D. Others:
thoughts, as evidence by frequent irrelevancies, disconnectedness,
1. Child/adolescent patients
or loosening of associations when not under pressure.
2. Adverse effects of drugs
6 = Severe – Thinking is seriously derailed and internally
3. Quality of life
inconsistent, resulting in gross irrelevancies and disruption of
4. Dissociative disorders
thought processes, which occur almost constantly.
7 = Extreme – Thoughts are disrupted to the point where the
RATING SCALES USED FOR SCHIZOPHRENIA AND PSYCHOSIS
patient is incoherent. There is marked loosening of associations,
1. Brief Psychiatric Rating Scale (BPRS)
which results in total failure of communication, (e.g. “word salad”)
2. Schedule for Affective Disorders and Schizophrenia (SADS)
or mutism.
3. Scale for the Assessment of Negative Symptoms (SANS)
4. Scale for the Assessment of Thought, Language and
HAMILTON RATING SCALE FOR DEPRESSION
Communication (TLC)
Instructions: For each item select the “cue” which best describes
5. Thought Disorder Index (TDI)
the patient.
6. Quality of Life Scale (QLS)
7. Chestnut Lodge Prognostic Scale for Chronic Schizophrenia
1: Depressed Mood (Sadness, hopeless, helpless, worthless)
RATING SCALES USED FOR MOOD DISORDERS - 0 = Absent
1. Backs Depression Inventory
2. Standard Assessment of Depressive Disorder (SADD)
- 1 = These feelings states indicated only on questioning
3. Zung Self-rating Scale for Depression - 2 = These feeling states spontaneously reported verbally
4. Caroll Rating Scale for Depression
5. Montgomery-Asbug Scale
- 3 = Communicates feeling states nonverbally—ie, through
facial expression, posture, voice, and tendency to weep
6. Raskin Depression Rating Scale
7. Inventory to Diagnose Depression - 4 = Patient reports VIRTUALLY ONLY these feeling states
8. Manic Rating Scale in his spontaneous verbal and nonverbal communication
9. Mania State Rating Scale 2: Feelings of Guilt
10. Hamilton Rating Scale for Depression - 0 = Absent
RATING SCALES USED FOR ANXIETY DISORDERS - 1 = Self-reproach, feels he has let people down
1. Brief Outpatient Psychopathology Scale
2. Physician's Questionnaire
- 2 = Ideas of guilt or rumination over past errors or sinful
deeds
3. Covi Anxiety Scale
4. Anxiety States Inventory - 3 = Present illness is a punishment. Delusions of guilt
5. Fear Questionnaire
6. Mobility Inventory For Agoraphobia
- 4 = Hears accusatory or denunciatory voices and/or
experiences threatening visual hallucinations
7. Social Avoidance and Distress Scale
3: Suicide
8. Acute Panic Inventory
9. Leyton Obsessional Inventory - 0 = Absent
10. Fear Thermometer
11. Impact of Events Scale
- 1 = Feels life is not worth living
- 2 = Wishes he were dead or any thoughts of possible
PANSS RATING MANUAL death to self
Instructions: For each item below (P1, P2, etc.) enter the code
that best describes the patient’s psychopathology.
- 3 = Suicide ideas or gesture
- 4 = Attempts at suicide (any serious attempt rates 4)
POSITIVE SCALE 4: Insomnia early
P1 DELUSIONS: Beliefs which are unfounded, unrealistic, and
idiosyncratic.
- 0 = No difficulty falling asleep
Basis for rating: thought content expressed in the interview and its - 1 = Complains of occasional difficulty falling asleep – ie,
influence on social relations and behavior. more than ¼ hour

1 = Absent – Definition does not apply.

- 2 = Complains of nightly difficulty falling asleep
5: Insomnia middle
2 = Minimal – Questionable pathology; may be at the upper
extreme of normal limits - 0 = No difficulty
3 = Mild – Presence of one or two delusions which are vague,
uncrystallized and not tenaciously held. Delusions do not interfere
- 1 = Patient complains of being restless and disturbed
during the night
with thinking, social relations or behavior.
4 = Moderate – Presence of either a kaleidoscopic array of poorly - 2 = Waking during the night—any getting out of bed rates
formed, unstable delusions or a few well-formed delusions that 2 (except for purpose of voiding)
occasionally interfere with thinking, social relations or behavior
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 RATING

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) Difficulty in concentration,

poor memory

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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