5.2.7 Rating scales in psychiatry
Rating Scales in Psychiatry
Rating scales are tools commonly used in psychiatry to assess and quantify the severity of mental and behavioural symptoms. They provide a standardized and objective method for measuring symptoms, which can be helpful in tracking changes over time, evaluating the effectiveness of treatment, and making comparisons between patients. Some of the most commonly used rating scales in psychiatry include:
| Condition | Clinician rated | Patient rated |
| Alcohol dependence | AUDIT (Alcohol Use Disorders Identification Test) FAST (Fast Alcohol Screening Test) | |
| Bipolar | YMRS (Young Mania Rating Scale) | |
| Dementia | CAMDEX (Cambridge Mental Disorders of the Elderly Examination) | |
| Depression / Anxiety | MADRS (Montgomery-Asberg Depression Rating Scale) HAMD (Hamilton Depression rating scale) BASDEC (Brief Assessment Schedule Depression Cards) HAMA (Hamilton Anxiety rating scale) CSDD (Cornell Scale for Depression in Dementia) | BDI (Beck Depression Inventory) GDS (Geriatric Depression Scale) ZSRDS (Zung Self-Rated Depression Scale) HAD (Hospital Anxiety Depression scale) EPDS (Edinburgh Postnatal major Depression Scale) |
| Global function | CGI (Clinical Global Impression) GAF (Global Assessment of Functioning) | GHQ (General Health Questionnaire) |
| Medication | AIMS (Abnormal Involuntary Movement Scale) SAS (Simpson-Angus Scale) | LUNSERS (The Liverpool University Neuroleptic Side Effect Rating Scale) DESS (Discontinuation-Emergent Signs and Symptoms scale) |
| OCD | Y-BOCS (Yale-Brown Obsessive Compulsive Scale) | |
| Schizophrenia | BPRS (Brief Psychiatric Rating Scale) PANSS (Positive And Negative Syndrome Scale) |
(Semple, 2019)
Alcohol Dependence
AUDIT: The WHO developed AUDIT (Alcohol Use Disorders Identification Test) as a simple method of screening for excessive drinking. The ten-question test attempts to cover the three domains of harmful use, hazardous use, and dependence. 10-question survey which takes about 2-3 minutes to finish. It has been demonstrated that it outperforms CAGE and biochemical markers in predicting alcohol problems. The minimum score is 0 and the maximum score is 40. A score of 8 or higher in men and 7 or higher in women indicates a high risk of hazardous or harmful alcohol consumption. A score of 15 or higher in men and 13 or higher in women indicates alcoholism.
FAST: (Fast Alcohol Screening Test) is a short and quick test with only four questions designed for use in a busy medical setting. It evolved from the AUDIT test. 4 question survey with a minimum score being 0 and a maximum score is 16. The hazardous drinking score is 3 or higher. In response to the first question, 1 drink is equal to 1/2 pint of beer, 1 glass of wine, or 1 single spirit. If the patient answers ‘never’ to the first question, he or she is not abusing alcohol. If the patient answers ‘Weekly’ or ‘Daily or almost daily,’ the patient is a hazardous, harmful, or dependent drinker. This one question will classify more than half of the population.
Bipolar
YMRS (Young Mania Rating Scale): The YMRS is an 11-item questionnaire used to determine the severity of mania in people with bipolar illness.
Dementia
CAMDEX (Cambridge Mental Disorders of the Elderly Examination): Created to aid in the early detection and assessment of dementia in the elderly. Includes three components: a clinical interview, a battery of cognitive tests, and an interview with a patient’s relative to get independent information about the patient’s past and present condition. It consists of 40 items that assess various aspects of cognitive and mental function, including memory, language, attention, and mood.
Depression and Anxiety
HAMD (Hamilton Depression rating scale): The HAMD is a multiple-choice questionnaire designed to assess the severity of depression. There are either 17 or 21 things depending on the version used. Each item is rated between 3 and 5 points. The bigger the overall number of points obtained, the more severe the depression. Scores for the 17-item version (the most often used) vary from 0 to 54. Scores of 24 or above indicate serious depression.
HAMA (Hamilton Anxiety rating scale): is a 14-item rating scale designed to measure the severity of anxiety. It is clinician-rated.
MADRS (Montgomery-Asberg Depression Rating Scale): The MADRS is a ten-item diagnostic questionnaire that is used to determine the severity of depressive episodes. It was created to be more sensitive to the effects of antidepressants and other types of therapy.
ZSRDS (Zung Self-Rated Depression Scale): The ZSRDS was created to determine the severity of depression. The scale has 20 elements, each of which is rated from 1-4.
BDI (Beck Depression Inventory): The BDI is a measure used to determine the severity of depression. There are a total of 21 elements, each with a score ranging from 0 to 3. In 1966, the scale was updated. 0-13 denotes mild depression, 14-19 moderate depression, 20-28 serious depression, and 29-63 severe depression.
GDS (Geriatric Depression Scale): The GDS is a 30-item self-report measure used to test elderly people for depression. Each question has a yes or no response, resulting in a total score of 30. Normal is 0-9, mild depression is 10-19, and severe depression is 20-30.
BASDEC (Brief Assessment Schedule Depression Cards): The BASDEC is a depression screening test. It employs a deck of cards with comments such as “I feel anxious all the time” or “I’m so lonely” which are presented to the patient. In response to each card, the patient indicates whether the card is accurate or untrue. There are 19 cards in all, with a possible score of 21. (two cards carry 2 points each). It is a fast test that may be completed in less than 5 minutes. A cut-off score of 7 is commonly utilised. The exam was designed for use in busy wards to provide some privacy.
CSDD (Cornell Scale for Depression in Dementia): This test was designed primarily to detect depression in dementia patients. It consists of a 20-minute interview with a caregiver and a 10-minute conversation with the patient. A total of 19 elements are classified as ‘absent, mild/intermittent, or severe.’
EPDS (Edinburgh Postnatal major Depression Scale) typically takes around 10 minutes to complete, as it is a self-report questionnaire that assesses symptoms of depression and anxiety in women who have recently given birth.
Global Function
GAF (Global assessment of functioning): The GAF provides a single measure of global functioning. It assesses occupational function and psychological function only. The overall score is out of 100.
CGI (Clinical global impression): The CGI is a scale that asks the clinician to score the severity of the patient’s disease at the time of evaluation in comparison to the physician’s previous experience with patients with the same diagnosis.
Medication
DESS (Discontinuation-Emergent Signs and Symptoms scale): The DESS is used to quantify discontinuation symptoms associated with stopping antidepressants. This 43-item rating scale spans a broad spectrum of discontinuation symptoms and can be helpful in documenting symptoms of depressed patients in order to diagnose the likely cause of distress.
SAS (Simpson-Angus Scale): The Simpson-Angus Scale (SAS) is a 10-item rating scale frequently used to measure neuroleptic-induced parkinsonism. It includes one element that measures gait (hypokinesia), six elements that measure rigidity, and three elements that measure glabella tap, tremor, and salivation, in that order.
LUNSERS (The Liverpool University Neuroleptic Side Effect Rating Scale): Self-rated scale for measuring the side-effect of antipsychotic medications. It measures the 41 known side effects of neuroleptics.
AIMS (The Abnormal Involuntary Movement Scale): A 12-item clinician-rated scale with the aim to assess the severity of dyskinesias in patients prescribed neuroleptics. It requires a short assessment time and thus can be used in routine clinical examinations.
Obsessive Compulsive Disorder
Y-BOCS (Yale-Brown Obsessive Compulsive Scale): The Y-BOCS is used in two parts – the severity of OCD and the patient’s response to treatment. The Y-BOCS (Yale-Brown Obsessive Compulsive Scale) is primarily used to measure the severity of obsessive-compulsive symptoms in individuals who have been diagnosed with Obsessive Compulsive Disorder (OCD). The scale covers both obsessions and compulsions, and scores range from 0 to 40, with higher scores indicating more severe symptoms. It helps to monitor the symptom change during the treatment, and track the progress of the patient over time.
Schizophrenia
BPRS (Brief psychiatric rating scale): A common tool for assessing psychopathology in schizophrenic patients. Originally comprised of 16 elements, the inclusion of two aspects resulted in the usual 18. Later, the enlarged 24-item version (Brief Psychiatric Rating Scale-Expanded) was established to evaluate additional features of schizophrenia, including items for odd behaviour, self-neglect, suicidality, high mood, motor hyperactivity, and distractibility.
The PANSS (Positive and Negative Syndrome Scale): assesses both positive and negative symptoms in people with schizophrenia. It uses a diverse set of data, including data from interviews, as well as reports from medical staff and family members. The data collected is based on how the patient was the previous week. There are 30 elements in total.
References:
(1) Semple, D. and Smyth, R. (2019). Oxford handbook of psychiatry. Oxford: Oxford University Press.