Chapter 13 - Psychiatric rating scales

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Abstract

A wide array of psychiatric rating scales have been developed and refined over the past 50 years to provide reliable and objective assessments of the symptom severity of a large number of psychiatric disorders. Although primarily used to assess changes in illness severity during treatment trials (i.e., as dependent measures in randomized controlled trials), psychiatric rating scales also may be used as relatively brief screening tools for diagnosis and as useful tools in nonresearch settings to monitor illness activity and response to treatment within disease management or measurement-based care paradigms. In this chapter, we briefly review the development and psychometric characteristics of some of the most widely used psychiatric rating scales for depression, mania, generalized anxiety disorder, obsessive-compulsive disorder, schizophrenia, and dementia, as well as several of the common conditions in children and adolescents.

Section snippets

Hamilton Rating Scale for Depression (HAM-D)

The HAM-D was developed by Professor Max Hamilton more than 50 years ago (Hamilton, 1959). Although it was designed to assess the severity of depressive symptoms in hospitalized patients, it has become the most widely used outcome measure in clinical trials of treatments of depressive disorders.

The original version is a 21-item, clinician-rated scale that can be completed in 20–30 minutes and, although seldom done in current practice, could use sources of information other than the patient

Hamilton Rating Scale for Anxiety (HAM-A)

The HAM-A was developed by Professor Max Hamilton and is widely used to measure the severity of anxiety symptoms and their change over time in response to treatment. This is a 14-item, clinician-rated scale that includes both psychological and somatic symptoms of anxiety and can be completed in 10–20 minutes.

The items included in HAM-A are:

  • 1.

    anxious mood

  • 2.

    tension

  • 3.

    fears

  • 4.

    insomnia

  • 5.

    intellectual (concentration and memory)

  • 6.

    depressed mood

  • 7.

    somatic – muscular

  • 8.

    somatic – sensory

  • 9.

    cardiovascular symptoms

  • 10.

    respiratory

Brief Psychiatric Rating Scale (BPRS)

The BPRS is a rating scale developed to characterize psychopathology and to measure change in clinical psychopharmacology research (Overall and Gorham, 1962). While the BPRS can be used for syndromes other than schizophrenia, it includes psychotic symptoms of greatest importance for assessing the clinical condition of schizophrenic patients. Originally developed with 16 items, the following standard 18-item version has been used for more than 40 years (Guy, 1976), with each symptom rated on a

Global Assessment of Function (GAF) scale

The GAF is the most widely used scale measuring an individual's overall psychological, social, and occupational functioning (American Psychiatric Association, 2000). Its wide use stems from its role in anchoring the fifth axis of the five-axis diagnostic system employed by the DSM.

The GAF is a continuous scale with descriptors for each increment of 10 indicating the functional correlate of a given 10-point range. The overall score is determined by selecting the most severe score among the

Child Behavior Checklist (CBCL)

The CBCL is a questionnaire that assesses a broad range of emotional and behavioral problems in children. There are separate versions for preschool (CBCL/1.5–5, for ages 1.5–5) and school-age (CBCL/6–18, for ages 6–18) children (Achenbach and Rescorla, 2000, Achenbach and Rescorla, 2001). The checklists consist of statements about the child (such as “argues a lot”). Responses are coded as 0 (not true), 1 (somewhat or sometimes true), or 2 (very true or often true).

For school-age children, three

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