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PubMedDate not supplied

Dimensions of the Brief Psychiatric Rating Scale: an examination of stability during haloperidol treatment.

The purpose of the study was to investigate invariance of the factor structure of the Brief Psychiatric Rating Scale (BPRS) during haloperidol treatment. Data were collected in a placebo-controlled, double-blind, crossover treatment study examining the relationship between haloperidol plasma level and clinical outcome. Subjects were 173 acutely exacerbated, newly admitted patients with a diagnosis of schizophrenia or schizoaffective disorder. Exploratory (EFA) and confirmatory (CFA) factor analyses were performed at four time points: (1) last day of the preplacebo period; (2) last day of the placebo period; (3) end of the first treatment week; and (4) end of the treatment period. EFAs demonstrated (1) good reproducibility of commonly used BPRS factors at the preplacebo time point, (2) substantial changes in the factor structure during the placebo period, and (3) a reemergence of the initial (preplacebo) factor structure for most of the factors during haloperidol treatment. CFAs showed that traditional clinical factors were correlated with each other at all time points and that there were substantial changes in correlation among these factors over time. Our results suggest that longitudinal applications of traditional BPRS subscales should take factorial stability over time into consideration. Since many clinical trials use placebo data as a standard for longitudinal comparisons, further psychometric investigation is necessary to increase construct reliability and temporal stability.

Adult↗
PubMed2001

New subscales for an anchored version of the Brief Psychiatric Rating Scale: construction, reliability, and validity in acute psychiatric admissions.

Attending psychiatrists completed an anchored version of the 18-item Brief Psychiatric Rating Scale (BPRS-A) based on admission and evaluation information on a total of 2,921 adult patients treated at 1 public sector acute psychiatric teaching hospital. Exploratory factor analysis was applied to a 6-month sample to construct 4 nonoverlapping subscales: Resistance, Positive Symptoms, Negative Symptoms, and Psychological Discomfort. Confirmatory factor analysis compared these new subscales to 3 other published subscale models using a second 6-month sample. Internal consistency, rater influence, and interrater agreement were estimated in separate studies. Discriminant validity was explored by comparison of diagnosis-based samples. Application of the BPRS-A as a debriefing instrument in the study of symptomatic change and the multiple challenges inherent in psychometric study of such a rating scale in realistic hospital practice are discussed.

Adult↗
PubMed2006

Left temporal perfusion associated with suspiciousness score on the Brief Psychiatric Rating Scale in schizophrenia.

We evaluated the relationship between regional cerebral blood flow (rCBF) and clinical symptoms in patients with schizophrenia. Single photon emission computed tomography with N-isopropyl-p-[123I]iodoamphetamine (123I-IMP) was used to study 29 patients with schizophrenia. Clinical symptoms were assessed using the Brief Psychiatric Rating Scale (BPRS). We examined the correlation between rCBF and each BPRS item score using Statistical Parametric Mapping software. Corrected P-values < 0.05 were considered as statistically significant. The suspiciousness score on the BPRS was positively correlated with rCBF in the left inferior temporal gyrus. There was no significant correlation between rCBF and any other items of the BPRS. There was no significant correlation between rCBF and chlorpromazine-equivalent dosage. This analysis permits the quantitative assessment of the severity of persecutory delusions in relation to left temporal perfusion in patients with schizophrenia.

Adolescent↗
PubMed2003

Inter-rater reliability of the Brief Psychiatric Rating Scale and the Groningen Social Disabilities Schedule in a European multi-site randomized controlled trial on the effectiveness of acute psychiatric day hospitals.

The objectives of this study were to report the inter-rater reliability of the Brief Psychiatric Rating Scale (BPRS 4.0) and the Groningen Social Disabilities Schedule (GSDS-II) as assessed in a randomized controlled trial on the effectiveness of psychiatric day hospitals spanning five sites in countries of Central and Western Europe. Following brief training sessions, videotaped BPRS-interviews and written GSDS-vignettes were rated by clinically experienced researchers from all participating sites. Inter-rater reliability often proved to be poor for items assessing the severity of both psychopathology and social dysfunction, but findings suggest that both instruments allow for the assessment of the presence or absence of specific psychopathological symptoms or social disabilities. Inter-rater reliability at subscale level proved to be good for both instruments. Results indicate that, with a brief training session and proper use of the instruments, psychopathology and social disabilities can be reliably assessed within cross-national research studies. The results are of particular interest given that the need to conduct cross-national multi-site studies including countries with different cultural backgrounds increases.

Adolescent↗
PubMed1984

The Brief Psychiatric Rating Scale (BPRS) in geropsychiatric research: I. Factor structure on an inpatient unit.

Factor analysis of symptom ratings recorded on the Brief Psychiatric Rating Scale (BPRS) for a sample of 87 geropsychiatry inpatients resulted in five relatively independent factors. The factor structure differed in two important respects from that previously observed in numerous analyses of BPRS ratings of patients from the general adult psychiatric population. The symptom of depressive mood combined with emotional withdrawal and motor retardation to define a withdrawn depression factor, whereas depressive mood has routinely evidenced greater affinity for anxiety and tension in younger adults. In addition, the unitary thinking disturbance factor that has been observed routinely in data from the younger adult psychiatric population split into separate factors of cognitive dysfunction and psychotic distortion. Construct validity of the cognitive dysfunction factor was examined with reference to an objective mental status questionnaire.

Aged↗
PubMed1975

[The use of the brief psychiatric rating scale (BPRS) by overall and gorham for the diagnosis of acute paranoid psychoses: evaluation of a german translation of the BPRS (author's transl)].

A German translation of Overall and Gorham's "Brief Psychiatric Rating Scale" (BPRS) has been used to select patients with acute paranoid psychoses for a drug trial and to evaluate the results of the treatment. The BPRS proved very useful in screening, and as a reliable method to judge the global therapeutic outcome. The total score showed a high degree of interrater reliability; it also reflected a marked decrease of psychopathological symptoms at the end of the trial. Interrater correlation coefficients were lower than 0.7 in 9/16 items. This may be due to the somewhat unprecise and ambigous formulation of several items. The average BPRS profile of patients with "paranoid-hallucinatory schizophrenia" were similar to those published by French authors for the corresponding diagnosis.

Acute Disease↗
PubMed1999

Reliability of an Italian standardized and expanded Brief Psychiatric Rating Scale (BPRS 4.0) in raters with high vs. low clinical experience.

OBJECTIVE: The aims of this study were (i) to assess the inter-rater reliability of the latest Italian expanded 24-item version of the Brief Psychiatric Rating Scale, BPRS version 4.0 and (ii) to assess the feasibility of obtaining reliable BPRS 4.0 ratings by reliability training of clinically less experienced trainees (medical and rehabilitation students). METHOD: A videotape-training procedure was used, and the inter-rater agreement scores of three different groups of raters, namely psychiatrists and psychologists (n=28), psychosocial rehabilitation students (n=27) and medical students (n=54) were calculated and compared. RESULTS: The results indicated that both experienced raters (psychiatrists and psychologists) and inexperienced raters (medical and psychosocial rehabilitation students) were able to achieve high levels of inter-rater reliability. CONCLUSION: Our results are of particular interest in view of the increasing need to draw upon professionals, other than psychiatrists and psychologists, for cost-effective and standardized evaluation of rehabilitation interventions.

Adult↗
PubMed2000

The Brief Psychiatric Rating Scale as an acute inpatient outcome measurement tool: a pilot study.

BACKGROUND: Recent guidelines for length of stay at psychiatric hospitals may have an unacceptable impact on patient outcome at discharge. A valid measurement tool is needed to evaluate significant patient change during brief hospitalization, typically 7 days, and to provide early prediction of unfavorable short-term outcome. This study examines the utility of the Brief Psychiatric Rating Scale (BPRS) as such a tool. METHOD: During a 2-month testing period, the BPRS was administered to 87 successive adults admitted to an acute general psychiatric inpatient unit at admission, 2 days, 7 days, and weekly thereafter until discharge. Total BPRS scores and 4 subscores were used in the data analysis, which included paired t tests and correlation analyses. RESULTS: Mean BPRS total scores demonstrate significant (p < .001) patient improvement at days 2, 7, and 14 of the hospital stay. Changes in subscores and their relationship to eventual outcome vary across diagnostic groups. CONCLUSION: The BPRS appears to be a useful inpatient outcome measure since it is capable of demonstrating significant change during brief stays of 1 week or less. Subscale scores may provide more specific prediction of change and may help clarify outcome in individual patients who show insignificant change by total score.

Adult↗
PubMed1996

Empirical evaluation of the factorial structure of clinical symptoms in schizophrenia: effects of typical neuroleptics on the brief psychiatric rating scale.

There has been little investigation of the effect of neuroleptic medication on the structure of symptoms in schizophrenia. In this study, 135 male schizophrenic patients were rated with the Brief Psychiatric Rating Scale (BPRS) after 4 weeks of treatment with typical neuroleptic medication and after 2 weeks free of neuroleptics, with the order of assessment varying across patients. Confirmatory factor analyses (CFA) found that there were no differences in symptom structure across medication status and no differences in the structure of symptoms in treatment responders and nonresponders. The typical 5-factor BPRS model fit the data poorly and the fit improved considerably through deletion of items measuring symptoms not associated with schizophrenia, suggesting that some of the symptoms that contribute to a total BPRS score may be adding primarily error variance. Although the sample size in this study is limited, the results suggest that using total BPRS scores to measure severity of schizophrenic symptoms should be reconsidered.

Adult↗
PubMed1991

Relationship between the Brief Psychiatric Rating Scale and the Scale for the Assessment of Negative Symptoms: a study of their correlation and redundancy.

Because overlapping psychometric scales are used frequently in psychiatric research, examination of the relationship between scales has become increasingly important. The concept of relationship is the focus of this article. By way of illustration, the Brief Psychiatric Rating Scale (BPRS) and the Scale for the Assessment of Negative Symptoms (SANS) were compared for correlation and redundancy. Since these scales are frequently represented by derived summary variables (e.g., factors, total scores), it is also important to assess the effect of such representation on measures of relationship. The SANS and the BPRS were found to be highly intercorrelated. Nevertheless, the individual items and the subscale scores of the SANS contain information independent from the BPRS: the best BPRS predictor variates can explain only approximately half of the total variance of the SANS. When the SANS, however, is represented by a single variable (composite score), it becomes highly redundant with the anergia factor of the BPRS.

Adult↗
PubMed1993

Use of the brief psychiatric rating scale by nurses.

1. Nurses are intimately involved in the assessment of patients in inpatient clinical settings and in community settings--and nurses have a role to play in the systematic rating of severe psychopathology. 2. The Brief Psychiatric Rating Scale (BPRS) provides a means of assessing mental health status from an interview using 16 rating concepts. Analysis of BPRS rating profiles obtained from a variety of patients and settings have consistently revealed four syndromes: withdrawal-retardation, anxious depression, hostile-suspiciousness, and thinking disturbance. 3. Once properly trained regarding the BPRS, nurses can use the scale effectively in the assessment and ongoing monitoring of patient conditions. The scale is an added tool for nurses to use in monitoring the effectiveness and outcome of both medical and nursing interventions.

Clinical Competence↗
PubMed2000

Psychometric measures of individual change: an empirical comparison with the Brief Psychiatric Rating Scale (BPRS).

OBJECTIVE: An empirical comparison of treatment efficacy estimates as based on psychometric measures of intra-individual change (Reliable Change methods). METHOD: All seven different methods of assessing Reliable Change that have been advocated in the past two decades are compared empirically in a large in-patient sample (n = 107). Estimates of treatment efficacy by each of these seven Reliable Change methods are computed, using pre-/post-score changes on the Brief Psychiatric Rating Scale (BPRS). RESULTS: It is demonstrated that Reliable Change methods may yield very different estimates of treatment efficacy. The Reliable Change method with the fewest statistical assumptions is one of the least sensitive Reliable Change methods. CONCLUSION: Disagreement on the proper definition of Reliable Change is not merely of theoretical importance, but also has major practical implications.

Adolescent↗
PubMed2001

The brief psychiatric rating scale for children (BPRS-C): validity and reliability of an anchored version.

OBJECTIVE: Because the accuracy of problems reported by referred children may be compromised by their academic, cognitive, or motivational limitations, clinician rating forms may contribute to the accurate assessment of youth adjustment. One such measure, the 21-item Brief Psychiatric Rating Scale for Children (BPRS-C), received psychometric study to estimate its potential contribution to the measurement of symptom dimensions. BPRS-C reliability and concurrent validity were calculated for youths who were receiving psychiatric services within a medical school department. METHOD: Five hundred forty-seven children aged 3 to 18 years were rated by faculty or trainees; a subsample of 90 was concurrently rated by two observers. BPRS-C psychometric performance was demonstrated through interrater agreement, factor analysis, and multivariate analyses of variance across seven diagnosis-based groups. RESULTS: Although items and scales demonstrated substantial reliability and concurrent validity, item factor analysis revealed a few apparent errors in item-to-scale assignment. These errors were minimized by the use of three new second-order factor-derived scales: Internalization, Developmental Maladjustment, and Externalization. CONCLUSIONS: The BPRS-C can be easily integrated into academic clinical practice and is a reliable and valid method of child description. Additional study of three new BPRS-C factor scales and the application of the BPRS-C to the quantification of clinician observation of child symptomatic status are warranted.

Adolescent↗
PubMed1989

Correlations between the MMPI and the Brief Psychiatric Rating Scale in schizophrenic and schizoaffective patients.

Though self-report measures and clinician-based ratings are extensively used to document psychopathology, there has been little work examining the relationship between these different types of measurement techniques. The current work examined the relationship between the Minnesota Multiphasic Personality Inventory (MMPI) and the Brief Psychiatric Rating Scale (BPRS) in patients with schizophrenia and schizoaffective disorder. Correlations were calculated in an initial exploratory sample, and a set of relationships was selected for confirmation in a second sample. The BPRS items of hallucinatory behavior and tension significantly correlated with MMPI measures of psychoticism. BPRS measures of hostility correlated with scale 4 (Psychopathic Deviate) of the MMPI. BPRS and MMPI measures of depression also were related. In contrast, BPRS and MMPI measures thought to reflect negative symptoms were uncorrelated. These results offer behavioral validity for the use of the MMPI in schizophrenic samples and suggest that the two measures tap similar as well as separable symptom constructs thought to be common in schizophrenia.

Adult↗
PubMed2000

Interrater reliability of the Brief Psychiatric Rating Scale used at a community-based inpatient crisis stabilization unit.

In 1993, the State of Georgia passed a law reforming the mental health system to include more consumers of services and their families on local boards, to provide services in the community, and to measure and report the outcomes of these services. As mental health services expanded in the community, it became necessary to extend the use of reliable and valid instruments appropriate to a brief treatment setting. This field study investigates the usefulness of the Brief Psychiatric Rating Scale (BPRS) using paired ratings to measure the level of psychiatric symptoms of clients treated in an urban community inpatient crisis stabilization unit. Interrater agreement for all paired assessments exceeded .85 comparing favorably with previous studies reported in the literature. The BPRS was found to be a useful and efficient instrument in this community setting.

Community Mental Health Services↗
PubMed1998

Use of the Brief Psychiatric Rating Scale as a predictor of psychiatric admission for non-suicidal patients.

OBJECTIVE: We hypothesized that a systematic determination of symptom severity would predict psychiatric admission for non-suicidal patients referred for a psychiatric evaluation in an urban emergency department (ED) setting. METHOD: In a pilot study involving consecutive patients referred for a psychiatric evaluation in an urban ED, symptom severity was quantified using the Brief Psychiatric Rating Scale (BPRS). The BPRS scores of all non-suicidal patients were subjected to receiver operator characteristic (ROC) curve analysis to determine the sensitivity, specificity, and optimal cutoff score of the BPRS in predicting admission for non-suicidal patients. RESULTS: A BPRS cutoff score of 39 had a sensitivity of 85.71 percent and a specificity of 86.11 percent. The area under the ROC curve was .8671 (Somer's D = .7342) and the standard error of the curve was .1124. The cutoff score of 39 correctly identified six of seven non-suicidal patients who were hospitalized. CONCLUSIONS: It is anticipated that use of the BPRS in the ED will be further refined when a larger patient sample is studied. Potentially, a subset of BPRS items could be identified which would be more sensitive in predicting admission than the full BPRS and increase the overall efficiency of administering the BPRS in the ED.

Adult↗
PubMedDate not supplied

The development, use, and reliability of the brief psychiatric rating scale (nursing modification)--an assessment procedure for the nursing team in clinical and research settings.

The role of nursing staff in the systematic rating of psychopathology has been explored in a small number of studies in recent years. Nurses are uniquely placed to carry out relatively continuous observations of high validity which are sensitive to change, yet on the basis of the limited data available, some doubts remain concerning the reliability of such ratings, particularly when they extend to nonobservational phenomena. Nevertheless, since in practice nurse ratings form an important part of the psychopathological assessment arm in many research settings, continuing uncertainty about their reliability is clearly undesirable. Following a brief review of nurse rating, this report describes the role of the nursing team in a developing research environment and reports interrater reliability data for randomly selected pairings of nurses drawn from a mainstream clinical team who had been trained in the use of a specially modified version of the Brief Psychiatric Rating Scale (Nursing Modification) (BPRS[NM]). The findings indicate that nursing staff can reliably rate this range of psychopathology under ordinary clinical conditions, provided they have been properly trained and that appropriate modifications have been made to the procedure. Although validity was not formally assessed in this study, the extension of the time period covered by the BPRS, combined with the special place of nurses in the ward milieu can also be expected to enhance the validity and sensitivity of the ratings. Other effects of the involvement of therapeutically-oriented nursing staff in research procedures are also discussed.

Humans↗