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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↗
PubMed2001

Reduced volume of the cerebellar vermis in neuroleptic-naive schizophrenia.

BACKGROUND: Neuroimaging studies have suggested the possible role of the cerebellum in the pathophysiology of schizophrenia. However, no study has investigated the detailed structures of the cerebellum in patients without a history of neuroleptic medication. The objective of this study is to examine the volume of detailed structures of the cerebellum in neuroleptic-naive schizophrenic patients and to examine the relationship between cerebellar morphology and clinical symptoms. METHODS: Magnetic resonance imaging scans were acquired from 20 male neuroleptic-naive schizophrenic patients and 20 healthy control subjects. We measured the volumes of the cerebrum, cerebellar hemisphere, cerebellar gray and white matter, and vermis. Symptoms were assessed with the Brief Psychiatric Rating Scale. Total Brief Psychiatric Rating Scale scores and subscale scores were used for analysis. RESULTS: The volume of the vermis was significantly reduced in the schizophrenic group relative to the control group, whereas no significant differences were found in the volumes of other cerebellar structures and the cerebrum. Reduction in the vermal volume correlated with the total Brief Psychiatric Rating Scale Depression subscore and Paranoia subscore. CONCLUSIONS: This study indicates that the volume of the vermis is reduced in patients with schizophrenia, and reduction in vermal volume is suggested to be related to the pathophysiology of the disease.

Adult↗
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↗
PubMed2001

Use of the Brief Psychiatric Rating Scale to facilitate differential diagnosis at acute inpatient admission.

BACKGROUND: The advent of managed care has necessitated strategies for quickly and accurately diagnosing psychiatric disorders. The aim of the present study was to ascertain whether the Brief Psychiatric Rating Scale-Anchored (BPRS-A) would be a useful adjunct to more traditional diagnostic strategies at acute inpatient admission. METHOD: Using a sample of 207 inpatients admitted during an 8-month index period, we examined the utility of the BPRS-A in predicting whether patients were more likely to be diagnosed with schizophrenia, bipolar disorder, or major depression (DSM-IV). RESULTS: Discriminant function analyses were used to correctly predict 68%, 60%, and 74% of patients diagnosed with schizophrenia, bipolar disorder, and major depression, respectively. The main predictors of diagnostic category, in descending order. were BPRS-A depressed mood item, BPRS-A positive symptoms scale, BPRS-A excitement item, BPRS-A guilt feelings item, BPRS-A mannerisms and posturing item, and number of previous episodes. CONCLUSION: As efforts are directed toward continuous quality improvement within mental health settings, an emphasis must be placed on improving the efficiency and accuracy of diagnostic procedures. The BPRS-A shows promise as a time-efficient assessment instrument that may be useful in facilitating differential diagnosis at inpatient admission and may increase the likelihood that efficacious prerelease interventions and appropriate aftercare services are implemented.

Acute Disease↗
PubMedDate not supplied

[Assessment of the Life Skills Profile and the Brief Psychiatric Rating Scale as predictors of the length of psychiatric hospitalization].

INTRODUCTION: Length of hospital stay is generally used as an indirect indicator of effectiveness and efficiency of treatment programs, but it is uncommon that other factors related with hospital stay are also contemplated. The aims of this study are to analyse the relationship between illness severity and adaptative behavior and to assess the predictive power of both constructs on the length of hospital stay. METHODS: Multicenter prospective study (n = 132). The outcome variable is the length of hospital stay cut off at 90 days. The illness severity (BPRS) and the adaptative behavior (LSP) of psychiatric patients are explanatory variables. RESULTS: After adjusting for age, gender and psychiatric diagnosis, negative symptoms (OR = 2.3; 95%CI = 1.3 4.1), self-competence (OR = 0.85; 95% CI = 0.78 0.93), and the total LSP score (OR = 0.96; 95% CI = 0.93 0.98), were significantly associated to the length of hospital stay. These three variables shared a similar predictive power (chi2 = 1.9 on 2 d.f.; P = 0.4). CONCLUSION: Deficits in adaptative behaviour are as relevant as negative symptoms to explain the length of hospital stay. Both assessment domains should be included in the administrative information at discharge.

Activities of Daily Living↗
PubMed1990

The Brief Psychiatric Rating Scale (BPRS) and the Nurses' Observation Scale for Inpatient Evaluation (NOSIE) in the evaluation of positive and negative symptoms.

Positive and negative a priori symptom scales were operationalized with the BPRS and the NOSIE. Acutely and consecutively admitted psychiatric patients (N = 247) were rated with these scales. Research questions dealt with the psychometric properties of the scales. It was found that the positive symptom scales had sufficient internal consistency; the negative scales did not. Diagnostic groups could be distinguished better with the positive symptom (PS) than with the negative symptom (NS) scales. The outcome of this research suggests that the positive and negative symptoms distinction is less meaningful in cross-sectional research, in which acute patients are rated, than in longitudinal research.

Adaptation, Psychological↗
PubMed1986

Two self-rating scales for depression in Hmong refugees: assessment in clinical and nonclinical samples.

An exploratory cross-cultural study was undertaken of two widely used self-rating scales: the Zung and the Depression Scale on the 90 Item Symptom Checklist, or SCL-Depression. Both scales were translated into Hmong and tested in two samples of Hmong refugees in the U.S.A. One sample (n = 86) consisted of a field survey of all Hmong people living in Minnesota. Of the 86, 15 sought treatment and were diagnosed as having major depression during the year following their self rating, so that a comparison of patients' scores with nonpatients' scores was possible. The other sample consisted of another 51 Hmong psychiatric patients with major depression. This second group was also assessed by four psychiatric rating scales (i.e. Hamilton Depression Scale, brief Psychiatric Rating Scale, Inpatient Multidimensional Rating Scale, and Nurse's Observation Scale for Inpatient Evaluation) and two measures of treatment intensity (i.e. number of visits, duration of treatment). In the general Hmong population (n = 86), both self-rating scales were highly intercorrelated, and strongly associated with patient status. In the patient sample (n = 51), only the SCL-Depression showed any correlations with psychiatric rating scales or with treatment variables. This is contrary to the anticipated outcome, as it had been expected that the Zung would perform better than the SCL-Depression. In addition, duration of treatment was inversely correlated with the SCL-Depression, also opposite to our prediction. Probable causes for these unexpected results are presented. An item analysis was undertaken, comparing 71 Hmong survey subjects who were not treated for depression with 51 Hmong psychiatric patients who were treated for depression. Most Zung and SCL-Depression items showed significantly higher symptom levels in the depressed patients. However, non-depressed controls unexpectedly reported significantly higher symptom levels on certain items. No significant differences were observed on several Zung and SCL items. These unexpected findings are discussed in light of the refugee's adjustment and experience.

Cross-Cultural Comparison↗