THE OBS-SCALE A rating scale for Organic Brain Syndrome (Gustafson, Westling, Lindgren 1985)

Transcription

1 THE OBS-SCALE A rating scale for Organic Brain Syndrome (Gustafson, Westling, Lindgren 1985) PART 1 DISORIENTATION SUBSCALE Patient: Born: Tested by: Date: Rating no: Time: Normal Impaired Comments Hearing Vision Speech 1. What is your first name? Right answer Wrong answer or 2. What is your surname? Right answer Maiden name or previous surname Wrong answer or 3. What year were your born? Right answer Wrong by 1 year Wrong by 2 to 10 years 4. Month and day of birth? Right answer Right day but wrong month 10 years or Right month but wrong day Wrong month and day or 5. How old are you? Right answer Wrong by one year Wrong by 2 to 10 years 6. Where are you now? (hospital, ward) Right answer (hospital and ward) 10 years or Hospital or ward 7. Where are you now? (city, town etc) Right answer Patient mentions other nearby place with hospital 8. What time is it? Right answer Slightly wrong (early in the morning instead of in the middle of the morning) Patient know s/he is in an institution, but not of what kind wrong or Patient mentions domicile wrong or 4 hours but knows the difference between day and night wrong or

2 9. What day of the week is it? Right answer Wrong by 1 day Knows whether it is in the beginning, in the middle or at the end of the week wrong or 10. What month is it? Right answer Wrong by 1 month Wrong by 2 months 2 months 11. What date is it? Right answer Wrong by 1 to 2 days Wrong by 3 days to 2 weeks 12. What season is it? Right answer Slightly wrong, e.g. spring instead of summer 2 weeks Patient can not tell the difference between summer and winter wrong or 13. What year is it? Right answer Wrong by 1 year Wrong by 2 years 2 years 14. How long have you been in hospital? Right answer Wrong by 1 to 2 days Wrong by 3 days to a week 15. What is the name of the king? (queen, president, prime minister ) 16. Who was king (queen, president, prime minister) before him/her? 1 week or Right answer Wrong answer or Right answer Wrong answer or

3 THE OBS-SCALE A rating scale for Organic Brain Syndrome (Gustafson, Westling, Lindgren 1985) PART 2 CONFUSION SUBSCALE Patient: Born: Informant: Date: Rating no: Time: Normal Impaired Comments Hearing Vision Speech VARIATION OF THE CLINICAL STATE 1. Tiredness, drowsiness during the day Periodically drowsy, but not sleeping Falling asleep occasionally when not activated Several sleeping periods with difficulties to arouse 2. Episodic during the day Solitary, short lasting s 3. Variation between days Solitary variation from one day to another slight or solitary of marked marked Moderate variation Strong variation between days 4. Nocturnal or late evening 5. Diurnal variation. Improvement during the day, worst off in the morning 6. Changes for the worse during the day Solitary, short lasting slight or solitary of marked marked Slight improvement Moderate improvement Marked improvement during day time Slight change Moderate change Strong evident

4 SUSPICIOUSNESS 7. Suspiciousness of staff members or fellow patients (attitudes as well as verbal report) Slight and occasional manifestation Repeated slight manifestations or solitary marked Constant or repeated manifestations of pronounced suspiciousness 8. Suspiciousness of relatives (attitudes and verbal reports) Slight and occasional manifestation Repeated slight manifestations or solitary marked Constant or repeated manifestations of pronounced suspiciousness Not possible to rate EMOTIONAL REACTIONS 9. Anxiousness (verbal report as well as behaviour: tremor, perspiration, breathing, papillary size, etc.) 10. Psychomotor slowing (concerns speed of movement) 11. Depressed mood verbal report (such as pessimism, worthlessness, usefulness, self-blame, guilt feelings) and behaviour (facial expression, crying, sighing) 12. Latency in reaction and in response to verbal stimuli Slight and occasional manifestation Slight repeated manifestations or solitary marked Constant or repeated manifestations of pronounced anxiousness Slight slowing Moderate slowing Strong manifest slowing Slightly depressed but possible to comfort Appears depressed, gloomy, ruminating but to some extent possible to comfort Globally depressed, pessimistic and full of despair No latency Slight delay Moderate delay Strong delay, may need repeated stimulation 13. Restlessness, agitation Difficulty in keeping hands still, changes posture 14. Irritability Sometimes touchy, irritable 15. Aggressivity Solitary actions such as pushing Marked restlessness, hand-wringing and attempt to rise Inability to sit still for more than short periods, pacing Repeated s of irritability and anger with raised voice, changes in vocabulary, gestures Strong irritability, threatening speech or aiming at other persons Repeated s with pushing, blows, pinching, biting, etc. Constant or frequent aggressive behaviour 16. Emotional lability (easily provoked, mostly seen as tears) Slight and short-lasting Easily provoked tears and crying Strong manifestation of crying

5 17. Euphoria Cheerful and selfconfident, but also expression of adequate emotions Elated, uncritical, joking, but to some extent possible to calm down Constant elation with high self-esteem LANGUAGE 18. Impaired understanding of speech (optimal use of hearing aid) Slight impairment, compensation by repetition Impairment only partly compensated by repetition, but understanding short, simple messages Marked impairment (does not exclude communication like gestures and mimic) Not possible to rate 19. Dysarthria (indistinct, slurred speech) Slight slurring but easy to understand Marked slurring of certain words, but the context understandable Marked dysarthria, incomprehensible speech 20. Deficiency in expressive speech Difficulty in finding the right word or expression with pausing and hesitation 21. Unnecessary repetition of phrases and sentences (= perseveration) Marked difficulties in finding names of common objects, long pauses and circumlocutions Extreme difficulties. Ordinary conversation not possible. Solitary repetition Frequent repetition not severely disturbing the conversation Frequent repetition disturbing the conversation Not possible to rate DELUSIONS 22. Delusions (inadequate false belief, difficult to correct such as ideas of persecution, poisoning or guilt) Periodic delusions, to some extent possible to divert Periodic delusions, not possible to divert, or permanent but less stable delusions Permanent and stable delusions Describe ideas, if possible with the patient s own words:

6 23. Hallucinations or illusions Slight indication of solitary One or several shortlasting s Repeated s of marked hallucination or illusion Describe (type, size, time): NEUROLOGICAL SYMPTOMS 24. Syncopal attacks Solitary, short-lasting Several short-lasting attacks Attack or attacks of long duration How long duration? 25. Epileptic seizures (muscular twitchings during unconsciousness) 26. Myoclonic twitchings during wakefulness Possibly observed Single in 24 hours Several s in 24 hours Possibly observed Solitary of moderate strength Repeated or longlasting s SPATIAL ORIENTATION - RECOGNITION 27. Orientation, own room Finds the way easily Sometimes difficulties, needs some assistance. Easy to correct Often difficulties, but possible to direct to his/her room Completely unable 28. Orientation, seat in dining room or similar room Finds the seat easily Sometimes difficulties, needs some assistance. Easy to correct. Often difficulties, but possible to direct his/her seat Completely unable 29. Orientation, lavatory Finds the way easily Sometimes difficulties, needs some assistance. Easy to correct. 30. Recognition of staff members Recognizes and know their names Often difficulties, but possible to direct to lavatory Completely unable Sometimes difficulties to recognize Often difficulties and needs 5-10 min to recognize Always difficulties

7 31. Recognition of close relatives Recognizes and know their names Sometimes difficulties Often difficulties and needs 5-10 min to recognize Always difficulties Not possible to rate 32. Misidentification of persons (e.g. mistakes other patient or staff for relative) Never Solitary, easily corrected Often, but possible to correct Often, but not possible to correct Describe: PHYSICAL AND PRACTICAL ABILITIES 33. Dressing, need of assistance Never Sometimes assistance and reminder 34. Washing, need of assistance Never Sometimes assistance and reminder 35. Toilet, need of assistance Never Sometimes assistance and reminder 36. Eating, need of assistance Never Sometimes assistance, reminder and cleaning 37. Physical mobility No difficulty Walks with support by a person, with a stick or rollator Often some assistance in dressing and choice of clothes Often extensive assistance Often some assistance Always difficulties Often assistance, reminder and failure Often extensive failure Often some assistance to divide food and avoid soiling Often extensive difficulties Walks with strong assistance, such as from two persons, or sits without support Bed ridden or sits with strong support SOCIABILITY 38. Social contacts with fellow patients or staff Frequent Somewhat aspontaneous or selective Few and short-lasting No attempts or unable to communicate 39. Reading Often Reads spontaneously for short periods Reads when repeatedly encouraged No interest or incapable of reading