Rating Scales. Chris Smart

Transcription

1 Rating Scales Chris Smart

2 Overview General Points Purpose Diagnosis-specific: Depression, Mania, Anxiety, OCD, Schizophrenia, Dependence, Eating Disorder, Personality Disorder Pan-diagnoses/ Functional Side Effects Conclusions

3 General Points Observer reported (OR) vs self reported (SR) Trained vs lay observer Simple vs complex

4 Purpose Reliability Validity Sieve : screening, diagnostic, severity, improvement

5 Diagnosis Specific - Depression (1) Hamilton Rating Scale (HAM-D) To assess depression severity OR staff member 21 items (originally 17, up to 29), each score up to 5 Emphasises somatic symptoms Cut-offs: <7 normal; 8-13 mild; moderate; severe; 23+ very severe Gold standard for >50yrs Bagby et al 2004: Adequate internal/convergent/discriminatory reliability adequate, other areas poor.

6 Diagnosis Specific - Depression (2) Beck Depression Inventory (BDI) Aaron Beck father of CT Screening tool SR 21 items, score 0-3 Cut-offs: <13 minimal; mild; moderate; severe Good reliability BDI-II (1996) covers DSM-IV No more valid/reliable than HAMD

7 Diagnosis Specific - Depression (3) Montgomery Asberg Depression Rating Scale (MADRS) To assess Rx response OR 10 items, each score up to 6 Cut-offs: <6 normal; 7-19 mild; moderate; >34 severe Hospital Anxiety and Depression Scale (HADS) Screening tool SR 14 items (7D/7A), each scores up to 3 Cut-offs: 8/21 for both D and A 2 o care outpt clinics/ 1 o care Sensitive and specific ( )

8 Diagnosis Specific - Depression (4) Edinburgh Postnatal Depression Scale (EPDS) Screening tool SR 10 items reverse scoring, each scored up to 3 Cut-off: >10 depression

9 Diagnosis Specific Mania Young Mania Rating Scale (YMRS) Assesses severity OR 11 item; 4 items scored up to 8, the rest up to 4 Cut-off of 20 for inclusion in bipolar disorder RCTs Adult/children Altman Self-Rating Mania Scale (ASRM) SR 5 item; 4 items scored up to 4 Cut-off of 6

10 Diagnosis Specific - Anxiety Hamilton Rating Scale (HAM-A) To assess severity OR 14 items, each scored 0-4 Cut-offs: <17 mild; mild/moderate; moderate/severe Beck Anxiety Inventory (BAI) SR 21 items, each scored up to 3 Cut-offs: <7 minimal; 8-15 mild; moderate; severe

11 Diagnosis Specific - OCD Yale-Brown OC Scale (YBOCS) To assess severity and type of symptoms Comprehensive, semi-structured interview OR 19 items, 1-10 give score YBOCSII improved reliability and validity

12 Diagnosis Specific - Schizophrenia Positive and Negative Syndrome Scale (PANSS) Assesses +ve. ve and general psychopathology Info from staff, family etc 30 items, scored up to 7 To assess response to Rx Requires some training Scale for the Assessment of Negative Symptoms (SANS) Info from staff, family etc 26 items, each scored up to 5 Also a SAPS

13 Diagnosis Specific - Dependence Severity of Alcohol Dependence Questionnaire (SAD-Q) OR 20 items, each scored up to 3 Cut-offs: >16 mild, moderate, >30 severe >16 chlordiazepoxide Alcohol Use Disorders Identification Test (AUDIT) 10 items, each scored up to 4 Cut-offs: >8 hazardous drinking; >20 suggests dependence 8-15 simple advice; brief counselling; >20 refer to specialist

14 Diagnosis Specific Eating Disorder Eating Attitudes Test (EAT-26) Particularly useful for school-age SR 26 items, each scored up to 5 Cut-offs (for referral) for each criteria

15 Pan-diagnoses/ Functional (1) Patient Health Questionnaire (PHQ-9) Pfizer, but public domain SR/OR Depression, anxiety, alcohol, eating disorder Specific and sensitive Used widely in 1 o care

16 Pan-diagnoses/ Functional (2) Clinical Global Impression (CGI) Severity and improvement Cheap and cheerful Global Assessment of Functioning (GAF) EuroQol

17 Side-effects Liverpool Uni Neuroleptic Side Effect Rating Scale (CGI) Includes red herrings!

18 Conclusions Crucial adjunct Widely used Bolster objectivity Still vulnerable to bias Useful for pts Useful for us all

19 References Wiki: List of diagnostic classification and rating scales used in psychiatry for ADHD, ASD, Dementia, PD etc PubMed for reliability and validity studies.

20 Thanks