Rating Scales Flashcards
Is Beck’s Depression Inventory self-rated?
Yes
Is GHQ self-rated?
Yes
Is the Edinburgh postnatal depression scale clinician-rated?
No - self-rated
What are schedules?
Based on clinical expectations
Deal with categories of disorders based on known classification systems
What are the types of procedures used to select items for scales?
Based on previous clinical literature
Based on calibration
What needs to be considered when selecting a screening measure for a study?
Characteristics of population to be screened
Psychometric properties of the instrument
Time required to complete
Ease of use
Cost of obtaining measure
What is GHQ used for?
First-level assessment in epidemiological studies before detailed schedules employed
Who introduced the GHQ?
Goldberg
What is the purpose of GHQ?
Screening tool to detect those likely to have or be at risk of developing a psychiatric disorder
How many items does the GHQ have?
28
Scoring of GHQ
Each item is a 5 point Likert, allowing total of 84
Name the clinician-administered diagnostic schedules
Clinical interview schedule
Composire International Diagnostic Interview
Present State Examination
Schedule for Affective Disorders and Schizophrenia
Schedule for assessment in neuropsychiatry
Structured clinical interview for DSM IV
Which diagnostic schedules can be used by trained primary care workers?
Hopkins Symptom Check List
Which diagnostic schedules are self-report?
Diagnostic Interview Schedule
Patient Health Questionnaire
What is the aim of the Clinical Interview Schedule?
Identify common disorders in primary care and community 0 focus on neurosis
Who developed the Composite International Diagnostic Interview?
WHO
Which diagnostic schedule uses both ICD and DSM?
Composite International Diagnostic Interview
What does Diagnostic Interview Schedule study?
Lifetime DSM diagnosis initially, then current diagnosis
How many items in the Hopkins Symptoms Check list?
58
What does Hopkins symptoms check list measure?
Neurotic symptom distress in OP
Who developed the PHQ?
Spitzer
Aim of PHQ 9?
Diagnose common neurotic conditions in primary care
What does present state examination do?
Provides clinical diagnosis in line with ICD
Aim of Schedule for Affective disorders and schizophrenia?
Covers all major mental illness.
Which diagnostic schedule has a kids version?
Schedule for affective disorders and schizophrenia - Kiddie-SADs
Which diagnostic schedule has replaced the present state examination?
Schedule for assessment in neuropsychiatry
Items in total in schedule for assessment in neuropsychiatry?
1872
Which patients is the structured clinical interview for DSM IV used for
Patients in whom a psych diagnosis is suspected
Name some clinician-rated depression rating scales
Hamilton depression scale
Montgomery-Asberg depression rating scale
Name some self-rated depression rating scales
2 question scale/PHQ-2
Beck depression inventory
Zung depression inventory
Visual analogue scale
Easiest scale to quantify depression severity?
Visual analogue scale
What happens in the Visual Analogue scale?
10cm line where patient indicates state of mood
How many items in Hamilton depression rating scale?
17-21
What duration of symptoms does Hamiltion depression rating scale refer to?
Last 1-2 weeks
Which depression rating scale is a reference standard?
Hamilton
How many items in the Montgomery-Asberg depression rating scale?
10
Which depression rating scale is most sensitive to change?
Montgomery-Asberg Depression rating scale
How many items in Beck depression inventory?
21
Max score in Beck depression inventory?
63
Duration of symptoms tested in Beck depression inventory?
Last 2 weeks
Scoring in Beck depression inventory
0-13 - minimal
14-19 - mild
20-28 - moderate
>28 severe
Disadvantages of Beck Depression Inventory
Lacks discriminatory power among severely ill
How many items in Zung Depression inventory?
20
Advantage of Zung Depression Inventory
Avoids imbalance towards psychological factors such as Becks
Disadvantages of Zung Depression Inventory
Insensitive to change
Poor correlation with observer rating
When is depression rating scale appropriate for children?
At least 7 years of age
Name two depression rating scales for children
Reynolds Child Depression Scale
Children’s Depression Inventory
Number of items in Childrens Depression Inventory
27 - full version
10 - screening
At what age can Becks Depression Inventory be used?
14+
Which depression rating scale is NICE approved and has a parent version?
Mood and Feelings Questionnaire
Perinatal depression rating scales
Becks Depression Inventory
Edinburgh Postnatal depression scale
Center for Epidemiological Studies - depression scale
Duration of symptoms in Edinburgh postnatal depression scale?
Last 7 days
How many items are there in Edinburgh postnatal depression scale?
10
Characteristics of Geriatric depression scale?
Fewer somatic symptoms
Symptoms in past week
Yes/no answers
Depression rating scales for patients with cognitive deficits
Cornell Scale for Depression in Dementia - for caregiver
Hamilton Rating Scale for Depression
Which depression rating scale is for use in hospital?
Brief Assessment Schedule Depression cards - avoids patients being overhead - choose from a deck of 19 cards
Depression rating scale for those with schizophrenia?
Calgary Depression Scale for Schizophrenia
Name some Alcohol rating scales
CAGE
AUDIT
MAST
CIWA
Score to suggest alcohol misuse in CAGE?
2
How many items in AUDIT?
10
Score suggestive of alcohol misuse in AUDIT
8 or more
Score suggestive of dependence drinking in women and men in AUDIT?
13 - women
15 - men
Which alcohol questionnaire is recommended by WHO for primary care use?
AUDIT
How many items in MAST?
25, self-report
Scoring system of MAST
3-5 - early indicator of problems
6 or more - problem drinker
How many items does CIWA consist of?
10
Total score in CIWA?
67
Name some scales used in child psychiatry
Child and Adolescent Functional Assessment Scale
Child behaviour checklist
Diagnostic interview schedule for children
Conners rating scale
Is the Child and Adolescent Functional assessment scale self-reported?
No
When is Child and Adolescent Functional Assessment scale used?
Assessing outcome over time and directing case management activities
What does Child and Adolescent functional assessment scale measure?
Aggression and conduct problems between 7-17 years
How many items in the Child Behaviour Checklist?
113
What does Child Behaviour Checklist measure?
Behavioural problems and competencies of children 4-16 as reported by parents/teachers
Scores of Child Behaviour Checklist
Total score
Internalizing behaviours score
Externalizing behaviours score
Which scale is used for DSM-based diagnosis in children?
Diagnostic interview schedule for children
Which rating scale is commonly used to assess ADHD?
Conners Rating Scale
Name some scales used in Old Age Psychiatry
Geriatric Mental state schedule MMSE AMTS Alzheimers Disease Assessment Scale BEHAVE-AD Neuropsychiatry Inventory MOUSEPAD Clifton assessment procedure for the elderly Bristol Activities of Daily Living
Cut off in MMSE suggestive of cognitive impairment?
23
What does MMSE not pick up?
Frontal lobe deficits
Cut off for cognitive impairment in MMSE?
10
Which rating scale is used to assess changes in cognitive function in anti-dementia drug trials?
Alzheimers Disease Assessment scale
Is BEHAVE-AD scale self-report?
No
What does BEHAVE-AD measure?
Behavioural symptoms in patients with Alzheimers
What does Neuropsychiatric Inventory measure?
Records severity of associated behavioural symptoms in dementia over ten domains
Scoring in Neuropsychiatry Inventory
1-144
What does MOUSEPAD stand for?
Manchester and Oxford Universities Scale for the Psychopathological Assessment of Dementia
Who is MOUSEPAD administered to?
To carers by clinicians
What does MOUSEPAD measure?
Behavioural and psychiatric symptoms of dementia
What does Clifton assessment procedure for the elderly measure?
Level of disability and estimate need for care
Structure of Clifton assessment procedure for elderly
Short cognitive scale
Behavioural rating scale, divided into four sub-scales; physical disability, apathy, communication difficulties and social disturbance
What does Bristol Activities of Daily Living Scale assess?
20 daily living abilities in patients with dementia
Who is the Bristol Activities of Daily Living scale tested on?
Caregivers by trained HCPs
How many items in Positive and Negative Symptoms Scale?
30
Is the Positive and Negative Symptom scale self-reported?
No
Who is the Yale-Brown Obsessive-Compulsive scale used on?
Severity in those already with OCD
Clinician-administered
Which eating disorder scale has high sensitivity
SCOFF
Is MMPI a projective test?
No
Is MMPI self-report?
Yes
How many items in MMPI?
567:
8 psychopathology
2 of personality type
3 scales of truthfulness
Is IPDE self-report
No
What is IPDE based on?
ICD 10
What does IPDE consist of?
67 questions
57 for screening
Is Clinical Global Improvement scale self-report?
No
Structure of Clinical Global Improvement scale
Two-item - severity (current condition on 1-7)
Extent of improvement (1-7)
Where is Clinical Global Improvement Scale used?
For any psych disorder on ward or clinic
Is Brief Psychiatric Rating scale self-report?
No
Results of Brief Psychiatric Rating Scale?
Hostility-suspiciousness withdrawl-retardation Thinking disturbance Depression-anxiety Activation
What is the Scale for assessment of positive/negative symptoms used for?
Not for diagnosis
Used in studies of neurobiological correlates of symptom grouping
Structure of Scale for assessment of positive/negative symptoms
Clinician-reported
Positive symptoms- 34
Negative - 25
Is PDQ-4 self-report?
Yes
Which classification does PDQ-4 use?
DSM IV
What is used with PDQ-4?
Clinical significance scale as follow-up to estimate if trait is enduring, present in absence of other disorders and leads to distress/impairment
Which scale is available as an appendix in DSM IV?
Global assessment of function scale
Social and Occupational Functioning Assessment Scales
How many items in the Global Assessment of Functioning scale?
10 -item (100 points)
What is Global Assessment of Functioning scale based on?
Self-report and info from interview
Combines symptomatic severity, functional impairment and clinicians appraisal of functional limitation
Structure of Social and Occupational Functioning Assessment Scale?
Clinician-rated
100-oint scale
Who can administer the Short form health survey-26?
Self-administered by those 14+ years of age
What does SF-36 assess?
Limitations on physical activities due to illness Limitations in social activities Limitations in role performance Bodily pain General mental distress and well-being Limitations in role performance due to emotional problems Vitality General health perceptions
What is the most widely used psych rating scale in the NHS?
Health of the Nation Outcome scale
Who developed the Health of the Nation Outcome scale?
RCPsych in 1993
Items in Health of the nation Outcome scale?
12 measuring behaviour, impairment, symptoms and social functioning
What does the Health and Nation Outcome Scale base its measurement on?
Routine clinical assessment
What measures the internal consistency of a test?
Cronbach’s alpha
What does Cronbach’s alpha do?
Correlates each item of a test with the total score and averages the correlation coefficient
Cut-off of Cronbach’s alpha for test to be considered internally consistent?
0.7 and above
What is intraclass correlation coefficient used for?
for continuous variables
Scores of intraclass correlation coefficient
0 (unreliable) - 1 (reliable)
What is used to measure reliability in a test with nominal data of more than two categories?
Kappa or weighted kappa
What is face validity?
Subjective measure of deciding whether the test measures the construct of interest on its face value
What is construct validity?
Measures whether a test really measures the construct of interest or something else
What is unified construct validity
Both content and criterion validity
What is content validity?
Whether the contents e.g. items of the test, are in line with the objectives the test was designed to measure.
Looks for coverage across all domains thought to be related.
How can content validity be measured?
Cannot be statistically tested
Experts called to comment
What is criterion validity?
Performance against an external criterion such as another instrument (concurrent) or future diagnostic possibility (predictive)
What is concurrent validity?
Ability of a test to distinguish between subjects who differ concurrently in other measures (other instruments)
What is predictive validity?
Ability of a test to predict future group differences according to current group differences in score
What is incremental validity?
Ability of a measure to predict or explain variance over and above other measures
How can construct validity be classified?
Content & criterion validity
or
Convergent, discriminant and experimental validity
What is convergent validity?
Agreement between instruments that measure some construct e.g. BDI and Hamilton for depression.
This agreement can be tested in contrast groups e.g. depressed and non-depressed
What is discriminant validity?
Degree of disagreement between two scales measuring different constructs
What is experimental validity?
Refers to sensitivity to change. An instrument must show the difference in results when an intervention is carried out to modify the measured domain.
What is factorial validity?
Form of construct validity established via factor analysis of items in scale
What is precision?
Degree to which a calculated central value (e.g. mean) varies with repeated sampling
What leads to imprecision?
Random errors
What does a narrow variation mean?
More precise the value
What factors reduce precision?
Wide limits of the interval
2. Expecting higher confidence interval
What is accuracy?
Correctness of the mean value i.e. how close it is to the true population value
Name the three problems with predicting risk
Low base rate
Multifactorial
Unknown interactions
what is low base rate?
Events of interest being rare, therefore predictive value will be low, leading in false positive rate.
What is the multifactorial difficulty of risk assessment?
Risk is dependent on multiple factors which change over time
What are the unknown interactions in risk assessment?
Risk evaluations are time-consuming and often the degree and nature of interactions are unknown
What are stable risk factors?
Long term and enduring issues but modifiable to some extent
What is the clinical approach to risk assessment?
Clinicians subjective, intuitive judgement informed by experience and knowledge is used to estimate risk and decide treatment
How many clinical judgements on risk have been fond to be correct?
33%
What does actuarial risk approach not tell you?
Does not inform clinician about risk factors requiring targeting to minimise risk
Problems of actuarial tools?
Historical aspects given more importance
High false positive rates
Generalisation to another setting is difficult
Focused on static and stable factors rather than dynamic and modifiable
What is the structured professional judgement to risk?
Combines evidence base for risk factors with individual clinical assessment to complement psychiatric opinion
What is used in structured professional judgement of risk?
Structured, scales-based assessment
Who created the stages of risk assessment and management?
Bouch and Marshall
What are the stages in risk assessment?
Identifying need for assessment
Assessing static, stable, dynamic and future risk factors and protective factors
Individual formulation of risk applied to current presentation
Considering possible interventions/support
Anticipating impact of interventions
Developing management plan with short and long term implementations
Reviewing and revising plan with variations in risk factors
Who created the HCR-20?
Webster
What does HCR stand for?
Historical, Clinical Risk
Advantage of HCR-20?
Good inter-rater reliability
What does HCR-20 consist of?
10 historical items
5 Clinical
5 Risk management
Historical items in HCR-20
Previous violence Young age at first incident Unstable relationships Major MI Substance Use Psychopathy Employment issues PD Early maladjustment Previous supervision failure
What are the clinical items in HCR 20?
Negative attitudes to health services Active symptoms Impulsivity Treatment unresponsiveness Lack of insight
What are the risk items in HCR-20?
Management plan lacks feasibility Exposure to destabilisers (e.g. alcohol) Non-compliance Stress Lack of personal support
What is SARA?
Spousal Assault Risk Assessment
How many items in SARA?
20
What is SVR-20?
20-item scale for sexual violence risk
What is SAD PERSONS Score?
10 major demographic risk factors used to assess immediate suicidal risk in general hospital.
Name the items in SAD PERSONS SCORE
Sex - 1 if male, 0 if female A - Age, 1 if <20 or >44 D - Depression (1) P - Previous attempt (1) E - Ethanol abuse (1) R - Rational thinking loss (1) Social supports lacking (1) Organized plan (1) if lethal No spouse (1) Sickness (1) if chronic, debilitating and severe
What does Becks Hopelessness Scale consist of?
20 True/false statements focused on pessimism and about the future
Score analysis of Becks Hopelessness Scale?
0-3 - minimal suicide risk
4-8 mild
9-14 moderate
15-20 severe
How many items in Beck Scale for Suicidal Ideation?
24 self-report
How are actuarial instruments formed?
Group data obtained from high risk individuals and then applied to patient. Gives group risk
Who created CRAG?
Quinsley - 1995
What does VRAG stand for?
Violence Risk Appraisal Guide
What is VRAG based on?
Historical factors
How many items in VRAG?
12
Structure of Violence Risk scale?
23 dynamic and 6 static variables
Purpose of PCL-R (Hare)?
Diagnose psychopathy, inform risk assessment and treatment decisions.
How many items and score range in PCL-R?
20 items
0-40 score range
Cut off for diagnosis of psychopathy in PCL-R?
25
Who created Static 99?
Hanson and Thornton
Number of items in Static 99?
Ten item actuarial assessment
Who is Static 99 used in?
Male adult sex offenders at least 18 years of age at time of release into community
What does SORA stand for?
Sexual risk offender appraisal guide
What does SORA consist of?
14 item actuarial instrument that incorporates PCL_R
What is Manchester Self Harm Rule?
Actuarial instrument for self-harm risk assessment
Advantage of Manchester Self Harm Rule?
High sensitivity
Disadvantage of Manchester Self Harm Rule?
Low specificity
