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MRCPsych Part A big > Rating Scales > Flashcards

Rating Scales Flashcards

1
Q

Is Beck’s Depression Inventory self-rated?

A

Yes

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2
Q

Is GHQ self-rated?

A

Yes

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3
Q

Is the Edinburgh postnatal depression scale clinician-rated?

A

No - self-rated

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4
Q

What are schedules?

A

Based on clinical expectations

Deal with categories of disorders based on known classification systems

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5
Q

What are the types of procedures used to select items for scales?

A

Based on previous clinical literature

Based on calibration

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6
Q

What needs to be considered when selecting a screening measure for a study?

A

Characteristics of population to be screened
Psychometric properties of the instrument
Time required to complete
Ease of use
Cost of obtaining measure

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7
Q

What is GHQ used for?

A

First-level assessment in epidemiological studies before detailed schedules employed

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8
Q

Who introduced the GHQ?

A

Goldberg

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9
Q

What is the purpose of GHQ?

A

Screening tool to detect those likely to have or be at risk of developing a psychiatric disorder

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10
Q

How many items does the GHQ have?

A

28

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11
Q

Scoring of GHQ

A

Each item is a 5 point Likert, allowing total of 84

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12
Q

Name the clinician-administered diagnostic schedules

A

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

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13
Q

Which diagnostic schedules can be used by trained primary care workers?

A

Hopkins Symptom Check List

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14
Q

Which diagnostic schedules are self-report?

A

Diagnostic Interview Schedule

Patient Health Questionnaire

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15
Q

What is the aim of the Clinical Interview Schedule?

A

Identify common disorders in primary care and community 0 focus on neurosis

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16
Q

Who developed the Composite International Diagnostic Interview?

A

WHO

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17
Q

Which diagnostic schedule uses both ICD and DSM?

A

Composite International Diagnostic Interview

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18
Q

What does Diagnostic Interview Schedule study?

A

Lifetime DSM diagnosis initially, then current diagnosis

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19
Q

How many items in the Hopkins Symptoms Check list?

A

58

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20
Q

What does Hopkins symptoms check list measure?

A

Neurotic symptom distress in OP

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21
Q

Who developed the PHQ?

A

Spitzer

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22
Q

Aim of PHQ 9?

A

Diagnose common neurotic conditions in primary care

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23
Q

What does present state examination do?

A

Provides clinical diagnosis in line with ICD

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24
Q

Aim of Schedule for Affective disorders and schizophrenia?

A

Covers all major mental illness.

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25
Q

Which diagnostic schedule has a kids version?

A

Schedule for affective disorders and schizophrenia - Kiddie-SADs

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26
Q

Which diagnostic schedule has replaced the present state examination?

A

Schedule for assessment in neuropsychiatry

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27
Q

Items in total in schedule for assessment in neuropsychiatry?

A

1872

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28
Q

Which patients is the structured clinical interview for DSM IV used for

A

Patients in whom a psych diagnosis is suspected

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29
Q

Name some clinician-rated depression rating scales

A

Hamilton depression scale

Montgomery-Asberg depression rating scale

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30
Q

Name some self-rated depression rating scales

A

2 question scale/PHQ-2
Beck depression inventory
Zung depression inventory
Visual analogue scale

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31
Q

Easiest scale to quantify depression severity?

A

Visual analogue scale

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32
Q

What happens in the Visual Analogue scale?

A

10cm line where patient indicates state of mood

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33
Q

How many items in Hamilton depression rating scale?

A

17-21

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34
Q

What duration of symptoms does Hamiltion depression rating scale refer to?

A

Last 1-2 weeks

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35
Q

Which depression rating scale is a reference standard?

A

Hamilton

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36
Q

How many items in the Montgomery-Asberg depression rating scale?

A

10

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37
Q

Which depression rating scale is most sensitive to change?

A

Montgomery-Asberg Depression rating scale

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38
Q

How many items in Beck depression inventory?

A

21

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39
Q

Max score in Beck depression inventory?

A

63

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40
Q

Duration of symptoms tested in Beck depression inventory?

A

Last 2 weeks

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41
Q

Scoring in Beck depression inventory

A

0-13 - minimal
14-19 - mild
20-28 - moderate
>28 severe

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42
Q

Disadvantages of Beck Depression Inventory

A

Lacks discriminatory power among severely ill

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43
Q

How many items in Zung Depression inventory?

A

20

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44
Q

Advantage of Zung Depression Inventory

A

Avoids imbalance towards psychological factors such as Becks

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45
Q

Disadvantages of Zung Depression Inventory

A

Insensitive to change

Poor correlation with observer rating

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46
Q

When is depression rating scale appropriate for children?

A

At least 7 years of age

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47
Q

Name two depression rating scales for children

A

Reynolds Child Depression Scale

Children’s Depression Inventory

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48
Q

Number of items in Childrens Depression Inventory

A

27 - full version

10 - screening

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49
Q

At what age can Becks Depression Inventory be used?

A

14+

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50
Q

Which depression rating scale is NICE approved and has a parent version?

A

Mood and Feelings Questionnaire

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51
Q

Perinatal depression rating scales

A

Becks Depression Inventory
Edinburgh Postnatal depression scale
Center for Epidemiological Studies - depression scale

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52
Q

Duration of symptoms in Edinburgh postnatal depression scale?

A

Last 7 days

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53
Q

How many items are there in Edinburgh postnatal depression scale?

A

10

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54
Q

Characteristics of Geriatric depression scale?

A

Fewer somatic symptoms
Symptoms in past week
Yes/no answers

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55
Q

Depression rating scales for patients with cognitive deficits

A

Cornell Scale for Depression in Dementia - for caregiver

Hamilton Rating Scale for Depression

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56
Q

Which depression rating scale is for use in hospital?

A

Brief Assessment Schedule Depression cards - avoids patients being overhead - choose from a deck of 19 cards

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57
Q

Depression rating scale for those with schizophrenia?

A

Calgary Depression Scale for Schizophrenia

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58
Q

Name some Alcohol rating scales

A

CAGE
AUDIT
MAST
CIWA

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59
Q

Score to suggest alcohol misuse in CAGE?

A

2

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60
Q

How many items in AUDIT?

A

10

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61
Q

Score suggestive of alcohol misuse in AUDIT

A

8 or more

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62
Q

Score suggestive of dependence drinking in women and men in AUDIT?

A

13 - women

15 - men

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63
Q

Which alcohol questionnaire is recommended by WHO for primary care use?

A

AUDIT

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64
Q

How many items in MAST?

A

25, self-report

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65
Q

Scoring system of MAST

A

3-5 - early indicator of problems

6 or more - problem drinker

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66
Q

How many items does CIWA consist of?

A

10

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67
Q

Total score in CIWA?

A

67

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68
Q

Name some scales used in child psychiatry

A

Child and Adolescent Functional Assessment Scale
Child behaviour checklist
Diagnostic interview schedule for children
Conners rating scale

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69
Q

Is the Child and Adolescent Functional assessment scale self-reported?

A

No

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70
Q

When is Child and Adolescent Functional Assessment scale used?

A

Assessing outcome over time and directing case management activities

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71
Q

What does Child and Adolescent functional assessment scale measure?

A

Aggression and conduct problems between 7-17 years

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72
Q

How many items in the Child Behaviour Checklist?

A

113

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73
Q

What does Child Behaviour Checklist measure?

A

Behavioural problems and competencies of children 4-16 as reported by parents/teachers

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74
Q

Scores of Child Behaviour Checklist

A

Total score
Internalizing behaviours score
Externalizing behaviours score

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75
Q

Which scale is used for DSM-based diagnosis in children?

A

Diagnostic interview schedule for children

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76
Q

Which rating scale is commonly used to assess ADHD?

A

Conners Rating Scale

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77
Q

Name some scales used in Old Age Psychiatry

A 
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
78
Q

Cut off in MMSE suggestive of cognitive impairment?

A

23

79
Q

What does MMSE not pick up?

A

Frontal lobe deficits

80
Q

Cut off for cognitive impairment in MMSE?

A

10

81
Q

Which rating scale is used to assess changes in cognitive function in anti-dementia drug trials?

A

Alzheimers Disease Assessment scale

82
Q

Is BEHAVE-AD scale self-report?

A

No

83
Q

What does BEHAVE-AD measure?

A

Behavioural symptoms in patients with Alzheimers

84
Q

What does Neuropsychiatric Inventory measure?

A

Records severity of associated behavioural symptoms in dementia over ten domains

85
Q

Scoring in Neuropsychiatry Inventory

A

1-144

86
Q

What does MOUSEPAD stand for?

A

Manchester and Oxford Universities Scale for the Psychopathological Assessment of Dementia

87
Q

Who is MOUSEPAD administered to?

A

To carers by clinicians

88
Q

What does MOUSEPAD measure?

A

Behavioural and psychiatric symptoms of dementia

89
Q

What does Clifton assessment procedure for the elderly measure?

A

Level of disability and estimate need for care

90
Q

Structure of Clifton assessment procedure for elderly

A

Short cognitive scale
Behavioural rating scale, divided into four sub-scales; physical disability, apathy, communication difficulties and social disturbance

91
Q

What does Bristol Activities of Daily Living Scale assess?

A

20 daily living abilities in patients with dementia

92
Q

Who is the Bristol Activities of Daily Living scale tested on?

A

Caregivers by trained HCPs

93
Q

How many items in Positive and Negative Symptoms Scale?

A

30

94
Q

Is the Positive and Negative Symptom scale self-reported?

A

No

95
Q

Who is the Yale-Brown Obsessive-Compulsive scale used on?

A

Severity in those already with OCD

Clinician-administered

96
Q

Which eating disorder scale has high sensitivity

A

SCOFF

97
Q

Is MMPI a projective test?

A

No

98
Q

Is MMPI self-report?

A

Yes

99
Q

How many items in MMPI?

A

567:
8 psychopathology
2 of personality type
3 scales of truthfulness

100
Q

Is IPDE self-report

A

No

101
Q

What is IPDE based on?

A

ICD 10

102
Q

What does IPDE consist of?

A

67 questions

57 for screening

103
Q

Is Clinical Global Improvement scale self-report?

A

No

104
Q

Structure of Clinical Global Improvement scale

A

Two-item - severity (current condition on 1-7)

Extent of improvement (1-7)

105
Q

Where is Clinical Global Improvement Scale used?

A

For any psych disorder on ward or clinic

106
Q

Is Brief Psychiatric Rating scale self-report?

A

No

107
Q

Results of Brief Psychiatric Rating Scale?

A 
Hostility-suspiciousness
withdrawl-retardation
Thinking disturbance
Depression-anxiety
Activation
108
Q

What is the Scale for assessment of positive/negative symptoms used for?

A

Not for diagnosis

Used in studies of neurobiological correlates of symptom grouping

109
Q

Structure of Scale for assessment of positive/negative symptoms

A

Clinician-reported
Positive symptoms- 34
Negative - 25

110
Q

Is PDQ-4 self-report?

A

Yes

111
Q

Which classification does PDQ-4 use?

A

DSM IV

112
Q

What is used with PDQ-4?

A

Clinical significance scale as follow-up to estimate if trait is enduring, present in absence of other disorders and leads to distress/impairment

113
Q

Which scale is available as an appendix in DSM IV?

A

Global assessment of function scale

Social and Occupational Functioning Assessment Scales

114
Q

How many items in the Global Assessment of Functioning scale?

A

10 -item (100 points)

115
Q

What is Global Assessment of Functioning scale based on?

A

Self-report and info from interview

Combines symptomatic severity, functional impairment and clinicians appraisal of functional limitation

116
Q

Structure of Social and Occupational Functioning Assessment Scale?

A

Clinician-rated

100-oint scale

117
Q

Who can administer the Short form health survey-26?

A

Self-administered by those 14+ years of age

118
Q

What does SF-36 assess?

A 
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
119
Q

What is the most widely used psych rating scale in the NHS?

A

Health of the Nation Outcome scale

120
Q

Who developed the Health of the Nation Outcome scale?

A

RCPsych in 1993

121
Q

Items in Health of the nation Outcome scale?

A

12 measuring behaviour, impairment, symptoms and social functioning

122
Q

What does the Health and Nation Outcome Scale base its measurement on?

A

Routine clinical assessment

123
Q

What measures the internal consistency of a test?

A

Cronbach’s alpha

124
Q

What does Cronbach’s alpha do?

A

Correlates each item of a test with the total score and averages the correlation coefficient

125
Q

Cut-off of Cronbach’s alpha for test to be considered internally consistent?

A

0.7 and above

126
Q

What is intraclass correlation coefficient used for?

A

for continuous variables

127
Q

Scores of intraclass correlation coefficient

A

0 (unreliable) - 1 (reliable)

128
Q

What is used to measure reliability in a test with nominal data of more than two categories?

A

Kappa or weighted kappa

129
Q

What is face validity?

A

Subjective measure of deciding whether the test measures the construct of interest on its face value

130
Q

What is construct validity?

A

Measures whether a test really measures the construct of interest or something else

131
Q

What is unified construct validity

A

Both content and criterion validity

132
Q

What is content validity?

A

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.

133
Q

How can content validity be measured?

A

Cannot be statistically tested

Experts called to comment

134
Q

What is criterion validity?

A

Performance against an external criterion such as another instrument (concurrent) or future diagnostic possibility (predictive)

135
Q

What is concurrent validity?

A

Ability of a test to distinguish between subjects who differ concurrently in other measures (other instruments)

136
Q

What is predictive validity?

A

Ability of a test to predict future group differences according to current group differences in score

137
Q

What is incremental validity?

A

Ability of a measure to predict or explain variance over and above other measures

138
Q

How can construct validity be classified?

A

Content & criterion validity
or
Convergent, discriminant and experimental validity

139
Q

What is convergent validity?

A

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

140
Q

What is discriminant validity?

A

Degree of disagreement between two scales measuring different constructs

141
Q

What is experimental validity?

A

Refers to sensitivity to change. An instrument must show the difference in results when an intervention is carried out to modify the measured domain.

142
Q

What is factorial validity?

A

Form of construct validity established via factor analysis of items in scale

143
Q

What is precision?

A

Degree to which a calculated central value (e.g. mean) varies with repeated sampling

144
Q

What leads to imprecision?

A

Random errors

145
Q

What does a narrow variation mean?

A

More precise the value

146
Q

What factors reduce precision?

A

Wide limits of the interval

2. Expecting higher confidence interval

147
Q

What is accuracy?

A

Correctness of the mean value i.e. how close it is to the true population value

148
Q

Name the three problems with predicting risk

A

Low base rate
Multifactorial
Unknown interactions

149
Q

what is low base rate?

A

Events of interest being rare, therefore predictive value will be low, leading in false positive rate.

150
Q

What is the multifactorial difficulty of risk assessment?

A

Risk is dependent on multiple factors which change over time

151
Q

What are the unknown interactions in risk assessment?

A

Risk evaluations are time-consuming and often the degree and nature of interactions are unknown

152
Q

What are stable risk factors?

A

Long term and enduring issues but modifiable to some extent

153
Q

What is the clinical approach to risk assessment?

A

Clinicians subjective, intuitive judgement informed by experience and knowledge is used to estimate risk and decide treatment

154
Q

How many clinical judgements on risk have been fond to be correct?

A

33%

155
Q

What does actuarial risk approach not tell you?

A

Does not inform clinician about risk factors requiring targeting to minimise risk

156
Q

Problems of actuarial tools?

A

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

157
Q

What is the structured professional judgement to risk?

A

Combines evidence base for risk factors with individual clinical assessment to complement psychiatric opinion

158
Q

What is used in structured professional judgement of risk?

A

Structured, scales-based assessment

159
Q

Who created the stages of risk assessment and management?

A

Bouch and Marshall

160
Q

What are the stages in risk assessment?

A

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

161
Q

Who created the HCR-20?

A

Webster

162
Q

What does HCR stand for?

A

Historical, Clinical Risk

163
Q

Advantage of HCR-20?

A

Good inter-rater reliability

164
Q

What does HCR-20 consist of?

A

10 historical items
5 Clinical
5 Risk management

165
Q

Historical items in HCR-20

A 
Previous violence
Young age at first incident
Unstable relationships
Major MI
Substance Use
Psychopathy
Employment issues
PD
Early maladjustment
Previous supervision failure
166
Q

What are the clinical items in HCR 20?

A 
Negative attitudes to health services
Active symptoms
Impulsivity
Treatment unresponsiveness
Lack of insight
167
Q

What are the risk items in HCR-20?

A 
Management plan lacks feasibility
Exposure to destabilisers (e.g. alcohol)
Non-compliance
Stress
Lack of personal support
168
Q

What is SARA?

A

Spousal Assault Risk Assessment

169
Q

How many items in SARA?

A

20

170
Q

What is SVR-20?

A

20-item scale for sexual violence risk

171
Q

What is SAD PERSONS Score?

A

10 major demographic risk factors used to assess immediate suicidal risk in general hospital.

172
Q

Name the items in SAD PERSONS SCORE

A 
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
173
Q

What does Becks Hopelessness Scale consist of?

A

20 True/false statements focused on pessimism and about the future

174
Q

Score analysis of Becks Hopelessness Scale?

A

0-3 - minimal suicide risk
4-8 mild
9-14 moderate
15-20 severe

175
Q

How many items in Beck Scale for Suicidal Ideation?

A

24 self-report

176
Q

How are actuarial instruments formed?

A

Group data obtained from high risk individuals and then applied to patient. Gives group risk

177
Q

Who created CRAG?

A

Quinsley - 1995

178
Q

What does VRAG stand for?

A

Violence Risk Appraisal Guide

179
Q

What is VRAG based on?

A

Historical factors

180
Q

How many items in VRAG?

A

12

181
Q

Structure of Violence Risk scale?

A

23 dynamic and 6 static variables

182
Q

Purpose of PCL-R (Hare)?

A

Diagnose psychopathy, inform risk assessment and treatment decisions.

183
Q

How many items and score range in PCL-R?

A

20 items

0-40 score range

184
Q

Cut off for diagnosis of psychopathy in PCL-R?

A

25

185
Q

Who created Static 99?

A

Hanson and Thornton

186
Q

Number of items in Static 99?

A

Ten item actuarial assessment

187
Q

Who is Static 99 used in?

A

Male adult sex offenders at least 18 years of age at time of release into community

188
Q

What does SORA stand for?

A

Sexual risk offender appraisal guide

189
Q

What does SORA consist of?

A

14 item actuarial instrument that incorporates PCL_R

190
Q

What is Manchester Self Harm Rule?

A

Actuarial instrument for self-harm risk assessment

191
Q

Advantage of Manchester Self Harm Rule?

A

High sensitivity

192
Q

Disadvantage of Manchester Self Harm Rule?

A

Low specificity

MRCPsych Part A big (22 decks)

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