Scales Flashcards
Depression inventory that allows patients to self rate
Becks depression inventory (BDI)
Cgi scale = clinical global impression scale
Global measure of improvement where 1 = very much improved, 2 much impr, 3 minimally impr, 4 no change, 5 minimally worse, 6 much worse, 7 very much worse
Panss
Positive and negative symptoms score 30 items each scored 1-7 7 positive items 7 negative items 16 general psychopathology
Results: Mild sx 50s to 60s Moderate sx 70s to 80s Marked sx 90s to 100s Severe sx over 110
Gad 7
For anxiety 7 items , 3 pts each 5-9 = mild 10-14 moderate 15-21 = severe
Internal state scale
Both manic and depressive sx Self rates (not clinician) 15 items on 10 pt scale 0= rarely or none 9= very much so, most of time
Children’s depression rating revised - CDRS-R
Clinical purpose Clinician rated Dx and screening clear Sum of rating on 17 items most on 7 point scale ** no standard interp of #'s!!
Children’s depression inventory
CDI
Clinical purpose Self rated Dx and screening value both 27 items on 3 pt scale, scores range from 0-54 Response = <18 points
First few days depression sx improve in:
Appetite
Agitation
Insomnia sleep
1-3 weeks Activity Sex drive Self care Concn Memory Movements
2-4 weeks Depressed mood relief Pleasure Fewer hopeless feelings Subsiding of suicidal thoughts
Upsdrs
unified Parkinson’s disease rating score
Total of 195 pts with higher score meaning worsening disability
Modified hoehn and yahr scale
Parkinson’s disease
Stages I to V with worsening disability at higher scores
Schwab and England ADL scale
For Parkinson’s disease
Rated 0 to 100% with LOWER percentages represent worsening disease (higher percents mean better ADL accomplishment)
Mmpi 2
Minnesota multiphasic personality inventory 2
Personality disorder
Diagnosis by clinical rated
567 true false items
PAI
For personality disorder
Personality assessment inventory
By clinician for diagnosis
344 responses on 2 part sheet
MCMI-III
Millikan clinical multiracial inventory
- assessment of DSM-IV related personality disorders and clinical syndromes
By clinician for diagnosis
Scale for behavioral sx in dementia
Neuropsychiatric Inventory NPI
Scale for assessment of response to dementia Pharm tx (hope to slow decline)
Adas Alzheimer's disease assessment scale 21 items 1 to 5, 5 being worst Goal: short term improve 4 pts Long term > 12 months maintain baseline
BPRS
Brief psychotic rating scale
- response = 20 to 40% reduction
18 items version commonly used
7 point scale: 1= not present, 7=most server
Sx measured include observations by clinician (tension emotional withdrawal mannerisms motor sx uncooperativeness disorientation)
Panss
Positive and negative symptom scale
Response = 20-30% reduction
30 items - sub scales for pos neg and general psychopathology rated on 1-7 1=not present, 7=extremely severe
SANS
Scale for the Assessment of Negative Sx
Response = variable
25 items - 20 individual 5 global
Rated on 0-5 scale global summary 0-25,
5 domains including affective flattening/blunting, alogia, avolition, anhedonia/asociality, attention
CGI
Clinical global impression
Two different - assessment and improvement
CGI-S =severity of illness scale - measures level of illness
CGI improvement scale 1 v much improve 4 no change 7 v much worse
Response - mostly much improve to v much improved
Clinician or self rated
Symptom assessment
1-7 severity rating with 3 sub scales
1=normal or very much improved , 7= most extremely ill or very much worse
GAF
Global Assessment of Functioning
Assess functional level (most impaired) 0-100 (highest functioning)
Calgary Depression Scale for Schizophrenia
Assessment of depressive sx
9 pt scale (from 0-3) to assess depressive sx other than pos, neg, and extrapyramidal
** score above 6 has an 82% specificity and 85% sensitivity for predicting presence of major depressive episode
SAPS
Scale for assessment of positive symptoms
Response: generally 30%
Assesses pos sx : hallucinations delusions bizarre behavior and positive formal thought disorder
34 items (30 individual and 4 global items) 0-5 scale: 0=none 5=severe
Individual items 0-150
Global summary 0-20
Domains: hallucinations , delusions, bizarre behavior, pos formal thought disorder)
Barnes scale
Akathisia
Simpson angus scale
Eps
Tardiff dyskinesia scales
Aims
Discus
- complete baseline and at least biannually
Bars
Barnes akathisia rating scale
Screen for akathisia
2 or more implies akathisia
SAS
Simpson angus scale For Parkinsonism and other eps 10 item scale each on 0-4 continuum Global score - total Points divided by items - 0.3 or less is wnl, more is problem
ESRS
Extra pyramidal symptom score
Screen for eps incl Parkinsonism akathisia dystonia tardive dyskinesia
6 questions on subjective experience 7 rater assessed items
Response not defined
May not differentiate between dystonia and dyskinesia
AIMS
Abnormal involuntary movement scale
To assess for dyskinesia like TD- not diagnostic but quantifies involuntary movements to aid in diagnostics
- response score not defined
12 items 0-4, 2 yes no, scales 0-40 measure subject awareness and incapacitation
Discus
Dyskinesia identification system condensed user scale
** score of 5 or above =RED FLAG
Assessment for monitoring TD
15 items 0-4
PSQI
Pittsburgh sleep quality index
Subjective assessment of sleep quality, latency, duration, disturbances and sleep meds used and daytime functioning
19 items produce 7 component scores that yield a global score. First 4 questions are quantitative follower by 0-3 scle
Score rabge 0-21, >5 suggests poor sleep quality
ESS
Epworth Sleepiness Scale
Self rated clinician scored
Assesses likelihood of falling a asleep in a given situation (watching tv in a car reading etc)
8 questions 0-3 each (0=no chance 3=high chance)
Pts who score >10 should seek medical attention, 10-15= excessively/very sleepy, >16=dangerously sleepy
SSS
Stanford sleepiness scale Self rated Rates daytime alertness Likert 1-7, 1=active, 7=struggling to stay wake Simple
ISI
Insomnia severity index
Self rated
Assessed pt perception o insomnia
7 items each 0-4 with total score up to 28,
Higher scores more indicative of insomnia
DBAS
Dysfunctional beliefs and attitudes about sleep questionnaire
Evaluates negative sleep cognitive
Self rated
Multiple versions
30 items on 100mm analog
0=strongly disagree, 100=agree strongly
Bigger scores indicate more negative sleep attitudes
AHi
Apnea Hypopnea index # apneaa or hypoppneas per hr AHI>= 5 associate with cv risk 5-14 mild 15-19 moderate >30 seberw
BFI
Brief Fatigue Inventory
OSA
Subjective scale measuring fatigue and impact on ADL
Self rated
9 items 0-10 Likert scale with huger score more severe
PDSS
Pediatric daytime sleepiness scale
For OSA
Measure of subjective daytime sleepiness for middle school kids
Self rated
8 questions 0-4 solar 0=never 4=very often but #3 inversely scored
Score >15 associated wit poorer academic achiever
Abnormal: >26 for 6/7th and >30 8th graders
RLSQ
RLS symptoms questionnaire Self an spouse rated for sx severity 10 questions on scale of 0-4 (0 none , 4 severe) Total score: 1-10 mild 11-20 moderate 21-30 severe 31-40 very severe
IRLS
International RLS rating scale Clinician rating Same rating as RLSQ 10 questions on 0-4 scale none-very Total score 1-10 mild 11-20 moderate 21-30 severe 31-40 very severe
CH-RLSq
Cambridge Hopkins
RLS questionnaire
7 items
Definite RLS defined by answers to certain questions
Validated and provided sens 87% spec 94%
CIWA-Ar
Clinical institute if withdrawal assessment - alcohol, revised
- gold std withdrawal assessment, part of sx triggered approach
- clinician admin
- 10 items max score 67
Scores:
18 severe withdrawal
— lower score implies less alcohol withdrawal severity, higher scores indicate need for medications
AUDIT
Alcohol use disorders identification test
Evaluates quant, freq, physiological dependence on alcohol, harmful use
10 items, score 0-40
Score 8 or above identified heavy drinkers
“Zones” of interventions based on score
CAGe
Cut down Angry/annoyed Guilty Eye opener - self or clin - 4 questions- yes to 2 or more likely problem- prompts for further assessment
ASI
Addiction severity index -past 30 days or lifetime Semi structured interview that addresses 7 problem areas: Medical status Employment and support Alcohol use Drug use Legal status Family social status Psychiatric status
Frequency, durations, severity of problems
Pt and interviewe rating included
Problem severity measured by: “need for additional treatment” + composite score to measure problem severity
Compare to national database /”:9 to previous composite scores (eg baseline)
COWS
Clinical opiate withdrawal scale
Purpose: Monitor course of withdrawal sx an effectiveness of med regimens
Scoring 0 to 5- 4 I 5 severely symptomatic
Total score:
5-12 mild
13-24 moderate25-36 moderately severe
>36 severe withdrawal
ASI
Addiction severity index
Assessment for 30 days or lifetime
Patient and interviewer ratings
Composite score compare to nationwide Database as well as to pt earlier previous scores
Overt aggression scale
Four categories Clinician rated Checklist for observable aggressive/violent behavior 4 domains: Verbal aggression Physical aggression against self Physical aggression vs objects Physical aggression vs others Higher score indicates more observed aggression
CMAI
Assesses agitated behaviors in elderly Cohen Mansfield agitation inventory Scores 0-30 C- m - I agitated! (Cmai)
CABS
Corrigan agitated behavior scale
Degree to which specific behaviors are observed
Degree ratings from 1 absent to 4 extreme, score from 14-56
Cabs are never zero!
Panss-EC
Positive and negative syndrome scale- Excitatory Component! Evaluates 5 items: Poor impulse control Tension Hostility Uncooperativeness Excitement/tension
1=absent, 4=moderate, 7=extreme
Higher score more ill
Most studies use score of 14 or 15 for inclusion
Ybocs
10 items from zero to 4 Ratings include observations during interviews as well as average occurrence for each item during last 7 days 32-40 extremely severe sx 24-31 severe sx 16-23 moderate sx 8-15 Mild sx 0-7 subclinical
Response - at least 25% reduction in sx , remission score <8
YMRS
Young mania rating scale Assess severity of abnormality Clinician rated Screening symptom severity 11 items max score 60 25 severe mania *not used to evaluate treatment
MSRS
Manic state rating scale
Assess severity of manic sx
Useful for pts who are difficult to interview
26 items with 0-5 frequency and 1-5 intensity score
Clinical rated for screening and sx severity
ISS
Internal state scale
Assesses both manic and depressive scores
15 items on 10 pt scale
0 not at all
9 very much so most of time
Hamilton depression scale
Ham D
HSRD
Clinic chain rated
Assess severity depression
17 items multiple versions 7-29 ?’s
Response : score 22very severe depression
Madrs
Montgomery Asberg depression rating scale
Response : <10 10 items 0-6 sx absent 7-19 mild depression 20-34 moderate depression 35-60 severe depression
IDS
Inventory of depressive symptomatology
Assessment severity Response score < 12 30 items < 12 normal 13-22 mildly ill 23-30 moderately ill 31-38 moderately to severely ill
Zung self rating depression scale
Self rated Screening tool and assessment of sx Response < 50 20 items 70 severe depression
Beck depression inventory
BDI
Self rated Dx and assessment of behavioral manifestations of depression Response: score <9 21 items 0-9 minimal 10-16 mild 17-29 moderate 30-63 severe
Quick inventory of depressive symptomatology
QIDS-SR
Self rated 16 item version of IDS Assess severity Response score < 5 0-5 normal 6-10 mild 11-15 moderate 16-20 severe >20 very severe
PHQ-9
Patient Health Questionairre 9
Self rated for dx and assess tx response
9 items
Response = drop of 5 pts from baseline
5 pt drop is adequate response
2-4 pt drop prob inadequate response
1 pt drop - no change, or increase - inadequate response
