Crazy Meds Rates the Psychiatric Rating Scales

Whenever you read the methods section of a drug study, clinical trial, or really good abstract for either, you’ll find one or more assessment scales used to rate how well a drug performed. These are the tests given to people who are taking a drug (or a placebo). Researchers will ask different types of questions: yes or no, multiple guess, on a scale of one to kill-me-now, and so forth. Based upon the responses the people taking the pills give, the researchers are supposedly able to determine how well a med works. “Supposedly” because some of these tests seem pretty useless. One factor of determining if a study is any good is the rating scale(s) used.

Rating scales are used to test other subjective things, like pain. Here are a few of the more popular psychiatric rating scales used in trials and studies, and our opinions about them.

• Clinical Global Impression (CGI), reflects the impression of a skilled observer, fully familiar with the manifestations of schizophrenia, although it is vague enough to apply to any form crazy, about the overall clinical state of the patient. In other words, how loony your doctor thinks you are.
• Brief Psychiatric Rating Scale (BPRS), a multi-item inventory of general psychopathology originally used to evaluate the effects of drug treatment in schizophrenia, but can be applied to many forms of brain cooties. The BPRS psychosis cluster (conceptual disorganization, hallucinatory behavior, suspiciousness, and unusual thought content) is considered a particularly useful subset for assessing actively psychotic schizophrenic patients. It’s like the MMPI of crazy.
• The Positive and Negative Syndrome Scale (PANSS) a 30-item rating instrument evaluating the presence/absence and severity of positive, negative and general psychopathology. The scale was developed from the BPRS and includes other symptoms, such as aggression, thought disturbance, and depression. This is a much more accurate test, if standardized tests are your thing, of insanity. The version I have, from a hospital in Zurich, has some explanations/instructions/refinements in German.
• Scale for the Assessment of Negative Symptoms (SANS). This test measures the five A’s of negative symptoms:
  • affect flattening (Looking and sounding as if you don’t give a rat’s ass about anything, not making eye contact, etc.)
  • alogia (Poverty of speech, from not saying much, to using simpler words, to not talking at all.)
  • avolition-apathy (Really not giving a shit before you were put on antipsychotics)
  • anhedonia-asociality (Nothing is pleasurable, you don’t like people, i.e. you’re a natural born goth.)
  • attentional impairment (Huh? What did you say?).

• Young Mania Rating Scale (YMRS) . Whoopee shit. You score 0–60 on all of 11 items assessing irritability, disruptive/aggressive behavior, sleep, elevated mood, speech, increased activity, sexual interest, language/thought disorder, thought content, appearance, and insight. Basically if you didn’t have the bipolar diagnosis already the test would be fairly pointless in trying to figure out if you bipolar, schizophrenic, obsessive-compulsive, or even ADHD. Especially ADD/ADHD. Compare the YMRS with Adult ADHD Self-Report Scale (ASRS-v1.1) and this quiz at Psych Central. Which are you? Hypomanic, ADD or both?
  

• The Hamilton Rating Scale For Depression (HAM-D) - 21 questions where your doctor determines how much your life sucks.
• Beck Depression Inventory (BDI) - Another 21 questions where you give your opinion on how much your life sucks. Or you’ve been watching / listening to too much Glenn Beck. Or both. It’s something like that.
• The Montgomery-Asberg Depression Rating Scale (MADRS) - For doctors too busy to ask the 21 questions on the HAM-D. No shit. As with the YMRS it’s popular with drug companies because MADRS scores improve regardless of the antidepressant used.
• The Manic State Rating Scale (MSRS) - 26 behaviors, scored on frequency and intensity. Covers dysphoric and euphoric manias. There’s less cross-over with ADD/ADHD than the YMRS and as someone who has lived long-term manias and has been around plenty of people in dysphoric and euphoric manias, this is a much better indicator of mania. Does OK as far as standardized tests go in covering mixed states. But, really, if a doctor is going to being giving you a test for bipolar, this is the one to take - of the ones I’ve evaluated - as far as the manic phase goes.

For all other scales which might be used in various studies that I haven’t put up here or created links to, you’ll probably find them at Shawn Thomas’ treasure trove of psychiatric rating scales on Neurotransmitter.net or Psychiatric University Hospital Zurich’s page of Rating Instruments and Questionnaires (with both English and German questionnaires). Just don’t go downloading a bunch of these to self-diagnose. That’s just wasting your doctor’s time because you probably have a bad case of cyberchondria.

So which ones are the best? That’s a tough call. the YMRS and MADRS are worthless. In my utterly untrained and amateur opinion a combination of the CGI and an appropriate test or tests for the condition being evaluated. So for bipolar mania CGI, MSRS and PANSS or BPRS would be the way to go.

Date created 17 Nov 2010 - 17:24 Page Creator: Jerod Last edited by:

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¹ While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.

² Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?
[begin rant] I rent a dedicated server for Crazy Meds. It’s sitting on a rack somewhere in Southern California along with a bunch of other servers that other people have rented. The hardware is identical, but no two machines have exactly the same operating systems. I don’t even need to see what is on any of the others to know this. If somebody got their server at the exact same time, with the exact same features as I did, I’m confident that there would be noticeable differences in some aspects of the operating systems. So what does this mean? For one thing it means that no two computers in the same office of a single company have the same operating system, and the techs can spend hours figuring out what the fuck the problem could be based on that alone. It also means that application software like IP board that runs the forum here has to have so many fucking user-configurable bells and whistles that even when I read the manual I can’t find every setting, or every location that every flag needs to be set in order for a feature to run the way I want it to run. And in the real world it means you can get an MBA not only with an emphasis on resource planning, but with an emphasis on using SAP - a piece of software so complex there are now college programs on how to use it. You might think, “But don’t people learn how to use Photoshop or Adobe Illustrator in college?” Sure, in order to create stuff. And in a way you’re creating stuff with SAP. But do you get a Bachelor of Fine Arts degree with an emphasis on Photoshop?
Back in the Big Iron Age the operating systems were proprietary, and every computer that took up an entire room with a raised floor and HVAC system, and had less storage and processing power than an iPhone, had the same operating system as every other one, give or take a release level. But when a company bought application software like SAP, they also got the source code, which was usually documented and written in a way to make it easy to modify the hell out of it. Why? Because accounting principles may be the same the world over, and tax laws the same across each country and state, but no two companies have the same format for their reports, invoices, purchase orders and so forth. Standards existed and were universally ignored. If something went wrong it went wrong the same way for everyone, and was easy to track down. People didn’t need to take a college course to learn how to use a piece of software.
I’m not against the open source concept entirely. Back then all the programmers read the same magazines, so we all had the same homebrew utilities. We even had the forerunner to QR Code to scan the longer source code. Software vendors and computer manufacturers sponsored conventions so we could, among other things, swap recipes for such add-ons and utilities. While those things would make our lives easier, they had nothing to do with critical functions of the operating system. Unless badly implemented they would rarely cause key application software to crash and burn. Whereas today, with open source everything, who the hell knows what could be responsible some part of a system failing. [/end rant]