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?).
As negative symptoms are common in the autistic, it should be obvious why schizophrenia was almost as common a diagnosis as mental retardation before “autism” existed as a label; and why there is still occasional misdiagnosing in both directions today.
  • 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?
Hell, in the short term under the right conditions a freaking placebo can quell the manic symptoms as rated by the YMRS. That’s why longer trials and better metrics are required. In the short run, all sorts of non-med approaches will actually work to bring someone down from a manic high for a day or a week. (By the way, these are great emergency tactics if a benzodiazepine is unavailable or inappropriate.) That’s why Bach Flower Remedies or that Serenity crap appear to work in the short term. And why the miracle drug Placebo will sometimes beat a med in one of its short-duration trials when only the YMRS is used. It’s part of the reason why so many of us fall into the trap of thinking we can deal with our illness without meds, or with dangerously bogus “treatments.” But in the long term failure to deal with mania leads to kindling, and that will lead to a mental meltdown that will put you in the lock ward of the psych hospital. If you’re lucky.


  • 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 listening to too much Beck. 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 might find them at either Neurotransmitter.net’s treasure trove of psychiatric rating scales 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.

Another important thing to keep in mind is who sponsors the study, as that usually tends to make the results more favorable for the med in question, on average 3.6 times more likely, according to this Yale study. When I can I’ll include the sponsor of a study. These will all be studies with links you can go to.

Two additional papers along similar lines are Why Current Publication Practices May Distort Science and Why Most Published Research Findings Are False. This is why we also factor in a lot of anecdotal evidence in our conclusions regarding the likelihood of meds working, the prevalence of various side effects, etc.

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Crazymeds Rates the Psychiatric Rating Scales by Jerod Poore is copyright © 2010
Date created November 13, 2010, at 03:38 PM Page Creator: Jerod Poore Last edited by: JerodPoore on 2014–02–26

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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 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.

3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?* I don’t even need my big-ass rant any more. Heartbleed has made my case for me. And that’s just the one that got all the media attention. The very nature of an open source operating system makes security as much of an illusion as anonymity on teh Intergoogles. Before you flip out too much: the domain Crazymeds is hosted on uses a version of SSL that is not affected by the Heartbleed bug. That’s one of the many reasons why I pay a lot of money and keep this site on Lunarpages.

* Yes, I know I’m using open source browsers. I also test the site using the now-defunct IE and Safari browsers. Their popularity - and superiority - killed IE and Safari, so that’s why I rely on the open source browsers. It’s like brand vs. generic meds. Sometimes the generic is better than the brand.

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