Measurement

Brief Psychiatric Rating Scale

The BPRS is the most commonly used rating scale for patients suffering from schizophrenia who are participating in research studies

to determine the effectiveness of medication treatments. It is completed by an experienced rater. It is rarely used in the clinical

setting. There is evidence that using a 0-6 scale creates a more sensitive score than a 1-7 scale.

This form consists of 24 symptom constructs, each to be rated in a 7-point scale of severity ranging from 'not present' to 'extremely severe' If a specific symptom is not rated, mark 'NA' (not assessed). Circle the number headed by the term that best describes the patient's present condition.

1	2	3	4	5	6	7
not present	very mild	mild	moderate	moderately severe	severe	extremely severe


1	Somatic concern	NA	1	2	3	4	5	6	7
2	Anxiety	NA	1	2	3	4	5	6	7
3	Depression	NA	1	2	3	4	5	6	7
4	Suicidality	NA	1	2	3	4	5	6	7
5	Guilt	NA	1	2	3	4	5	6	7
6	Hostility	NA	1	2	3	4	5	6	7
7	Elated Mood	NA	1	2	3	4	5	6	7
8	Grandiosity	NA	1	2	3	4	5	6	7
9	Suspiciousness	NA	1	2	3	4	5	6	7
10	Hallucinations	NA	1	2	3	4	5	6	7
11	Unusual thought content	NA	1	2	3	4	5	6	7
12	Bizarre behavior	NA	1	2	3	4	5	6	7
13	Self-neglect	NA	1	2	3	4	5	6	7
14	Disorientation	NA	1	2	3	4	5	6	7
15	Conceptual disorganization	NA	1	2	3	4	5	6	7
16	Blunted affect	NA	1	2	3	4	5	6	7
17	Emotional withdrawal	NA	1	2	3	4	5	6	7
18	Motor retardation	NA	1	2	3	4	5	6	7
19	Tension	NA	1	2	3	4	5	6	7
20	Uncooperativeness	NA	1	2	3	4	5	6	7
21	Excitement	NA	1	2	3	4	5	6	7
22	Distractibility	NA	1	2	3	4	5	6	7
23	Motor hyperactivity	NA	1	2	3	4	5	6	7
24	Mannerisms and posturing	NA	1	2	3	4	5	6	7

4, 7, 12, 13, 22, and 23 were added for the expanded version

1. SOMATIC CONCERNS - degree of concern over present bodily health. Rate the degree to which physical health is perceived as a problem by the client, whether they have a realistic basis or not. Have you been concerned about your physical health in the past week? Have you had any physical illness or seen a medical doctor lately? What does s/he say is wrong? Has anything about your health interfered with your ability to perform your daily activities? Did you ever feel that parts of your body had changed or stopped working properly?

2. ANXIETY - reported apprehension, fear, panic or worry. Rate only the client's statements, not observed anxiety which is rated under the item "Tension". Have you been worried at all during the past week? What do you worry about? Have you felt nervous or frightened? Do you find yourself worrying about things like money or the future? When you are feeling nervous, do your palms sweat, or your heart race? How often do you feel this way? How much of the time have you been (use respondent's description of anxiety)? Does it interfere with your usual activities?

3. DEPRESSION - include sadness, unhappiness, anhedonia, preoccupation with depressing topics, hopelessness, loss of self-esteem. Don't include vegetative symptoms. What has your mood been like in the past week? Have you felt depressed, sad or down in the dumps? Do you find you've lost interest in things you used to enjoy, like being with friends or watching TV? How long do these sad feelings last? Do they make it difficult for you to do your usual activities? When you feel like that, are you able to stop and think of happier things when you want to?

4. SUICIDALITY - expressed desire, intent or actions to harm or kill oneself. Has felt as though life is not worth living, or felt like ending it all. If reports suicidal ideation, does the client have a specific plan? Have you felt that life wasn't worth living? Have you thought about harming or killing yourself? Have you felt tired of living or as though you would be better off dead? Have you ever felt like ending it all? How often have you thought about (use patient's description of suicide)? Did you (Do you) have a specific plan?

5. GUILTY - Overconcern or remorse for past behavior. Rate only the client's statements; do not infer guilty feelings from depression, anxiety or neurotic defenses. In the past week, is there anything you feel guilty about, or feel ashamed of? Do you tend to blame yourself for things that have happened in the past? How often have you been thinking about this? Does it interfere with your usual activities? Have you told anyone else about these feelings?

6. HOSTILITY - animosity, contempt, belligerence, threats, arguments, tantrums, property destruction, fights and other expressions of hostile attitudes or actions. In the past week, how have you been getting along with others? Do you find you've been unusually grumpy, or easily irritated by other people? How do you show it? In the past week, have you found you've been losing your temper or getting so irritable that you shout at others, start arguments or get into fights? Have you hit anyone in the past week?

7. ELEVATED MOOD - a pervasive, sustained and exaggerated feeling of well-being, cheerfulness, euphoria, optimism that is out of proportion to the circumstances. Have you felt so good or high that other people thought that you were not your normal self? Have you been feeling cheerful and "on top of the world" without any reason? Did it seem like more than just feeling good? How long did it last?

8. GRANDIOSITY - exaggerated self-opinion, self-enhancing conviction of special abilities or powers or identity as someone rich or famous. Rate only client's statements, not his or her demeanor. In the past week, did you often feel superior or special compared to other people? Do you think you have any special abilities or powers? What are they? In the past week, have you thought that you might be somebody rich or famous? Have you told anyone else about this, or acted on these ideas?

9. SUSPICIOUSNESS - expressed or apparent belief that other persons have acted maliciously or with discriminatory intent. Include persecution by supernatural or other non human agencies. Do you feel uncomfortable in public? Does it seem as though others are watching you? Are you concerned about anyone's intentions toward you? Is anyone going out of their way to give you a hard time, or trying to hurt you? Do you feel in any danger? How often have you been concerned that (use consumer's description)?

10. HALLUCINATIONS - reports perceptual experiences in the absence of relevant external stimuli. Some people say they can hear noises or voices when no one else is around. Has this happened to you in the past week? (If hears voices..) What do the voices say? In the past week, did you ever have visions or see things that others do not see? Did you smell any strange odors that others don't smell? (If yes to any hallucinations...) How do you explain these things? How often did you experience these (use respondent's description of hallucinations)? Have these experiences made it difficult to go about your usual routine?

11. UNUSUAL THOUGHT CONTENT - unusual, odd, strange or bizarre thought content. (thought insertion, withdrawal, broadcast, grandiose, somatic, persecutory delusions) In the past week, did you ever feel that someone/ something could control your thoughts/behavior, or that someone could read your mind? Have you been receiving any special messages from people/ objects around you? Have you seen references to yourself on TV or in newspapers in the past week? Is anything like electricity or radio waves affecting you? Are thoughts being put in your head that are not your own? How often do these strange things happen to you?

12. BIZARRE BEHAVIOR - reports of behaviors which are odd, unusual or psychotically criminal. Not limited to interview period. Include inappropriate sexual behavior and inappropriate affect. Have you done anything that has attracted the attention of others? Have you done anything that could have gotten you into trouble with the police? Have you done anything that seemed unusual or disturbing to others?

13. SELF NEGLECT - hygiene, appearance or eating behavior below usual expectations, below socially acceptable standards, or life threatening. How has your grooming been lately? How often do you take showers? Has anyone (parents/ staff) complained about your grooming or dress? Do you eat regular meals?

14. DISORIENTATION - does not comprehend situations or communications, such as questions asking during the entire interview. Confusion regarding person, place or time. May I ask you some standard questions we ask everybody? How old are you? What is the date? What is this place called? What year were you born? Who is the prime minister?

15. CONCEPTUAL DISORGANIZATION - degree to which speech is confused, disconnected, vague or disorganized. Rate tangentiality, circumstantiality, sudden topic shifts, incoherence, blocking.

16. BLUNTED AFFECT - restricted range in emotional expressiveness of face, voice and gestures. Marked indifference or flatness even when discussing distressing topics.

17. EMOTIONAL WITHDRAWAL- deficiency in client's ability to relate emotionally during interview situation. Presence of "invisible barrier" between client and interviewer. Include withdrawal apparently due to psychotic processes.

18. MOTOR RETARDATION - reduction in the energy level evidenced by slowed movements and speech, reduced body tone, decreased number of spontaneous body movements. Rate on the basis of observed behavior of the patient only.

19. TENSION - observable physical and motor manifestations of tension, nervousness and agitation. Self-reported experiences of tension should be rated under the item "anxiety".

20. UNCOOPERATIVENESS - resistance and lack of willingness to cooperate with the interview. The uncooperativeness might result from suspiciousness.

21. EXCITEMENT - heightened emotional tone, or increased emotional reactivity to interviewer or topics being discussed, as evidenced by increased intensity of facial expressions, voice tone, expressive gestures or increase in speech quantity and speed.

22. DISTRACTIBILITY - degree to which observed sequences of speech and actions are interrupted by stimuli unrelated to interview. Distractibiltiy is rated when client shows a change in the focus of attention or marked shift in gaze.

23. MOTOR HYPERACTIVITY - increase in the energy level evidenced by more frequent movement and/ or rapid speech.

24. MANNERISMS/ POSTURING - unusual and bizarre behavior, stylized movements or acts, or any postures which are clearly uncomfortable orinappropriate.1234567