Innovations In Clinical Neuroscience

NOV-DEC 2017

A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience

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11 ICNS INNOVATIONS IN CLINICAL NEUROSCIENCE November-December 2017 • Volume 14 • Number 11–12 R E V I E W state of the patient. Although research psychologists, in an effort to attain a high degree of objectivity, frequently define anxiety in terms of physical signs, in the Brief Scale, observable physical signs of tension and subjective experiences of anxiety are rated separately. Although anxiety and tension tend to vary together, developmental research with an earlier form of the Brief Scale indicated that the degree of pathology in the two areas might be quite different in specific patients. A patient, especially when under the influence of a drug, might report extreme apprehension but give no external evidence of tension whatsoever, or vice versa. In rating the degree of tension, the rater should attend to the number and nature of signs of abnormally heightened activation level such as nervousness, fidgeting, tremors, witches, sweating, frequent changing of posture, hypertonicity of movements, and heightened muscle tone. Grandiosity. Grandiosity involves the reported feeling of unusual ability, power, wealth, importance, or superiority. The degree of pathology should be rated relative to the discrepancy between self-appraisal and reality. The verbal report of the patient and not his or her demeanor in the interview situation should provide the basis for evaluation of grandiosity. Care should be taken not to infer grandiosity from suspicions of persecution or other unfounded beliefs where no explicit reference to personal superiority as the basis for persecution has been elicited. Ratings should be based upon opinions currently held by the patient, even though the unfounded superiority may be claimed to have existed in the past. Although these definitions are extensive, the BPRS itself tended to be reproduced as a single page with briefer definitions and without specifically identifying items as based on verbal report or observation. The original 16 items from the BPRS were augmented by two more items—Excitement and Disorientation—to create the 18-item scale that is most familiar to users. These later items are also included in the PANSS as Items P4 and G10. Additional items in the PANSS have their roots in an earlier scale developed by Stanley Kay and colleagues—the Psychopathology Rating Schedule—briefly described by Singh and Kay. 8 Although all 18 items from the BPRS are retained, the definitions of items in the PANSS do not always correspond to those in the BPRS. SCALE MODIFICATION By 1978, the original 1962 article describing the BPRS was designated a "citation classic," having received over 500 citations. A more recent Google search noted that it has now been cited over 10,000 times. The value of the BPRS is perhaps best attested to by the numerous modifications that were made to it over the years, most of which continued to incorporate the name of the scale in some fashion. To note some of the most important developments: • There were numerous efforts made to include definitions in the printed versions of the scale itself. Efforts were made to define the anchor points for the ratings. In the original scale, they are all seven-point ratings ranging from 1= not present to 7= extremely severe. Woerner and colleagues provided a widely used version of the BPRS with detailed anchors. 9 • Other efforts were made to expand the number of items in the scale in order to provide a more comprehensive assessment of areas that seemed to be under-represented. 10 • Some versions (often without citation) added items, defined anchors, reordered the scale to group those based on observation and those based on report together, and offered probe questions to guide the interviewer. One found online is called BPRS 4.0 and is un-authored. • CONCLUSION One definition of value is when a trademark is used as a generic; Kleenex and Jello come to mind. From that perspective, the BPRS became the name for numerous scales that went far beyond the original. Perhaps the distinction of the PANSS is that it changed the terrain by creating both a new name and a brand. With its remarkable utility in the development of new antipsychotic medications and other treatments in schizophrenia and psychotic disorders today, the PANSS will help to shape the future of assessment tools, and ultimately psychiatric research. REFERENCES 1. Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull. 1987;13(2): 261–276. 2. Overall JE, Gorham DR. The Brief Psychiatric Rating Scale. Psychol Rep. 1962;10(3):799–812. 3. Lorr M, Jenkins RL, Holsopple JQ. Multidimensional Scale for Rating Psychiatric Patients. V A Tech Bull. 1953;10-507. 4. Lorr M, McNair DM, Klett CJ, Lasky JJ. A confirmation of nine postulated psychotic syndromes. Am Psychol. 1960;15:495. 5. Lorr M, Klett CJ, McNair DM, Lasky JJ. Inpatient Multidimensional Psychiatric Scale Manual. Palo Alto, CA: Consulting Psychologists Press; 1962. 6. Singh MM, Kay SR. A comparative study of haloperidol and chlorpromazine in terms of clinical effects and therapeutic reversal with benztropine in schizophrenia: theoretical implications for potency differences among neuroleptics. Psychopharmacologia. 1975;43(2):103–113. 7. Woerner MG, Mannuzza S, Kane JM. Anchoring the BPRS: an aid to improved reliability. Psychopharmacol Bull. 1988;24(1):112–117. 8. Lukoff D, Neuchterlein KH, Ventura J. Manual for Expanded Brief Psychiatric Rating Scale (BPRS). Schizophr Bull. 1986;12(4):594–602. ICNS

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