Innovations In Clinical Neuroscience

NOV-DEC 2017

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

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14 ICNS INNOVATIONS IN CLINICAL NEUROSCIENCE November-December 2017 • Volume 14 • Number 11–12 R E V I E W from the prior factor analyses reported by Degan, Wittenborn, and Guetin, but only considered those syndromes that could be evaluated through clinical interviews. 10 He asserted that the actual formulation for the syndromes was based primarily on empirical analyses and thus was unhampered by theoretical or diagnostic biases—a premise that was heavily critiqued by others. 11,15 With the IMPS, Lorr also sought to classify several syndrome-based patient types, showing that there were six in all. He hoped this finding would spark a reexamination of the 1952 version of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Rather than securing an intellectually derived consensus approved by the members of the American Psychiatric Association, he sought instead to introduce observational and statistically driven approaches to typology. 9,10 Lorr et al 17 evaluated versions of the scale and constructs using data from a national study on the effects of medications. Multiple group factor analysis was conducted based on hypothesized groupings of variables and it yielded the same 10 syndromes as the initial unrevised form, thus providing evidence of the validity of these syndromes to the authors of the IMPS. 16 The final instrument comprised 75 items and the MSRPP, with several exceptions. The most obvious was the list of 10 syndromes (Table 1). Lorr also eliminated the "unratable" category, converted the bipolar scales into unipolar continua, and added two sets of descriptors to express intensity and frequency in some of the scales. 10 He furthermore emphasized precision, clarity, and utility, with the goal of improving the reliability of the IMPS. At the time, he viewed the processes of diagnosis and assessment to be in disarray and the psychiatric and psychological training programs to still be in their infancy. Lorr anticipated that the individuals who would likely use the IMPS had experience in interviewing psychiatric patients and were familiar with psychosis. At the time, there was no standardized procedure for conducting a psychiatric interview. For the IMPS, it was recommended that interviewers check their ratings against another rater during their first administrations. To assure reliability, Lorr recommended the routine use of two raters to describe a single patient. Raters were advised to come to consensus when their opinions differed, but Lorr considered it permissible to average ratings. As he himself noted, his scales were equally a test of the presence of severity of a patient's symptoms as well as a test of the clinician's ability to detect those symptoms. 12 Lorr openly acknowledged the limitations of his instrument. Though it demonstrated good internal consistency and strong inter-rater reliability, the instrument's overall validity remained in question. As designed, the IMPS was intended for use in research and patient management. While Lorr anticipated that the IMPS would be able to detect change over time, some aspects of the IMPS did not appear to support his assumption that open-ward patients would exhibit less severe symptomatology across the instrument's domains. Lorr found that scores of the Disorientation, Anxious Intropunitiveness, and Retardation and Apathy categories were not as reduced over time as he had hypothesized. Lorr next turned his attention to typology TABLE 1. Evolution of Items Across the MSRPP, IMPS and BPRS MSRPP (Lorr et al, 1953) IMPS (Lorr et al, 1962) BPRS (Overall & Gorham, 1962) BPRS (Overall & Gorham, 1988) Manic Excitement/ Schizophrenic Excitement Excitement n/a Excitement Anxious Depression Anxious Intropunitiveness Anxiety Anxiety Paranoid Suspicion Paranoid Projection Suspiciousness Suspiciousness Grandiose Expansiveness Grandiose Expensiveness Grandiosity Grandiosity Perceptual Distortion Perceptual Distortion Hallucinatory Behavior Hallucinatory Behavior Activity Level Retardation & Apathy Motor Retardation Motor Retardation Disorientation Disorientation n/a Disorientation Conceptual & Thinking Disorganization Conceptual Disorganization Conceptual Disorganization Conceptual Disorganization Hostile Aggressiveness Hostile Belligerence Hostility Hostility n/a n/a Tension Tension n/a Motor Disturbance Mannerisms & Posturing Mannerisms & Posturing n/a n/a Guilt Feelings Guilt Feelings n/a n/a Uncooperativeness Uncooperativeness n/a n/a Unusual Thought Content Unusual Thought Content n/a n/a Blunted Affect Blunted Affect n/a n/a Somatic Concern Somatic Concern Withdrawal n/a Emotional Withdrawal Emotional Withdrawal Retarded Depression n/a Depressive Mood Depressive Mood MSRPP: Multidimensional Scale for Rating Psychiatric Patients; IMPS: Inpatient Multidimensional Psychiatric Scale; BPRS: Brief Psychiatric Rating Scale; n/a: not applicable

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