RATING SCALES IN

PSYCHIATRY

DR. AYESHA ABDUL HAMEED

FCPS II PSYCHIATRY
ABBASI SHAHEED HOSPITAL
 WHAT IS PSYCHOMETRY
The science of measuring Mental Faculties and is
the branch of psychology that deals with the
design, administration, and interpretation of
quantitative and qualitative tests for the
measurement of psychological variables such as
intelligence, aptitude, and personality traits and
clinical disorders such as
anxiety,depression,mania,obssessions &
compulsions, psychosis , somatic
symptoms,functional impairment etc….
 PROPERTIES OF GOOD PSYCHOMERTRIC
TESTS
• It should have a Proper Objective with a measurable
content.
• It should be Standardized with properly defined norms.
• It should be Reliable i.e have a consistency of outcome.
• It should be Validated i.e it should check what is
supposed to be checked.
• It should be Sensitive i.e ability to check true positives.
• It should be specific i.e ability to check true negatives.
 OBJECTIVE TESTS
• Are structured , standardized measurement
devices having self report nature.

• Tendency to use straight forward testing such as

direct Q`s about person`s opinion of themselves &
unambiguous instructions about completing the
test.
 PROJECTIVE TESTS
• Focus on Latent Unconcious aspect of personality

• They are designed not to measure 1 particular

personality characteristic but personality as a whole.

• Are Unstructured having indirect approach with

general instructions for the pt. to express their
fantasies

• Responses to Projective stimuli are inkblots,

pictures, drawing a picture etc….
 Some important projective tests

• Rorschach Inkblot Test

• Thematic apperception test (TAT)
• Sentence Completion test (SCT)
• Holtzman Inkblot test (HIT)
• Draw a person ( DAP ) & House Tree Person ( HTP )
• Human Figure drawing
• Make a picture story (MAPS)
• Word association Technique (WAT)
 IMPORTANT SCALES TO BE DISCUSSED
• BECKS DEPRESSION INVENTORY (BDI)
• BECKS ANXIETY INVENTORY (BAI)
• HAMILTON RATING SCALE FOR DEPRESSION(HAMD)
• HAMILTON RATING SCALE FOR ANXIETY (HAM-A)
• HOSPITAL ANXIETY AND DEPRESSION SCALE (HADS)
• MONTGOMERY & ASBERG DEPRESSION RATING SCALE (MADRS)
• YOUNG`s MANIA RATING SCALE (YMRS)
• YALE BROWN OBSESSSIVE COMPULSIVE SCALE (YBOCS)
• SCALE FOR THE ASSESSMENT OF POSITIVE SYMPTOMS (SAPS)
• SCALE FOR THE ASSESSMENT OF NEGATIVE SYMPTOMS (SANS)
• POSITIVE AND NEGATIVE SYNDROME SCALE (PANSS)
• BRIEF PSYCHIATRIC RATING SCALE (BPRS)
• GENERAL HEALTH QUESSIONNAIRE (GHQ-12)
• ABNORMAL INVOLUNTARY MOVEMENTS SCALE
(AIMS)
• MINI MENTAL STATE EXAMINATION (MMSE)
• MINNESOTA MULTIPHASIC PERSONALITY
INVENTORY (MMPI)
• QUALITY OF LIFE SCALE (QOLs)
• EDINBERG POST NATAL DEPRESSION SCALE (EPNDS)
• AUDIT ALCOHOL SCREENING QUESSIONNAIRE
• SEVERITY OF ALCOHOL DEPENDANCE
QUESSIONNAIRE (SADQ)
• BECKS SUICIDAL INTENT SCALE
• BRADFORD SOMATIC INVENTORY
• SHEEHAN DISABILITY SCALE
• DAP / HTP( DRAW A PICTURE & HOUSE TREE
PERSON TEST )
• THEMATIC & CHILDREN APPERCETION TEST ( TAT &
CAT )
• RORSCHACH INKBLOT TEST
• WECHSLER ADULT INTELLIGENCE TEST (WAIS III R )
• WECHSLER INTELLIGENCE SCALE FOR CHILDREN
(WISC III R )
• STANDFORD BINET TEST
• RAVEN PROGRESSIVE MATRICES
• BENDER GESTALT TEST
 PURPOSE OF RATING SCALES
• FOR THE CONFIRMATION OF DIAGNOSIS.

• FOR DETECTION OF SEVERITY OF ILLNESS.

• FOR ASSESSING EFFECT OF TREATMENT .

• FOR ASSSESSING RECOVERY .

• FOR ASSESSING PROGNOSIS.

BECKS DEPRESSION INVENTORY (bdi ii)
• Devised by Dr. Aron .T.Beck
• Widely used to see the severity of depression.
• Total 21 items.
• Maximum score 63.
• Cut off is 17

Standard cutoffs
0–9: indicates minimal depression
10–18: indicates mild depression
19–29: indicates moderate depression
30–63: indicates severe depression.

• Reliability ( Alpha = 0.92 )

 BECKS ANXIETY INVENTORY (bai)

• Devised by Aron .T. Beck.

• Used to assess the severity of Anxiety.
• There are 21 items.
• Maximum score is 63.
• Cutoff is 36
• Standard cutoff
• 0 – 21 → mild
• 22 – 35 → moderate
• > 36 → severe
 HAMILTON RATING SCALE FOR DEPRESSION
HAM-D
• Developed by Dr. Max.Hamilton
• Used see the severity of depression & effects of Rx.
• Total items are 17.(usually 1st 17 are considered)
• Maximum score is 76.
• Cut off is 20.
• Standard cutoffs
• 0-7 → Normal * sensitivity (76.7)
• 8-13→ mild * specificity (88.7)
• 14-18→ moderate
• 19-22→ severe
• >23 → profound
• Hamilton rating scale for depression is also avalilable of 29
items (HRSD 29)
 HAMILTON RATING SCALE FOR
ANXIETY HAM-A
• Devised by Dr.Max.Hamilton .
• Used to see the severity of anxiety & effect of Rx.
• Total items are 14.
• Maximum score is 56.
• Cutoff is 14.
• Standard cutoffs
• 0 -17→ mild
• 18-25 → moderate
• 26 – 30 → severe
• > 30 → very severe
 HOSPITAL ANXIETY AND DEPRESSION SCALE (HADS)
• Devised by Zigmund & snaith.
• Used for the diagnosis of both anxiety & depression.
• There are 14 items
• 7 items for depression & 7 items for anxiety.
• Cutoff for anxiety is 8/21
• anxiety = sensitivity 0.9 , specificity 0.78
• Cutoff for depression 8/21
• Depression = sensitivity 0.83 , specificity 0.79
• Standard cutoffs
• 0-7 → normal
• 8-10 → borderline
• > 11 → case
 MONTGOMERY & ASBERG DEPRESSION
RATING SCALE (MADRS)
• Developed by Montgomery & Asberg.
• Used to see the severity of depression & effects of Rx.
• Consists of definitions of both psychological & biological
questions of depression.
• Total items are 10.
• Maximum score is 60.
• Cutoff is < 7.
• Standard cutoffs
• < 7 → Normal & shows remission
• 8 – 19 → mild
• 20-34 → moderate
• > 34→ severe
 YALE BROWN OBSESSIVE COMPULSIVE
SCALE ( YBOCS )
• Devised by Wayne Goodman.
• Used to assess severity of obsessive compulsive disorder.
• Total items are 10.( 5 items for obsesssions & 5 items for
depression)
• Maximum score is 40.
• Cutoff is < 7.
• Standard cutoffs
• 0-7 → borderline/sub clinical
• 8-15→ mild
• 16 – 23 → moderate
• 24 -31→ severe
• > 32→ profound or extreme
YOUNGS MANIA RATING SCALE (YMRS)
• Devised by Youngs et .al.
• Used to assess the severity of mania.
• Total items are 11 ( 4 items are rated from 0-8
& 5 items are rated from 0-4 )
• Maximum score is 60.
• Cutoff is <20.
• Standard cutoffs
• 0-12→ normal
• 13 - 20→ mild to moderate
• > 20 severe mania
 Scale for the assessment of
positive symptoms (saps)
• Devised by Nancy Anderson.
• Used to see the severity of positive symptoms of
schizophrenia.
• Total items are 35.
• Maximum score is 175.
• Cutoffs????
 SCALE FOR THE ASSESSMENT OF
NEGATIVE SYMPTOMS (SANS)
• Devised by Nancy Anderson.
• Used to see the severity of negative symptoms in
schizophrenia.
• Total items are 24.
• Total score is 120.
• Cutoffs????
Positive and negative syndrome
scale (panss)
• Devised By Stanley Key, Lewis Opler & Abraham Fiszbein.
• Used to assess the severity of schizophrenia symptoms.
• Its has 3 subscales (positive , negative & gen.psychopathology
subscale)
• There are 30 items ( 7 items for +ve s/scale with total score 49, 7
items for –ve s/scale with total score 49 & 16 items of gen.
psychopathology with total score 112)
• Maximum score of PANSS = 210 , Minimum Score = 30
• Standard cutoffs (for severe symptoms)
• +ve subscale → >18
• -ve subscale → > 21
• Gen.psychopathology→ >37
 BRIEF PSYCHIATRIC RATING
SCALE (BPRS)
• Devised by Gorhem & Overall.
• Used to measure severity of psychiatric symptoms
& effect of Rx in schizophrenia.
• There are 18 – 24 items.
• Maximum score is 126 – 168.
• Sensitivity = 85.71
• Specificity = 86.11
• Cutoff ???
GENERAL HEALTH QUESSIONNAIRE (GHQ-12 &
GHQ-28)
• GHQ-12 a shorter version devised by Goldberg.
• Having 12 items.
• GhQ-28 is another version devised by Goldberg &
Hillar having 28 items ,total score of 84.
• More advanced version has 60 items.
• Used for the symptoms of Somatic, Anxiety,
Depression, & social Dysfunction.
• GHQ is used in primary care , by GP`s & community
survey`s for psychiatrist judgement of “case” and
“non-case”.
• Score > 24 → indicates Distress.
ABNORMAL INVOLUNTARY MOVEMENTS SCALE
(AIMS)
• Devised by W. ECDEU
• Used to assess the level of dyskinesias in patients taking neuroleptic
medications.
• There are 14 items.
• Maximum score is 28 (as only 1st 7 items are included for scoring)
• Items 1-4 → for orofacial movements
• Items 5-6 → for extremeties
• Item 7 → for truncal movements
• Item 8-10 → for global judgements about abnormal Movements.
• Item 11-14 → for dental status
• Standard cutoffs
• < 9 → normal
• 10-18 → mild
• 19-35 –> moderate
• > 35 → severe
 QUALITY OF LIFE SCALE (QOL)
• Devised by John Flanagan.
• Use to assess Quality of life in chronic illness group
patients.
• Measuring quality of life across patient groups and
cultures which is conceptually distinct from health
status or other causal indicators of quality of life.
• It’s a 16 item scale.
• Maximum score is 112.
• Highly validated.(0.92) with reliabilty of (0.84)
EDINBERG POST NATAL DEPRESSION
SCALE (EPNDS)
• Devised by J.L Cox et. al
• Used a screening tool for depression in 8
weeks postpartum women.
• Total items are 10.
• Maximum score = 30
• Standard Cutoffs
• <10→ possible depression
• Always look item 10 for suicidal thoughts.
• Sensitivity → 0.88 , Reliability → 0.87
(BJP)
 BECKS SUICIDAL INTENT SCALE
• Devised by Aron. T . Beck & Maria kovac`s
• Used to assess the severity of suicidal attempts &
risk of future suicide / suicidal attempts.
• It has 21 items
• Maximum score is 63.
• Standard Cutoff
• 0-19 → low risk
• 20-28→ medium risk
• >29 → high risk
 SEVERITY OF ALCOHOL DEPENDANCE
QUESSIONNAIRE (SADQ)
• Devised by Stockwell. T et.al
• Used as a screening tool to measure the presence &
level of alcohol dependance.
• Total items are 20
• Maximum score is 60
• Standard cutoffs
• <16→ mild dependance
• 15-30→ moderate dependance
• >31→ severe dependance
 AUDIT ALCOHOL SCREENING
TOOL(AUDIT-II)
• Devised by Thomas.F.Babor
• Used to determine Alcohol Consumption,Alcohol
dependance & Alcohol related problems.
• Total items are 10.
• Maximum score is 40.
• Standard cutoffs
• 0-7→normal
• 8-15→ possible increasing risk
• 16-19→ higher risk
• > 20→ possible dependance
CLIICAL INSTITUTE FOR WITHDRAWL
ASSESSMENT OF ALCOHOL revised
(CIWA-Ar)
• Its an objective scale .
• Its has 10 items.
• Maximum score is 67.
• Standard cutoffs
• <10 → mild withdrawl
• 11-15 → moderate withdrawl
• > 15 → severe withdrawl
• SCORE < 10 doesn’t need additional medication
for withdrawl.
SHORT ALCOHOL WITHDRAWL SCALE
(SAWS)

• It’s a self reporting scale.

• Administered within 24 hrs of alcohol withdrawl.
• It has 10 items.
• Mmaximum score is 30.
• Score > 12 needs Rx.
 SHORL ALCOHOL WITHRAWL SCALE
(SAWS)
Withdrawl Sx None (0) Mild (1) Modrate (2) Severe (3)
1. Anxious
2. Sleep
disturbance
3. Memory
problems
4. Nausea
5. Restless
6. Tremor
(shakes)
7. Confused
8. Sweating
9. Miserable
10. Heart
pounding
 CAGE QUESTIONNAIRE
• Devised by John. A. Ewing.
• Its an extensively used screening tool for
identifying “ Alcoholism “
• It has 4 questions.
• Every question is rated “0” or “1”.
• Score of 2 or greater indicates clinical significance.
• It has sensitivity of 93%
• And specificity of 76%
 BRADFORD SOMATIC INVENTORY (BSI)
• Devised by D.B Mumford et.al
• Used to assess symptoms of anxiety & depression.
• In JCPSP a study caried out in Rawalpindi general
hospital by Saeed K,Mubasshir,Mumford et al 2001
• Comparison of self-reporting questionnaire(SRQ) and
Bradford Somatic Inventory(BSI) as screening
instruments for psychiatric morbidity in community
settings in Pakistan.
The results suggested that SRQ had a sensitivity of 78%
and specificity of 81% for women and 78% sensitivity
and 70% specificity for men. The sensitivity value for
BSI for women was 82% and specificity was 71%
.
Journal of the College of Physicians and Surgeons Pakistan2011(4):229-231
SHEEHAN DISABILITY SCALE(sds)
• Devised by David . V. Sheehan
• used to assess functional impairment in 3 domains ,
work/school , social & family life.rated from 0 to 10.
• Used by Researchers & practicing Clinicians.
• Brief self Report Tool.
• Max. score 30.
• Theres no specific cutoff
• But score > 5 in any of the three domains indicates
marked functional impairment.
• Sensitivity → 83%
• Specificity→ 69%
 Mini mental state examination (mmse)
• Developed by Folstein.
• Used as a screening tool to assess the severity of cognitive impairment in
dementias,delerium,CVA, SOL,disorders of conciousness, psychiatric
disorders& effect of Rx in all these conditions.
• Assess “5” components (Orientation,Registration,Attention&calculation
,Recall and )
• 11 Questions
• Total score is 30
• Cutoff is 23.

Standard Cutoff`s (peperdine APA)

• < 10 → severe
• 11-20→ moderate
• 21-26→ mild
• > 27 → normal
• Errors in MMSE could be d/t * illiteracy *minimal schooling in <8yrs * in
elderly ppl >80yrs age
• Sensitivity = 87%
 RORSCHACH TEST
• Devised by Swiss Psychiatrist Herman Rorschach.
• Most frequently used projective personality test.
• Very useful in eliciting psychodynamic formulations,defence
mechanisms and subtle disorder of thinking.
• Consists of 10 ambiguous inkblots 5 coloured & 5 black n white
inkblots.
• It has two phases free association & inquiry phase.
• After free association phase,examiner inquire for imp. Aspects of
each response which is crucial to scoring.
• Psychologists keeps record of patients verbitem responses along
with initial reaction time & tim e spent on each card.
• Response in schizophrenia→ it cud be a predator? Lots of ink
predator ,have you seen that movie?
• In anxiety → I have to think about it ..it may be a tree.
• In depression→ it could be a leaf.
 DRAW A PERSON TEST (DAP) & HOUSE TREE
PERSON TEST (HTP)
• Devised by Florence Goodenough.
• It was initially used to measure intelligence but now in
adults as well.
• As a screening tool to detect organicity.
• Easily admministered by asking” Draw the best person
you can’
• Psychologist interrogate during drawing that what Is he
doing? What are his best questions??
• Draw a House-Tree-Person (HTP) is a modification of
Draw a person (DAP).
• Interpretation is that drawing a person represents self
image in the drawing.
 MINNESOTA MULTIPHASIC PERSONALITY
INVENTORY (MMPI)
• Devised by Starke Hatheway & J.C Mckinley.
• Most commonly used objective personality test , this is self
report inventory.
• MMPI-1 has 567 items
• MMPI – A (adolescence) has 350-478 items.
• MMPI 2 has 399 items in pak by LaeQ MirZa.
• Gives scores on 10 clinical scales to saperate medical &
psychiatric patients from normal controls.
10 clinical scales are
• hysteria,hypomania,hypochondriasis,psychopathic
deviation,psychasthenia,paranoia,depression,schizophrenia,
musculinity-feminity,social introversion.
• Now the interpretation of responses is done on computer
systems as well. synopsis
Thematic ( TAT ) & CHILDREN (CAT)
APPERCEPTION TEST
• Devised by Henry Murray & Christina Morgan.
• Its an another projective personality test.
• It consists of series of 30 pictures & one blank card .
• The person is asked to construct the story about the
pictures.and psychoanalysis is done on the basis of
persons emotional conflicts,theme of success & failure,
jealousy&competition,Relationships opinion,aggression
& sexuality,use of frequent defence mechanisms etc..
• Child version is called Children Appreception Test (CAT)
WECHsLER ADULT INTELLENCE SCALE
(WAIS III Revised)
• Devised by David wechsler.
• Done in 16 to 89 yrs + to measure I.Q.
• Have “7” verbal scale & “7” performance scale.
7 verbal scale includes
• Information,comprehension,vocabulary,similaritie
s,letter no# sequencing,arithmetic,& digit span.
7 performance scale includes
• Block design,picture completion,picture
arrangement,matrix reasoning,object
assessing,symbol search, digital symbol.
 WECHsLER INTELLIGENCE SCALE
FOR CHILDREN (WISC III R )
• Devised by David Wechsler.
• Done in children of 6 to 14 yr to measure I.Q.
• Have 4 indexes.
1. Verbal comprehensive index
Information,comprehension,vocabulary,similarities,a
bsurdities,word reasoning.
2. Perceptual reasoning index→ block designs,matrix
reasoning,picture designs,picture completion
3. Working memory index→digit span, letter numb
sequencing,arithmetic.
4. Processing speed index→ coding , symbol search
WISC IV
 RAVEN PROGRESSIVE MATRICES
• Devised by John. C . Raven.
• Used in 5 years till Elderly.
• Used to measure Reasoning ability (meaning
making ability) , Eductive ability ( ability to think
clearly with sense of complexities) &
Reproductive ability (ability to store & reproduce
information) , & Abstract ability.
• Its made up of a booklet of 60 matrices and a
mcQ`s paper.
• Used as an I.Q tool in Autism & Asperger`s
Syndrome.
 STANDFORD BINET TEST
• Devised by Alfred Binet & Theodr simon.
• Is the 1st I.Q test.
• Covers from 2-24 years of age.
• Scores I.Q ,verbal , visual / abstract/ quantitative
reasoning, short term memory & standard age.
• Yields score of mental age & I.Q as well.
• Disadvantages of standford Binet→
• culturally biased test,
• only assess academic achievement but not social
functioning,
• unreliable in children with I.Q <50
 BENDER GESTALT TEST
• Devised by Lauretta Bender.
• Used in both children & adults.
• Used to assess cognitive d/o, MR, aphasias, psychosis,neurosis &
malingering.
• Most frequently used as screening device in adults for organic dysfunction.
• Consists of 9 – 16 saperate design cards & to copy each design on a
saperate card,observation forms,motor & perception test,(1st 13 items →
4-7 yrs 5 – 16 items → > 8yrs) & theres no time limit.
• Adminstration includes copy & recall phase.
• Evaluation depends upon the designs produced & relation to one another
or whole spatial background

• Impairment in this test indicates Rt. Non-dominant occiptoparietal lobe

dysfunction responsible for visuo-spatial & perception skills.

• Reliability → 0.88 , validity copy phase (0.65) & recall phase(0.44)

THANK YOU