Which of the following scales can be used to measure drug induced Parkinsonism?
The Simpson-Angus scale was devised to measure drug-induced parkinsonism, providing standardised ratings for rigidity, tremor and salivation. The scale is entirely sign led.
Montgomery-Asberg scale14%Brief psychiatric rating scale5%Yale-Brown scale9%Simpson-Angus scale64%Clinical global impression scale8%
The Simpson-Angus scale was devised to measure drug-induced parkinsonism, providing standardised ratings for rigidity, tremor and salivation. The scale is entirely sign led.
Scales and assessment tools
Questions often arise which require candidates to know a bit about the various questionnaires and interviews that are used in psychiatry.
The college is keen on asking if certain assessment tools are self-rated or require clinical assistance. See table.
| Self rated | Clinician rated |
|---|---|
| BDI (Beck depression inventory) | BPRS (Brief psychiatric rating scale) |
| GHQ (General health questionnaire) | MADRS (Montgomery-Asberg depression rating scale) |
| GDS (geriatric depression scale) | HAMD (Hamilton depression rating scale) |
| ZSRDS (Zung self rated depression scale) | HAMA (Hamilton anxiety rating scale) |
| HAD (Hospital Anxiety depression scale) | PANSS (Positive and negative syndrome scale) |
| EPDS (Edinburgh postnatal major depression scale) | CGI (Clinical global impression) |
| AIMS (Abnormal involuntary movement scale) | |
| Y-BOCS (Yale-Brown Obsessive compulsive scale) | |
| YMRS (Young mania rating scale) | |
| GAF (Global assessment of functioning) | |
| SAS (Simpson-Angus scale) | |
| CAMDEX (Cambridge Mental Disorders of the Elderly Examination) | |
| Cornell Scale for Depression in Dementia | |
| Brief Assessment Schedule Depression Cards (BASDEC) |
Candidates need to have a working knowledge of the most frequently used scales.
| Condition | Scales used |
|---|---|
| Depression | HAMD, MADRS, GDS, ZSRDS, BDI |
| Mania | YMRS |
| Anxiety | HAMA |
| OCD | Y-BOCS |
| Schizophrenia | BPRS, PANSS |
| General scales | GAF, CGI |
| Medication side effects | SAS, AIMS, LUNSERS |
HAMD (Hamilton depression rating scale)
The HAMD is a multiple choice questionnaire used to rate the severity of depression. Depending on the version used there are either 17 or 21 items. Each item is scored out of between 3 and 5 points. The greater the total points scored the more severe the depression is. For the 17 item version (the most commonly used) scores range between 0 and 54. Scores over 24 indicate a severe depression.
MADRS (Montgomery-Asberg depression rating scale)
The MADRS is a ten-item diagnostic questionnaire used to measure the severity of depressive episodes. It was designed to be more sensitive to the changes brought on by antidepressants and other forms of treatment.
ZSRDS (Zung self rated depression scale)
The ZSRDS was devised to assess the severity of depression. There are 20 items on the scale, each one scored out of 1-4.
BDI (Beck depression inventory)
The BDI is another scale designed to assess the severity of depression. There are a total of 21 items, each is score out of 0-3. The scale was revised in 1966. 0-13 indicates minimal depression, 14-19 mild depression, 20-28 moderate, and 29-63 severe depression.
GDS (geriatric depression scale)
The GDS is a 30 item self-report scale used to screen for depression in the elderly. Each question has either a yes or no response make the total score out of 30. 0-9 is deemed normal, 10-19 is mild depression, and 20-30 is severe depression.
BASDEC (Brief Assessment Schedule Depression Cards)
The BASDEC is a screening test for depression. It uses a deck of cards with statements such as 'I've lost interest in things' which are shown to the patient. In response to each card, the patient indicates whether the card is true or false by pointing to another card. There are 19 cards with a maximum score of 21 (two cards carry 2 points each). It is a quick test and takes less than 5 minutes to administer. A cut off score of 7 is generally used.
The test was developed for use on busy wards to introduce a degree of privacy as other tests involve questions being read out and someone in the next cubicle hearing everything.
Cornell Scale for Depression in Dementia
This test was developed specifically to screen for depression in dementia cases. It involves a 20 min interview with a carer and 10 mins with the patient.
A total of 19 items are rated as either 'absent', 'mild / intermittent', or 'severe'.
YMRS (Young mania rating scale)
The YMRS is an 11-item instrument used to assess the severity of mania in patients with a diagnosis of bipolar disorder.
HAMA (Hamilton anxiety rating scale)
HAMA is a 14 item scale designed to measure the severity of anxiety.
Y-BOCS (Yale-Brown Obsessive compulsive scale)
The Y-BOCS is used to measure both the severity of OCD and the response to treatment.
BPRS (Brief psychiatric rating scale)
This is probably the most widely used scale in psychiatry. This looks at both psychotic and affective symptoms.
PANSS (Positive and negative syndrome scale)
The PANSS looks at both positive and negative symptoms in schizophrenia. It takes a wide sample of information, including data from and interview, along with reports from hospital staff and family. The information gathered is based on how the patient was in the previous week.
GAF (Global assessment of functioning)
The GAF is used as part of axis V of the DSM-IV. It provides a single measure of global functioning. It enquires about psychological and occupational functioning only. The total score is out of 100. A score of 100 is the best that can be achieved and indicates that a patient functions at the highest level possible.
CGI (Clinical global impression)
The CGI is a scale that requires the clinician to rate the severity of the patient's illness at the time of assessment, relative to the clinician's past experience with patients who have the same diagnosis.
DESS (Discontinuation-Emergent Signs and Symptoms scale)
The DESS is used to quantify discontination symptoms associated with stopping antidepressants. This 43-item rating scale spans a broad spectrum of discontinuation symptoms and can be helpful in documenting symptoms of depressed patients in order to diagnose the likely cause of distress.
