Rating Scales for Psychopathology, Health Status and Quality of Life: A Compendium on Documentation in Accordance with the DSM-III-R and WHO Systems

507 Pages·1993·37.643 MB·English

by  Per Bech M.D., Ph.D. (auth.)

Editorial Committee
W. Maier (Gennany)
C. Ballus (Spain)
G. Fava (Italy)
M. Kastrup (Denmark)
J. D. Guelfi (France)
S. Grandi (Italy)
P. Cialdella (France)
H. A. H. D'haenen (Belgium)
W. M. A. Verhoeven (Netherlands)
T. Marcos (Spain)
J. Tressera (Spain)
R. Guimaraes Lopes (portugal)
O. Chambon (France)
L. Lauritzen (Denmark)
C. Thompson (United Kingdom)
M. Gastpar (Gennany)
J. G. Sampaio Faria (portugal)
Per Bech
Rating Scales
for· Psychopathology,
Health Status and
Quality of Life
A Compendium on Documentation
in Accordance with the DSM-III-R
and WHO Systems
Springer-Verlag
Berlin Heidelberg New York
London Paris Tokyo
Hong Kong Barcelona
Budapest
Per Bech, M. D., Ph. D.
Professor of Psychiatry
Frederiksborg General Hospital
Department of Psychiatry
48, Dyrehavevej
DK-3400 Hiller~, Denmark
Library of Congress Cataloging·in·Publication Data. Bech, Per. Rating scales for psychopathology, health status, and
quality of life: a compendium on documentation in accordance with the DSM-III-R and WHO systemsIP. Bech p .
... em. Includes bibliographical references and index.
ISBN-13: 978-3-642-77761-5 e-ISBN-13: 978-3-642-77759-2
DOl: 10.1007/978-3-642-77759-2
1. Psychiatric rating scales. 2. Health status indicators. 3. Quality of life - Evaluation. I. Title.
[DNLM: 1. Health Status. 2. Mental Disorders - classification. 3. Psychiatric Status Rating Scales - classification. 4.
Psychopathology - classification. 5. Quality oflife. WM IS B39lr) RC473.P78B43 1993 616.89'075 - dc20
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© Springer-Verlag Berlin Heidelberg 1993
Softcover reprint of the hardcover 1st edition 1993
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The thing of deepest
or, at any rate, of comparatively
deepest significance in life
does seem to be its character of progress
James (1899)
There will be time,
there will be time to prepare a face
to meet the faces
... and time for all the works
and days of hands that lift and
drop a question on your plate;
... and time yet for a hundred indecisions,
and for a hundred visions
and revisions.
And indeed there will be time to wonder,
Do I dare? ...
Time to tum back and descend the stair,
with a bald spot in the middle of my hair ...
Do I dare
disturb the universe?
In a minute there is time
for decisions and revisions which
a minute will reverse ...
For I have known them all ...
have known the evenings, mornings, afternoons,
I have measured out my life ...
Eliot (1917)
A chain of summa genera,
genera, species, sub-species, and varieties
is not a chain of axioms, theorems, and riders.
But what is more,
it cannot, in general,
be deductively established
or established by reductio ad absurdum.
The work of a Linnaeus
cannot be done a priori.
Ryle (1965)
Preface
This book has grown out of a previous publication, the Mini-compendium (Bech
et al. 1986), which was developed as a guide both for clinical research and for the
documentation of routine activities in assessing psychiatric disability, whether in a
general hospital, by a district psychiatrist or a nurse, by a liaison-consultant psy
chiatrist, by a clinical psychologist, by a health worker, or in general practice. One
of its outstanding merits was that its scales were authoritative: During its prepara
tion Max Hamilton corrected and finally accepted the English versions of his
scales and Ole Rafaelsen corrected the English versions of the remaining scales.
While preparing this publication we were constantly reminded of how difficult it
is to accept that Max and Ole are no longer with us. _
One indication of the success of the Mini-compendium is the fact that it was
ttanslated into a number of languages, including Spanish (Ballus and Tressera,
1988), Italian (Fava and Grandi, 1988), French (pichot et al. 1989), Dutch
(D'haenen and Verhoeven, 1989), and German (Maier et al. 1991). Another indi
cation was its correspondence to the DSM-III (APA, 1980) criteria for anxiety,
depression, mania and schizophrenia. This volume refers to DSM-III-R (APA,
1987) and ICD-IO (WHO, 1992).
This compendium has, furthermore, followed the DSM-III-R principle in de
scribing health and disease by a multi-dimensional approach, including psychoso
cial stressors, social functioning and coping styles. In addition, health-related
quality of life scales as well as scales measuring side-effects of treatment have
been included. Within each dimension rating scales have been selected because of
their high validity and reliability. The content validity of the scales has reference
to DSM-III-R and ICD-I0. However, the construct validity of the included scales
has been tested by reference to modern psychometric models. Thus, each rating
scale has been selected by its ability to measure the underlying construct suffi
ciently. For measuring dimensions of health and disease Likert rating scales have
been found sufficient (i.e. brief scales including around 10 items each of which is
defined by categories from 0 (not present) to 4 (present to an extreme degree». By
use of such scales health status profiles can be scored. The global integration of
this profile from the patient's point of view gives the quality of life assessment
It is only three decades since Max Hamilton introduced the rating scale method
into clinical research. The first chapter of this compendium summarizes the psy
chometric literature on the scientific use of rating scales in health and disease
(from Hamilton's use of classical psychometric methods to the modern use of la
tent structure or trait methods). This compendium is intended not only for clini-
VIII Preface
cians interested in the scientific background for DSM-III-R or ICD-lO, but also
for those wishing to know more about the psychometric or clinimetric properties
of the different dimension of health and disease. Therefore, it is intended for all
health workers who have a primary interest in rating scales measuring clinical dis
ability, health status profile, and health-related quality of life.
The compendium has been completed in collaboration with an editorial com
mittee consisting of European colleagues who made the very difficult task of
translating the Mini-compendium to their respective languages. The compendium
has been through many revisions which secretary Pemille Slej, Hiller0d, has faith
fully and effectively performed. Thomas Thiekotter, Springer-Verlag, has from
the very beginning endeavoured that this compendium should cover all relevant
aspects of health and disease as measured by rating scales. Dr. Wilson and his
team in Springer-Verlag have carefully edited the compendium. In the final stage
Johan Sonne Mortensen, University of Odense, has organized the lay-out of the
scales in collaboration with Pemille Slej, and made the proof corrections. The
subject index (including lists of authors, scales and their abbreviations) has been
developed by Gabriele Bech-Andersen, Psychiatric Institute, HilIer0d.
Copenhagen Per Bech
References
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders.
Third edition (DSM-III). Washington DC, American Psychiatric Association, 1980.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders.
Third edition, revised version (DSM-III-R). Washington DC, American Psychiatric As
sociation, 1987.
BalIus C, Tressera J. Breve compendio de las escalas de evaluacio para los estados de an
siedad, depression, mania y esquizofrenia con los sindroms correspondientes en el
DSM-III. Barceloa, Espanxs, 1988.
Bech P, Kastrup M, Rafaelsen OJ. Mini-compendium of rating scales. Acta Psychiat Scand
1986; 73 (suppl. 326): 7-37.
D'haenen HAH, Verhoeven WMA. Mini-compendium van beoordelingsschalen in de psy
chiatrie. Brussels, VUB Press, 1989.
Eliot TS. Prufrock and other observations. London, Hogarth Press, 1917.
Fava GA, Grandi S. Minicompendio delle scale de valutazione di stati di ansia, depres
sione, mania, schizofrenia con Ie corrispondenti sindromi del DSM-III. Milano,
CE.D.RIM, 1988.
James W. Talks to Teachers. New York: Holt 1899.
Maier W, Gastpar M, Bech-Andersen G. Minikompendium fUr psykiatrische Ratingskalen.
Berlin, Springer 1991.
Pichot P, Chambon 0, Poncet F, Kiss L. Echelles d'anxiety, de manie, de depression, de
schizophrenie correspondance avec Ie DSM-III. Paris, Masson, 1989 (second edition
1991).
Ryle G. The academy and dialectic. In: Bambrough R (ed). New essays on Plato and Aris
totle. London, Routledge & Kegan Paul, 1965.
World Health Organization: International Classification of Disease, tenth revision. The
ICD-I0 Classification of Mental and Behavioural Disorders. Clinical descriptions and
diagnostic guidelines. Geneva, World Health Organization, 1992.
Contents
1 Introduction: Rating Scales versus DSM·nl·R and ICD·I0 1
1.1 Concordance Between Rating Scales and DSM-III-R
orICD-10 ... 2
1.1.1 Phenomenology ... 2
1.1.2 Psychopathology . . . 3
1.1.3 Health-Status Profiles 4
1.1.4 Health-Related Quality of Life:
A Measurement Problem . . . 5
1.2 Divergence Between Rating Scales and DSM-III-R 7
1.2.1 Target Syndromes: The Phenomenological Spectrum
of Core Symptoms Versus the Discriminating Points
of Diagnosis . . . . . . . . . . . . . . . . . . . 8
1.2.2 Procedural Algorithms Versus Rating Scale Spectrum 9
1.2.3 Administration: Types of Information . . . . . . . . 14
1.3 Comparison Between ICD-9, DSM-III and Rating Scales:
Degrees of Quantification ......... . 15
1.4 The Taxonomic Arrangement of Rating Scales:
The Multi-Axial Approach ........ . 17
1.5 The Psychometric Characteristics and Criteria
for the Selected Rating Scales 19
1.5.1 Content Validity ....... . 20
1.5.2 Criterion and Construct Validity 22
1.5.3 Inter-observer Reliability .... 26
1.6 General Considerations
on Quantifying Psychopathological States 30
1.6.1 Likert-type Rating Scales or Categorical Scales 31
1.6.2 Analogue or Graphic Scales ..... 32
1.6.2.1 Continuous or Visual Analogue Scales 32
1.6.2.2 Discretized Analogue Scales ..... 33
1.6.2.3 Global Severity Versus Global Improvement Scales 33
1.7 The User's Perspective for This Compendium 35
References ...................... . 38
x Contents
2 Rating Scales for Psychopathological States 45
2.1 Hamilton Anxiety Scale ..... . 47
2.2 Hamilton Depression Scale with Melancholia Scale 52
2.3 Mania Scale . . . . . . . . . 61
2.4 Brief Psychiatric Rating Scale 64
2.5 Other Versions of Rating Scales 71
2.5.1 Hamilton Depression Scale .. 71
2.5.2 Brief Psychiatric Rating Scale 77
2.5.3 Melancholia Scale for General Practice 78
2.5.4 Clinical Syndrome Circle: Self-Rating Scales 79
2.5.4.1 The Panic Attack Scale (PAS) 79
2.5.4.2 Generalized Anxiety Scale (GEAS) 79
2.5.4.3 Melancholia Scale (MES) 81
2.5.4.4 The Mania Scale (MAS) .... 83
2.5.4.5 The Psychotic Disintegration Scale (PDS) 84
2.5.4.6 The Borderline Anhedonia Scale (BAS) 86
2.5.5 Structured Interview
of the Hamilton/Melancholia Scale (HDS/MES) 87
References ........ .......... . 92
3 Rating Scales for Mental Disorders 107
Reference •. . . . . .... 109
3.1 Dementia (Chronic Organic Mental Syndrome) 109
References ...... ........... . 122
3.2 Delirium (Acute Organic Mental Syndrome) 123
References .... 130
3.3 Schizophrenia ... . 131
References .... ..... . 152
3.4 Mood (Affective) Disorders 153
3.4.1 Manic State .. . .. 153
References ...... ... . 157
3.4.2 Depression (Melancholic States) 158
References .......... . 159
3.4.2.1 The Depressive Syndrome 159
References .... ..... 169
3.4.2.2 The Diagnosis of Depression 171
References ..... . 183
3.5 Anxiety Disorders 184
3.5.1 Panic Attacks 189
3.5.2 Generalized Anxiety 191
References 194
3.5.3 Phobias ..... . 195
Contents XI
References ........... . 198
3.5.4 Obsessive-Compulsive States 198
References ........... . 210
3.5.5 Neurasthenia (Chronic Fatigue/Pain Syndromes) 211
References 218
3.5.6 Insomnia 219
References 221
3.6 Aggression 222
3.6.1 Aggressive States in Mental Handicap
and Conduct Disorder 222
References ............... . 225
3.6.2 Aggressive States: Generalized .. . 226
3.6.3 Aggression States: Attacks or Peak Episodes 232
3.6.4 The Social Dysfunction
and Aggression Scale (SDAS) 236
References 241
3.7 Conclusion........ 242
3.8 Other Scales . . . . . . . . 245
3.8.1 Gottfries-Brfule-Steen Scale 246
3.8.2 The Positive and Negative Syndrome Scale 247
3.8.3 Montgomery-Asberg Depression Scale 263
3.8.4 Sheehan Clinician Rated Anxiety Scale 265
3.8.5 Depressive Retardation Rating Scale 266
3.8.6 The Cognitive Subscale
of Alzheimer's Disease Assessment Scale (ADAS) 268
3.8.7 Mini Mental State Examination (MMSE) 270
References ..................... . 271
4 Psychopathological Self-Rating Scales 295
4.1 Methodological Considerations 296
4.1.1 Severity of Symptom Occurrence 298
4.1.2 Response Set ........ . 300
4.1.3 Self-Report Versus Others' Reports
and Clinical Interview 300
4.2 Depression Scales 301
4.3 Anxiety Scales .... 309
4.4 Aggression Scales " 317
4.5 Comprehensive Scales and Their Subscales 318
4.5.1 Cornell Medical Index ......... . 318
4.5.2 Hopkins Symptom Checklist .... . . . 319
4.5.3 Symptom Rating Scale for Depression and Anxiety 325
4.5.4 Kellner Symptom Questionnaire ........ . 330