Brief Psychiatric Rating Scale (BPRS)

Background:

  • Developed in the early 1960s by Overall and Gorham, using factor analysis.
  • Designed to assess the severity of schizophrenic states, with the aim of providing clinicians a way to quickly assess patient change
  • Each of the 18 items are designed to represent a discrete symptom area.
  • The scale is completed after an 18-min clinical interview.
  • Each of the 18 items takes roughly 2 – 3 mins to complete following the interview.
  • Five of the items (tension, emotional withdrawal, mannerisms and posturing, motor retardation and uncooperativeness) are based on observations of the patient. The remaining 13 items are based on the patient’s verbal report.
  • Items are rated on a 7-point Likert scale, from 1 = “not present” to 7 = “extremely severe”, with scores ranging from 18 to 126 (achieved through summing the item scores).

Psychometric properties:

  • Inter-rater reliability for the scales: range from 0.56 (tension) to 0.87 (guilt feelings and hallucinatory behaviour)
  • Inter-rater reliability for overall scores: range from 0.67 to 0.95
  • Divergent reliability: questionable, should not be used to differentiate diagnosis (even though original citation provides scoring weights for 13 diagnostic types)
  • Convergent reliability: up to 0.93 (depending on what it is being compared to).
  • Can differentiate between inpatient and outpatient populations

Settings and populations:

·        Inpatient psychiatric units·        Forensic populations
·        Community care settings·        Deaf populations
·        Research·        Validated in the Netherlands
·        Drug & alcohol populations·        Validated in Scandinavia 

 

Strengths:

  • Methodological soundness (i.e. based on research/factor analysis)
  • Widely used in research and clinical populations, enabling comparisons of outcome data
  • Lack of redundancy in items
  • With training nurses and social workers can also use it and produce high inter-rater reliability
  • Does not require patients to be able to read or write, as it is clinician administered

Limitations:

  • Raters need experience to elicit information about symptoms not obvious or accessible to the patient.
  • Requires training in operational definitions
  • Requires regular refresher training to counter rater drift from established protocols
  • There are is no explicit time frame specified for the ratings
  • There are no operational definitions for the ratings or score cut-offs

Cultural and gender considerations:

  • There are no differences in scores assigned based on age or gender
  • No cultural issues identified – however attitudes and beliefs held by clinicians will impact ratings. Clinicians need to be aware of the norms of the person they are rating, to account for cultural frames of references (in terms of assessing the presence or absence of psychopathology) – particularly important in schizophrenia.

References

Andersen, J., Larsen, J. K., Schultz, V., Nielsen, B. M., Korner, A., Behnke, K., . . . Bech, P. (1989). The Brief Psychiatric Rating Scale. Dimension of schizophrenia–reliability and construct validity. Psychopathology, 22(2-3), 168-176. doi: 10.1159/000284591

Dingemans, P. M., Winter, M.-L. F.-d., Bleeker, J. A. C., & Rathod, P. (1983). A cross-cultural study of the reliability and factorial dimensions of the Brief Psychiatric Rating Scale (BPRS). Psychopharmacology, 80(2), 190-191. doi: 10.1007/bf00427968

Hafkenscheid, A. (1991). Psychometric evaluation of a standardized and expanded Brief Psychiatric Rating Scale. Acta Psychiatrica Scandanavica, 84(3), 294-300. doi: 10.1111/j.1600-0447.1991.tb03147.x

Horton, H. K., & Silverstein, S. M. (2011). Factor structure of the BPRS in deaf people with schizophrenia: Correlates to language and thought. Cognitive Neuropsychiatry, 16(3), 256-283. doi: 10.1080/13546805.2010.538231

Leucht, S., Kane, J. M., Kissling, W., Hamann, J., Etschel, E. V. A., & Engel, R. (2005). Clinical implications of Brief Psychiatric Rating Scale scores. The British Journal of Psychiatry, 187(4), 366.  Retrieved from http://bjp.rcpsych.org/content/187/4/366.abstract

Ligon, J., & Thyer, B. A. (2000). Interrater reliability of the Brief Psychiatric Rating Scale used at a community-based inpatient crisis stabilization unit. Journal of Clinical Psychology, 56(4), 583-587. doi: 10.1002/(SICI)1097-4679(200004)56:4<583::AID-JCLP12>3.0.CO;2-U

McGorry, P. D., Goodwin, R. J., & Stuart, G. W. (1988). The development, use, and reliability of the brief psychiatric rating scale (nursing modification) — an assessment procedure for the nursing team in clinical and research settings. Comprehensive Psychiatry, 29(6), 575-587. doi: 10.1016/0010-440X(88)90078-8

Morlan, K. K., & Tan, S. Y. (1998). Comparison of the Brief Psychiatric Rating Scale and the Brief Symptom Inventory. Journal of Clinical Psychology, 54(7), 885-894. doi: 10.1002/(SICI)1097-4679(199811)54:7<885::AID-JCLP3>3.0.CO;2-E

Overall, J. E., & Gorham, D. R. (1962). The Brief Psychiatric Rating Scale. Psychological Reports, 10(3), 799-812. doi: 10.2466/pr0.1962.10.3.799

van Beek, J., Vuijk, P. J., Harte, J. M., Smit, B. L., Nijman, H., & Scherder, E. J. (2015). The factor structure of the Brief Psychiatric Rating Scale (expanded version) in a sample of forensic psychiatric patients. International Journal of Offender Therapy and Comparative Criminology, 59(7), 743-756. doi: 10.1177/0306624×14529077