Brief Psychiatric Rating Scale Ratings Research Articles

Equipercentile linking of the BPRS and the PANSS

The Positive and Negative Syndrome Scale (PANSS) and the Brief Psychiatric Rating Scale (BPRS) are the most frequently used scales to rate the symptoms of schizophrenia. There are many situations in which it is important to know what a given total score or a percent reduction from baseline score of one scale means in terms of the other scale. We used the equipercentile linking method to identify corresponding scores of simultaneous BPRS and PANSS ratings in 3767 patients from antipsychotic drug trials. Data were collected at baseline and at weeks 1, 2, 4 and 6. BPRS total scores of 18, 30, 40 and 50 roughly corresponded to PANSS total scores of 31, 55, 73 and 90, respectively. An absolute BPRS improvement of 10, 20, 30, 40 points corresponded to a PANSS improvement of 15, 32, 50, and 67. A percentage improvement of the BPRS total score from baseline of 19%, 30%, 40% and 50% roughly corresponded to percentage PANSS improvement of 16%, 25%, 35%, and 44%. Thus a given PANSS percent improvement was always lower than the corresponding BPRS percent improvement, on the average by 4–5%. A reason may be the higher number of items used in the PANSS. These results are important for the comparison of trials that used these rating scales. We present a detailed conversion table in an online supplement.

Comparative effectiveness of second-generation antipsychotics and haloperidol in acute schizophrenia

There is little information on the comparative effectiveness of second-generation antipsychotic agents. To determine if any of five second-generation antipsychotics or haloperidol is more effective in treating acutely ill patients with schizophrenia, schizoaffective disorder or schizophreniform disorder. A sample of 327 newly admitted patients were randomised to open-label treatment with aripiprazole, haloperidol, olanzapine, quetiapine, risperidone or ziprasidone for a minimum of 3 weeks. Measures of effectiveness were improvement in mental status so that the patient no longer required acute in-patient care, and changes in Brief Psychiatric Rating Scale (BPRS) scores. By the first measure, haloperidol (89%), olanzapine (92%) and risperidone (88%) were significantly more effective than aripiprazole (64%), quetiapine (64%) and ziprasidone (64%). Changes in BPRS ratings were not significant among treatments. Haloperidol, olanzapine and risperidone are superior to aripiprazole, quetiapine and ziprasidone for the acute treatment of psychosis in hospitalised patients with schizophrenia, schizoaffective disorder or schizophreniform disorder.

Linking the PANSS, BPRS, and CGI: Clinical Implications

To understand what given scores of the Brief Psychiatric Rating Scale (BPRS) and the Positive and Negative Syndrome Scale (PANSS) mean from a clinical point of view is important for the translation of research results into practice. We therefore (a) compared the absolute change of the BPRS/PANSS with the Clinical Global Impressions Ratings (CGI) -improvement score and the change of the CGI severity score, (b) analyzed whether the severity of illness at baseline had an impact on the latter association, and (c) attempted to replicate previous BPRS findings using a completely different data set based upon the PANSS-derived BPRS. The method used was equipercentile linking of BPRS and CGI ratings from 14 drug trials in acutely ill patients with schizophrenia (n=5970). An absolute reduction of the BPRS/PANSS by approximately 10/15 points corresponded to a CGI change of 'minimally improved' and to a change of the CGI severity score by one severity step. However, the latter associations depended on the severity of symptoms at baseline. Less severely ill patients required less BPRS/PANSS total score reduction to achieve the same CGI-improvement score than more severely ill patients. This effect of initial severity was attenuated using percentage rather than absolute BPRS/PANSS reduction scores. The linking analysis between the absolute BPRS/PANSS reduction and the CGI may have an implication for the interpretation of efficacy differences found in clinical trials, and for sample size estimations. Clinicians seem to base CGI ratings on relative change rather than on absolute change of symptoms.

Multiple-Family Group Treatment for English- and Vietnamese-Speaking Families Living With Schizophrenia

This study, which was the first evaluation in Australia of multiple-family group treatment, explored the effectiveness of this approach for a newly arrived non-English speaking migrant group, first-generation Vietnamese families, and for English-speaking families. Thirty-four pairs of English-speaking consumers and family members and 25 Vietnamese-speaking pairs were randomly assigned to a multiple-family group or a control group. All consumers had a diagnosis of schizophrenia. The multiple-family group intervention (26 sessions over 12 months) was delivered as an adjunct to case management services, which all consumers received. Outcomes, which were measured immediately after treatment and 18 months later, included the number of relapse episodes; the presence and severity of symptoms, as measured by the Brief Psychiatric Rating Scale (BPRS) and the Scale for the Assessment of Negative Symptoms; and social functioning, as measured by the Family Burden Scale, the Health of the Nation Outcome Scale, and the Quality of Life Scale. Relapse rates immediately after treatment were significantly lower for the multiple-family group than for the control group (12 and 36 percent), and relapse rates were also lower during the follow-up period (25 and 63 percent). BPRS ratings were significantly lower for participants in the multiple-family group, and vocational outcomes also improved. The reductions in relapse and symptoms were similar for the English-speaking and the Vietnamese-speaking family groups; sample size precluded statistical analysis of differences. Multiple-family group treatment is an effective cognitive-behavioral intervention in the treatment of schizophrenia. The findings suggest continued application of and research on family interventions for non-English speaking migrant populations.

Clinical implications of Brief Psychiatric Rating Scale scores

Despite the widespread use of the Brief Psychiatric Rating Scale (BPRS), the clinical meaning of its total score and cut-off values used to define treatment response are unclear. To link the BPRS to Clinical Global Impression (CGI) ratings. Equipercentile linking of BPRS and CGI ratings from seven drug trials in acutely ill patients with schizophrenia (n=1979). 'Mildly ill' according to the CGI approximately corresponded to a BPRS total score of 31, 'moderately ill'to a BPRS score of 41 and'markedly ill'to a BPRS score of 53.'Minimally improved'according to the CGI score was associated with percentage BPRS reductions of 24, 27 and 30% at weeks 1, 2 and 4, respectively. The corresponding numbers for a CGI rating of 'much improved' were 44, 53 and 58%. The results provide a clearer understanding of how to interpret BPRS total and percentage reduction scores in clinical trials with patients acutely ill with schizophrenia who are experiencing positive symptoms.

Comparison of risperidone and olanzapine as used under “real-world” conditions in a state psychiatric hospital

As a follow-up to our previous study of clozapine, medical records of a state psychiatric hospital were reviewed for patients who were prescribed an atypical antipsychotic. From that sample, demographic and clinical data were obtained for individuals with an initial score of 35 or greater on the Brief Psychiatric Rating Scale (BPRS), and at least two additional successive monthly BPRS ratings. A total of 100 patients met the criteria. Most received either olanzapine (46%) or risperidone (36%), with few administered quetiapine (11%) or clozapine (7%). Most also received adjunctive medications, including conventional antipsychotics, anticonvulsants/mood stabilizers, antidepressants, and antiparkinsonian agents. The number of patients whose BPRS total scores decreased by 20% or more from baseline was significantly greater for those who received olanzapine than those who received risperidone. However, there was no difference between the two antipsychotics in the number of patients who maintained that degree of improvement, in the average latency to achieve that decrease (1.67 and 1.47 months, respectively), or the average length of stay (LOS; 332 and 376 days, respectively). These results indicate a modest therapeutic advantage of olanzapine compared to risperidone, and a substantial degree of polypharmacy in the use of atypical antipsychotics. This uncontrolled “real-world” evaluation supports data from controlled clinical trials, showing that either risperidone or olanzapine would be a reasonable first choice in patients with treatment-resistant schizophrenia, with the decision based on the least adverse side effect profile and economic constraints. When compared to our previous clozapine study, we confirm a slight advantage for the effectiveness of clozapine in the treatment of this refractory population.

52. Reverse pharmacogenetics: a new approach to rapid relapse in schizophrenia?

A significant subgroup of patients with schizophrenia experience rapid exacerbations in clinical symptoms following antipsychotic drug discontinuation. There are limited clinical or biological data with which to predict which patients are at increased risk for rapid relapse. New assessment tools that provide more accurate risk-benefit profiles for individual patients may be of use in determining clinical management strategies of patients at high risk for medication discontinuation. Previously, we have examined the role of a functional polymorphism (5-HTTLPR) in the serotonin transporter gene in antipsychotic drug-free patients participating in a placebo-controlled clinical trial. In this study, the clinical profile of 50 schizophrenia patients was assessed with the Brief Psychiatric Rating Scale (BPRS) after 4 weeks of placebo administration. Analysis by genotype revealed that the 5-HTTLPR ll genotype was markedly over-represented in the group of patients with increased BPRS ratings of positive symptoms (p = 0.0003). Patients with the 5-HTTLPR ll genotype were also observed to experience greater negative symptoms, anxiety and depression BPRS ratings. Although these data are preliminary, they suggest that studies of genetic variation may provide a means to identify schizophrenia patients at high risk for rapid relapse following drug discontinuation. New studies are underway to assess the merits of this reverse pharmacogenetics approach.

Stability of the diagnosis of deficit syndrome in schizophrenia.

Primary, enduring negative symptoms have been distinguished from negative symptoms more generally and are used to define the deficit syndrome of schizophrenia. Although the validity of the deficit syndrome has been demonstrated by using brain imaging, neuropsychological, illness outcome, and developmental history data, the stability of this diagnostic category has not been tested prospectively by using direct patient assessments. Forty-three outpatients with schizophrenia and schizoaffective disorder were categorized into deficit and nondeficit groups an average of 3.8 years after having been previously categorized. There was 83% agreement between initial and blind follow-up designations of deficit status and 88% agreement on the nondeficit categorization. These results provide evidence for the long-term stability of the deficit syndrome in patients with schizophrenia and the reliability of the deficit/nondeficit categorization when diagnosed by those with appropriate training. Furthermore, they validate the method of categorizing deficit patients by using cross-sectional and retrospective data.

A functional serotonin transporter (5-HTT) polymorphism is associated with psychosis in neuroleptic-free schizophrenics.

The neurotransmitter serotonin has been implicated in the pathophysiology of psychosis. The serotonin transporter (5-HTT) plays a critical role in regulation of serotonergic function. A recently identified polymorphism in the promoter region of the 5-HTT gene (5-HTTLPR) produces significant differences in 5-HTT expression and function and was found to be associated with anxiety-related traits in healthy volunteers. We investigated whether 5-HTTLPR is associated with psychosis in neuroleptic-free schizophrenic or schizoaffective patients. Fifty patients with schizophrenia or schizoaffective disorder by DSM-III-R criteria were genotyped at 5-HTTLPR and underwent double-blind Brief Psychiatric Rating Scale (BPRS) ratings while neuroleptic-free for approximately 4 weeks. Patients with the 5-HTTLPR II genotype (n = 19) had significantly higher BPRS ratings for psychosis than patients with the Is (n = 25) or ss (n = 6) genotypes. Examination of individual items revealed a specific significant increase in intensity of hallucinations in patients with the 5-HTTLPR II genotpe. These data provide preliminary evidence for a role of serotonin in the pathophysiology of hallucinations and may represent the identification of an allelic variant that modifies the complex clinical presentation of schizophrenia.

BPRS syndrome scales during the course of an episode of psychiatric illness.

This report examines changes in symptom levels on the four major syndrome scales from the Brief Psychiatric Rating Scale (BPRS): thought disturbance, paranoid disturbance, anxiety/depression, and emotional withdrawal/motor retardation. Baseline BPRS ratings were obtained during the first week of hospitalization for an acute episode of psychiatric illness, in 120 patients with schizophrenia, schizoaffective disorder, and depression. BPRS ratings were carried out in the week prior to discharge. Findings indicated that patients with schizoaffective disorder showed a greater magnitude of general clinical improvement than schizophrenics, although both groups had comparable improvement on thought disorder from admission to discharge. Paranoid symptoms did not recover as completely among schizophrenics compared to schizoaffective disorder patients. As expected, anxiety and depression symptoms remitted most prominently among the depressed inpatients.

Symptom severity and number of previous psychiatric admissions as predictors of readmission.

The study examined factors predicting early readmission (within 30 days of discharge) to a state hospital. A total of 189 patients with acute symptoms who were admitted to a state hospital were evaluated at discharge using the Brief Psychiatric Rating Scale (BPRS) and the Nurses Observation Scale for Inpatient Evaluation (NOSIE). Patients who were readmitted within 30 days were compared with those who were not on BPRS and NOSIE ratings and on other variables, including length of stay, number of previous admissions, demographic characteristics, and diagnosis. Scores on the thought disorder factor and self-neglect question on the BPRS and the number of previous admissions were significantly higher among patients who where readmitted within 30 days of discharge. The variables correctly predicted readmission for 86 percent of cases in the study. The characteristics of high scores at discharge on the BPRS thought disorder factor and the BPRS item on self-neglect, along with a high number of previous admission, may be helpful in identifying patients at risk for readmission to inpatient psychiatric settings.

Evoked potential topography in major depression. II. Comparisons between subgroups

Brief Psychiatric Rating Scale (BPRS) ratings of 69 patients with major depression (MD) were employed in an attempt to define subgroups of MD with more homogenous evoked potential (EP) findings than the MD group as a whole. Correlations were computed between 6 BPRS ratings and scores for 32 EP factors; 14 correlations were significant. These indicated mainly that EP values were related to severity of depression. When age- and gender-matched groups of MDs with above-and below-median depressive mood (D) ratings were compared with controls, 3 of the 10 factors differing significantly between groups evidence of two different subgroups of MD. EPs of these subgroups differed from those of controls in opposite directions. Such bidirectional differences from normal suggest differing pathophysiology in the subgroups support the multiple oprocess view of depression.

The Brief Psychiatric Rating Scale (BPRS) in geropsychiatric research: I. Factor structure on an inpatient unit.

Factor analysis of symptom ratings recorded on the Brief Psychiatric Rating Scale (BPRS) for a sample of 87 geropsychiatry inpatients resulted in five relatively independent factors. The factor structure differed in two important respects from that previously observed in numerous analyses of BPRS ratings of patients from the general adult psychiatric population. The symptom of depressive mood combined with emotional withdrawal and motor retardation to define a withdrawn depression factor, whereas depressive mood has routinely evidenced greater affinity for anxiety and tension in younger adults. In addition, the unitary thinking disturbance factor that has been observed routinely in data from the younger adult psychiatric population split into separate factors of cognitive dysfunction and psychotic distortion. Construct validity of the cognitive dysfunction factor was examined with reference to an objective mental status questionnaire.

Therapist Ratings of Achievement of Objectives in Psychotherapy With Acute Schizophrenics*

Therapist ratings of patients' achievement of objectives in psychotherapy were used to examine the impact of drugs on psychotherapy, to identify attributes of patients who achieve therapy objectives, and to assess the importance of the implementation of a crisis-oriented model of therapy. Patients were part of a project investigating the long-acting phenothiazine fluphenazine enanthate and crisis-oriented family therapy in a 6-week program of aftercare treatment for briefly hospitalized first admission acute schizophrenics. The 44 patients in this study were randomly assigned to the psychotherapy condition and to either a high or low dosage of phenothiazines. Therapist ratings of the achievement of therapy objectives were significantly related to independent ratings on two outcome measures, the Global Assessment Scale and the Brief Psychiatric Rating Scale (BPRS) factor Thought Disorder, at 6-month followup. Analyses of predictors of the achievement of therapy objectives revealed significant interactions between drug level and Venables and O'Connor ratings of paranoid symptomatology among good permorbid patients and between drug level and BPRS ratings of Hostility for the entire sample.