Tuesday, 17 May 2022

Rating scales for catatonia

 Rating scales for catatonia

The routine use of validated rating scales has also been advocated to facilitate the identification of catatonic signs and a diagnosis of catatonia. A rating scale helps to identify people who have catatonia that might otherwise not have been diagnosed.

Seven catatonia rating scales were retrieved: 

  1. Modified Rogers Scale, 

  2. Rogers Catatonia Scale, 

  3. Bush-Francis Catatonia Rating Scale 

  4. Northoff Catatonia Rating Scale

  5. Braunig Catatonia Rating Scale 

  6. Kanner Scale.

The Bush–Francis Catatonia Rating Scale 

The Bush–Francis Catatonia Rating Scale, has been widely recommended for its ease of use and reliability and validity. In this scale, the presence of two or more signs is suggestive of catatonia.

Is the most widely used instrument for catatonia. The Bush–Francis Catatonia Rating Scale has twenty-three items, and there is also a shorter, 14-item screening version. The reliability and validity of the Bush–Francis Catatonia Rating Scale has been established (Bush et al, 1996). The screening section marks items #1-14 as either “absent” or “present.” The full-scale rates items #1-23 on a scale of 0-3. The ratings are made based on the observed behaviors during the examination, except for completing the items for “withdrawal” and “autonomic abnormality,” which may be based upon either observed behaviors and/or chart documentation. Rate items only if well defined. If uncertain, rate the item as “0”.

Using the Bush–Francis Catatonia Rating Scale, 32% of 225 patients with chronic schizophrenia meet the criteria for catatonia. See Ungvari et al., 2005. 

It has two subscales

  1. A screening instrument with fourteen items that are marked as either present or absent.  

  2. The full severity scale with nine extra items scored zero to three.

The Modified Rogers Scale

It rates abnormalities in movement, volition, speech, and overall behavior, and aids in the distinction of catatonic signs from similar extrapyramidal side-effects. It has eleven items out of which three or more constitute a diagnosis of catatonic syndrome. 

Items in the Modified Rogers Scale

  1. Stupor

  2. Mutism

  3. Negativism

  4. Opposition

  5. Posturing

  6. Catalepsy

  7. Automatic obedience

  8. Echophenomena

  9. Rigidity

  10. Verbigeration

  11. Withdrawal.


Ungvari GS, Leung SK, Ng FS, Cheung HK, Leung T. Schizophrenia with prominent catatonic features ('catatonic schizophrenia'): I. Demographic and clinical correlates in the chronic phase. Prog Neuropsychopharmacol Biol Psychiatry. 2005;29(1):27-38. doi:10.1016/j.pnpbp.2004.08.007

Bender-Gestalt Test

 

Bender-Gestalt Test

Definition

The Bender Visual-Motor Gestalt Test is a psychometric test used for ages three and over to assess visual-motor functioning, visual-perceptual abilities, cognitive disability, and emotional disturbances.

Purpose

The Bender-Gestalt is used to evaluate visual-motor maturity and to screen children for developmental delays. The test is also used to assess brain damage and neurological deficits. Individuals who have suffered a traumatic brain injury may be given the Bender-Gestalt as part of a battery of neuropsychological measures, or tests.

The Bender-Gestalt is sometimes used in conjunction with other personality tests to determine the presence of emotional and psychiatric disturbances such as schizophrenia.

Precautions

Psychometric testing requires a clinically trained examiner. The Bender Visual-Motor Gestalt Test should be administered and interpreted by a trained psychologist or psychiatrist. The Bender-Gestalt should always be employed as only one element of a complete battery of psychological or developmental tests, and should never be used alone as the sole basis for a diagnosis.

Description

The original Bender Visual Motor Gestalt test was developed in 1938 by psychiatrist Lauretta Bender. There are several different versions of the Bender-Gestalt available today (i.e., the Bender-Gestalt test; Modified Version of the Bender-Gestalt test for Preschool and Primary School Children; the Hutt Adaptation of the Bender-Gestalt test; the Bender Visual Motor Gestalt test for Children; the Bender-Gestalt test for Young Children; the Watkins Bender-Gestalt Scoring System; the Canter Background Interference Procedure for the Bender-Gestalt test). All use the same basic test materials but vary in their scoring and interpretation methods.

The standard Bender Visual Motor Gestalt test consists of nine figures, each on its own 3 × 5 cards. An examiner presents each figure to the test subject one at a time and asks the subject to copy it onto a single piece of blank paper. The only instruction given to the subject is that he or she should make the best reproduction of the figure possible. The test is not timed, although standard administration time is typically 10-20 minutes. After testing is complete, the results are scored based on accuracy and organization. Interpretation depends on the form of the test in use. Common features considered in evaluating the drawings are rotation, distortion, symmetry, and perseveration. As an example, a patient with frontal lobe injury may reproduce the same pattern over and over (perseveration).

The Bender-Gestalt can also be administered in a group setting. In group testing, the figures are shown to test subjects with a slide projector, in a test booklet, or on larger versions of the individual test cards. Both the individual and group-administered Bender-Gestalt evaluation may take place in either an outpatient or hospital setting. Patients should check with their insurance plans to determine if these or other mental health services are covered.

Normal results

Children normally improve in this test as they age, but, because of the complexity of the scoring process, results for the Bender-Gestalt should only be interpreted by a clinically trained psychologist or psychiatrist.


Confusion Assessment Method.

 

Confusion Assessment Method. 

It is a clinical tool that you can apply at the bedside, and it takes only two minutes to administer. It is not much different from clinical assessment, but it has standardised the entire process. So, it can be especially useful for learning. When you practice a few times on it, you can then do the same. You can download it from that link. 

GAD-7

 

Scoring

Scores of 5, 10, and 15 are taken as the cut-off points for mild, moderate and severe anxiety, respectively. When used as a screening tool, further evaluation is recommended when the score is ten or greater. 

Evidence

Using the threshold score of 10, the GAD-7 has a sensitivity of 89% and a specificity of 82% for GAD. It is moderately good at screening three other common anxiety disorders.

  1. Panic disorder (sensitivity 74%, specificity 81%)

  2. Social anxiety disorder 

    1. Sensitivity 72%

    2. Specificity 80% 

  3. Post-traumatic stress disorder 

    1. Sensitivity 66%

    2. Specificity 81%

Source

Spitzer RL, Kroenke K, Williams JBW, Lowe B. A brief measure for assessing generalized anxiety disorder. Arch Inern Med. 2006;166:1092-1097.

Beck Anxiety Inventory

 Beck Anxiety Inventory

The Beck Anxiety Inventory (BAI), created by Aaron T. Beck and other colleagues, is a 21-question multiple-choice self-report inventory that is used for measuring the severity of anxiety in children and adults. The questions used in this measure ask about common symptoms of anxiety that the subject has had during the past week (including the day you take it). It is designed for individuals who are of 17 years of age or older and takes 5 to 10 minutes to complete. Several studies have found the Beck Anxiety Inventory to be an accurate measure of anxiety symptoms in children and adults. 

Scoring and Interpretation

The BAI contains twenty-one questions, each answer being scored on a scale value of 0 (not at all) to 3 (severely). Higher total scores indicate more severe anxiety symptoms. The standardized cut-offs are:

  • 0–9: normal to minimal anxiety

  • 10–18: mild to moderate anxiety

  • 19–29: moderate to severe anxiety

  • 30–63: severe anxiety

Minimum score 0 max 63

Evidence

The BAI has been criticized for its predominant focus on physical symptoms of anxiety (almost akin to a panic response). As such, it is often paired with the Penn State Worry Questionnaire, which provides a more accurate assessment of the cognitive components of anxiety (i.e., worry, catastrophizing, etc.) commonly seen in generalized anxiety disorder.

The Trauma History Screen (THS)

 

The Trauma History Screen (THS)

 (Carlson et al., 2011)

The THS is a 14-item self-report measure assessing exposure to trauma in adults. The THS can be used as a screening tool. The THS has not been used with adolescents, nor does a separate adolescent version exist. The THS consists of two parts. In part one, questions probe for traumatic events (e.g., “a really bad car, boat, train or aeroplane accident”) and the number of times the event(s) occurred. Respondents indicate “yes” or “no” and the number of times the event occurred. In part two, respondents can provide further details about endorsed events (Carlson et al., 2011). This measure was designed to be administered in about 4 minutes (Carlson et al., 2011). The THS demonstrates adequate test-retest reliability over a period of one to two weeks (k = .61 -.77; Carlson et al., 2011) and concurrent validity with the Traumatic Life Events Questionnaire (TLEQ; Kubany et al., 2000). The measure is available online (http://www.istss.org/AssessmentResources/5347.htm). (Carlson et al., 2011).

The Post-Traumatic Stress Disorder Checklist - Civilian Version (PCL-C)

 

The Post-Traumatic Stress Disorder Checklist - Civilian Version (PCL-C)

 Weathers et al., 1993

The PCL-C is a 17-item self-report measure assessing symptoms of PTSD in adults. The PCL-C can be used as a screening and diagnostic tool (Wilkins, Lang, & Norman, 2011). The PCL-C has been used in studies with adolescents (Wang et al., 2012; Calderoni, Alderman, Silver, & Bauman, 2006) and a separate adolescent version exists (PCL-C/PR, Ford et al., 2000) but is not freely available. Each item is rated on a 5-point scale from one (“not at all”) to five (“extremely”). The PCL-C was designed to be administered in 5-10 minutes and can be scored in several ways, including a total symptom severity score that ranges from 17-85, or by mapping onto DSM-IV criteria for PTSD. Empirical research suggests that five points on the PCL-C is a minimum threshold for determining whether an individual has responded to treatment and 10 points as a minimum threshold for determining whether the improvement is clinically meaningful (Monson et al., 2008). The PCL-C demonstrates acceptable internal consistency (α > .75; Wilkins, Lang, & Norman, 2011) and adequate test-retest reliability over a period of one week (r = .75-.88; Campbell et al., 1999). In addition, the PCL-C demonstrates concurrent validity (Bollinger, Cuevas, Vielhauer, Morgan, & Keane, 2008) with the Clinician Administered PTSD Scale (CAPS; Blake et al., 1995) and the Mississippi PTSD scale (Keane, Caddel, & Taylor, 1988; Blake et al., 1995). The measure is available online (http://www.ptsd.va.gov).

Los Angeles Symptom Checklist (LASC)

 Los Angeles Symptom Checklist (LASC)

King, King, Leskin, & Foy, 1995

The LASC is a 43-item self-report measure assessing symptoms of PTSD in adults and adolescents for screening and diagnosis purposes. The LASC consists of items corresponding to the DSM-IV criteria for PTSD and items assessing distress and adjustment problems. Each item is rated on a scale from zero (“not a problem”) to four (“extreme problem”). A preliminary diagnosis of PTSD can be determined using the 17 items within the scale that correspond to the DSM-IV criteria for PTSD. A response counts towards the preliminary diagnosis if it is rated as a 2 or higher. The LASC was designed to be administered in 10-15 minutes. The LASC demonstrates excellent internal consistency for both the 17 items correlated with DSM-IV criteria (α = .94) and for the total score (α = .97). For use in adolescents, the LASC has demonstrated excellent internal consistency for the 17 items associated with DSM-IV criteria (α = .90) and the total score (α =.95; The LASC demonstrates convergent validity with measures of combat exposure and other measures of PTSD symptomatology It has also demonstrated a 75.6% accuracy in predicting a PTSD diagnosis from a structured interview. The measure can be obtained via (dfoy@pepperdine.edu).

(King et al., 1995). (Orsillo, 2001) (Foy et al. ,1997).

Impact of Event Scale-Revised (IES-R)

 Impact of Event Scale-Revised (IES-R)

(Weiss & Marmar, 1997).

The IES-R is a 22-item self-report measure assessing stress associated with the experience of traumatic events in adults. The IES-R can be used as a screening tool. The IES-R has been used in several studies with adolescents (e.g. Xia & Ding, 2011) and a separate adolescent version exists (CRIES-13, Smith, Perrin, Dyregrov, & Yule, 2003). The IES-R consists of three subscales: Intrusion, Avoidance, and Hyperarousal. Sample items include, “Pictures appeared in my mind,” “I tried not to talk about it,” and “I was jumpy and easily startled.” Each item is rated on a 5-point Likert scale from zero (“not at all”) to four (“extremely”). The IES-R demonstrates excellent internal consistency for the total score (α = .96), and good to excellent internal consistency for the subscales (r =.87-.94; Creamer, Bell, & Failla, 2003). It also demonstrates high concurrent validity with the Posttraumatic Stress Disorder (PTSD) Checklist (PCL; Weathers, Litz, Herman, Huska, & Keane, 1993). When compared to the PCL, a cut-off score of 33 provided a sensitivity of .91, a specificity of .82, a positive predictive power of .90, and a negative predictive power of .84 (Creamer et al., 2003). The measure is available via (daniel.weiss@ucsf.edu). The adolescent version of this measure is available (http://www.heardalliance.org/wp-content/uploads/2011/04/Child-Impact-of-Traumatic-Event-Scale-English.pdf).

(Orsillo, 2001).

The Post-Traumatic Stress Disorder Checklist - Civilian Version

 The Post-Traumatic Stress Disorder Checklist - Civilian Version

 (PCL-C; Weathers et al., 1993).

The PCL-C is a 17-item self-report measure assessing symptoms of PTSD in adults. The PCL-C can be used as a screening and diagnostic tool (Wilkins, Lang, & Norman, 2011). The PCL-C has been used in studies with adolescents (Wang et al., 2012; Calderoni, Alderman, Silver, & Bauman, 2006) and a separate adolescent version exists (PCL-C/PR, Ford et al., 2000) but is not freely available. Each item is rated on a 5-point scale from one (“not at all”) to five (“extremely”). The PCL-C was designed to be administered in 5-10 minutes and can be scored in several ways, including a total symptom severity score that ranges from 17-85, or by mapping onto DSM-IV criteria for PTSD. Empirical research suggests that five points on the PCL-C is a minimum threshold for determining whether an individual has responded to treatment and 10 points as a minimum threshold for determining whether the improvement is clinically meaningful (Monson et al., 2008). The PCL-C demonstrates acceptable internal consistency (α > .75; Wilkins, Lang, & Norman, 2011) and adequate test-retest reliability over a period of one week (r = .75-.88; Campbell et al., 1999). In addition, the PCL-C demonstrates concurrent validity (Bollinger, Cuevas, Vielhauer, Morgan, & Keane, 2008) with the Clinician-Administered PTSD Scale (CAPS; Blake et al., 1995) and the Mississippi PTSD scale (Keane, Caddel, & Taylor, 1988; Blake et al., 1995). The measure is available online (http://www.ptsd.va.gov)

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Rating scales for catatonia

  Rating scales for catatonia The routine use of validated rating scales has also been advocated to facilitate the identification of cataton...