Schizophrenic Assessment: Focus on the Brief Psychiatric Rating Scale - Essay Example

?Running Head: SCHIZOPHRENIC ASSESSMENT Schizophrenic Assessment: Focus on the Brief Psychiatric Rating Scale Schizophrenic Assessment: Focus on the Brief Psychiatric Rating Scale Introduction There are a great number of tools that can be used to assess the condition and symptomatic state of a psychiatric patient. A simple, yet effective tool that can be used is the Brief Psychiatric Rating Scale which was developed in 1962 (see Appendix 1). There are a number of research papers that have been conducted in relationship to this test. The test is used by a number of different medical professionals in the assessment of patients who are encountering difficulties with mental illness. The validity of this test has been verified through a number of research studies and the tool has been expanded and improved over time. The test has been found to have been used in studies across time since it was created, thus supporting it as a valuable addition to the study of schizophrenia during the last half of the 20th century and into the millennia. The BPRS tool has been evaluated over sixty years of use, expanding upon its structure with developments that can be used in modern practice. Tools There are different, but common tools that can be used to assess someone suffering from schizophrenia or to do research on diagnostic experiences of the disorder. One of the most common tools used in research is the Research Diagnosis Criteria (RDC) which was created in 1975. Structured interview instruments include the Present State Examination (PSE) from 1970, the Schedule for Affective Disorders and Schizophrenia (SADS), and the Structured Clinical Interview for DSM-IV are all valued instruments for the diagnosis of schizophrenia (Lieberman, 2006). The DSM-IV-TR is the most common diagnostic tool that is used for coming to the conclusion that someone is afflicted with the disorder of schizophrenia (see Appendix 3). One of the longest existing and still used assessments from the 20th century, however, is that of the Brief Psychiatric Rating Scale from 1962. The Brief Psychiatric Rating Scale was developed in 1962 by John E Overall and Donald R, Gorham in order to support a rapid assessment for psychiatric patients. The original assessment had sixteen criteria questions that all can be answered through a seven point ordered ratings scale. The purpose of the assessment is to efficiently determine changes that occur through an economic means so that the assessment supplies the most information possible within a short time. The developers of the tool recommend that two interviewers be present during the interview to independently assess the patient so that the best possible observations can accompany the assessment (Overall & Gorham, 1962). Throughout the fifty years since the creation of the test it has evolved into both an eighteen and a twenty-four question tool through experimentation and evaluation with the instrument. The use of the BPRS tool was originally confined to the use of the psychiatrist as he or she evaluated the progress of their patient. In the last couple of decades, however, nurses have been given the responsibility on a more frequent basis to administer the tool for later evaluation by the doctor involved in the case. Barker (2004) discusses how the tool as it is used to monitor “the experience of psychosis, or the differential effects of treatment” has been more often handed to nurses in recent years with a recognition and stipulation for validity based upon the understanding and clinical skills of the interviewer, in this case the nurse, who must be thoroughly trained on its use (p. 251). Nurses have been using the tool for the past couple of decades through a modified version used for evaluation that can be translated and interpreted across several providers of medical care. The tool evaluates the symptoms so that they can be tracked by the medical team and the immediate position of the mental state of the patient can inform them on how to proceed with treatment. Through the 24 question instrument that is used by most nurses a more comprehensive set of information can be gathered that allows for greater interpretation by a secondary party to the interview (Tusaie, & Fitzpatrick, 2013). Research Studies According to Kopelowicz, Ventura, Liberman, and Mintz (2008) the validity of the test to track the progress of patients with schizophrenia is substantial. Through tracking a total 565 patients over a 15 year period, the study showed that through evaluating four factors the on the 24 part BPRS that successful evaluation was provided by the tool. The BPRS provided enough evaluation so that interpreting the progress of patients with schizophrenia through the use of the tool was a valid effort. The capacity to track patients through the use of a tool like this through a long period of time provide for the development of an understanding of both the tool’s validity and the understanding of the psychiatric community about the disorder. In understanding the changes that occur over time, a greater understanding of the progression and regression of the illness can be developed. In a study that used a sample of 193 individuals with non-acute schizophrenia, Long and Brekke (1999) studied the effects of the illness every six months over a three year period of time. Using both the sixteen and eighteen versions of the assessment, the effects of thought disturbance, anergia, affect, and disorganization are endured and fairly constant over the course of time, but the way in which they are related to each other does vary. As would be expected, the expanded version of the tool was a bit better than the lesser version and the model of the instrument was invariant, with the sixteen question version being more so. Mueser, Curran, and McHugo (1997) reported that the five factor assessment was less successful than the four factor assessment (thought disturbance, anergia, affect, and disorganization) in evaluating with the BPRS. More recently, Hsiao, Hsieh, Tseng, Chien, and Chang (2012) used the BPRS tool along with several instruments in order to define the quality of life that is experienced by schizophrenia patients as they work towards existing within society. Finding that a number of factors contribute to the quality of life that an individual struggling with schizophrenia experiences, the tool helped to determine that the patient and family members should participate in treatment programs in order to sufficiently contribute within the social sphere so that integration and satisfaction can be achieved. Hsiao et al (2012) write that “Particularly, programs that enhance health status and mutuality should be identified and developed for both individuals with schizophrenia and their families” (p. 15). Conclusion The use of the BPRS has been a part of the study of psychiatric patients with schizophrenia for the last sixty years. Developed in 1962, the tool is used to evaluate the present condition of the patient so that progress or regression can be observed over the course of time. In recent decades the use of the tool has been handed over to nursing staff through an expanded version that can allow a secondary look at the patient and their state of symptoms. Changes can be seen through the changes that are given as answers to the questions on the tool about symptoms. Research studies have discovered that the aspects of thought disturbance, anergia, affect, and disorganization are the best assessed through the tool, providing for a dimensional evaluation of time and differentiation in the experience of the disorder. Working in teams with nurses and doctors, the tools of assessing psychiatric patients with schizophrenia allow for diagnosis and tracking. The BPRS allows for tracking of symptoms towards valued treatment. Resources Barker, Philip J. (2004). Assessment in Psychiatric and Mental Health Nursing: In Search of the Whole Person. Cheltenham: Nelson Thornes. Counseling Resource Research Staff. (2 April 2011). Schizophrenic symptoms. Counseling Resource. Retrieved from http://counsellingresource.com/lib/distress/schizophrenic/schiz ophrenia-dsm/schizophrenia-symptoms/ Hsiao, C., Hsieh, M., Tseng, C., Chien, S., & Chang, C. (2012). Quality of life of individuals with schizophrenia living in the community: Relationship to socio?demographic, clinical and psychosocial characteristics. Journal Of Clinical Nursing, 21(15-16), 2367-2376. Infotech Soft (2012). BPRS. Retrieved from http://infotechsoft.com/products/downloads/Psy chiatryand_Menta l_Health_Forms/BPRS18_BriefPsychiatricRatingScale.pdf Kopelowicz, A., Ventura, J., Liberman, R., & Mintz, J. (2008). Consistency of Brief Psychiatric Rating Scale factor structure across a broad spectrum of schizophrenia patients. Psychopathology, 41(2), 77-84 Lieberman, J. A. (2006). Textbook of schizophrenia. Washington, DC: American Psychiatric Publishing. Long, J. D., & Brekke, J. S. (1999). Longitudinal factor structure of the Brief Psychiatric Rating Scale in schizophrenia. Psychological Assessment, 11(4), 498-506. Mueser, K. T., Curran, P. J., & McHugo, G. J. (1997). Factor structure of the Brief Psychiatric Rating Scale in schizophrenia. Psychological Assessment, 9(3), 196-204. Overall, J. E. & Gorham, D. R. (1962). The brief psychiatric rating scale. Psychological Reports. 10, 799-812. Tusaie, K. R., & Fitzpatrick, J. J. (2012). Advanced practice psychiatric nursing: Integrating psychotherapy, psychopharmacology, and complementary and alternative approaches. New York, NY: Springer Publishing Co. Appendix 1 The Brief Psychiatric Rating Scale (BPRS) Please enter the score for the term which best describes the patient's condition 0 = not assessed, 1 = not present, 2 = very mild, 3 = mild, 4 = moderate, 5 = moderately severe, 6 = severe, 7 = extremely severe 1. SOMATIC CONCERN Read More