Psychiatric Rating Scales



Psychiatric Rating Scales





I. Introduction

Psychiatric rating scales or rating instruments are used in treatment planning to help establish a diagnosis, identify comorbid conditions, and assess levels of functioning. They also provide a baseline for follow-up of the progress of an illness over time or in response to specific interventions. This is particularly useful in the conduct of psychiatric research.


II. Rating Scales Used in DSM-IV-TR

Rating scales form an integral part of the text revision of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). The rating scales used are broad and measure the overall severity of a patient’s illness.


A. Global Assessment of Functioning Scale (GAF)



  • Used in Axis V of DSM-IV-TR.


  • Used to report a clinician’s judgment of a patient’s overall level of functioning.


  • Information is used to decide on a treatment plan and later to measure the plan’s effect (Table 4-1).


B. Social and Occupational Functioning Assessment Scale (SOFAS)



  • Can be used to track a patient’s progress in social and occupational areas.


  • Is independent of the psychiatric diagnosis and the severity of the patient’s psychological symptoms (Table 4-2).


C. Global Assessment of Relational Functioning (GARF)



  • Measures the overall functioning of a family or other ongoing relationship (Table 4-3).


  • The development of mental illness is higher in dysfunctional families.


  • Slow recovery in the absence of a supportive social network.


D. Defensive Functioning Scale (DFS)



  • Covers the defense mechanisms used by the patient to cope with stressors (Table 4-4).


  • Humor, suppression, anticipation, and sublimation are among the healthiest defense mechanisms.


  • Denial, acting-out, projection, and projective identification are some of the most pathological defense mechanisms.


III. Other Scales


A. Brief Psychiatric Rating Scale (BPRS)



  • Measures the severity of psychiatric symptomatology.


  • Used as an outcome measure in treatment studies of schizophrenia.


  • Most useful for patients with fairly significant impairment.









Table 4-1 Global Assessment of Functioning (GAF) Scale




































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Jun 8, 2016 | Posted by in PSYCHIATRY | Comments Off on Psychiatric Rating Scales

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Consider psychological, social, and occupational functioning on a hypothetical continuum of mental health–illness. Do not include impairment in functioning due to physical (or environmental) limitations.
Code Note: Use intermediate codes when appropriate, e.g., 45, 68, 72.
   100–91 Superior functioning in a wide range of activities, life’s problems never seem to get out of hand, is sought out by others because of his or her many positive qualities. No symptoms.
   90–81 Absent or minimal symptoms (e.g., mild anxiety before an exam), good functioning in all areas, interested and involved in a wide range of activities, socially effective, generally satisfied with life, no more than everyday problems or concerns (e.g., an occasional argument with family members).
   80–71 If symptoms are present, they are transient and expectable reactions to psychosocial stressors (e.g., difficulty concentrating after family argument); no more than slight impairment in social, occupational, or school functioning (e.g., temporarily falling behind in schoolwork).
   70–61 Some mild symptoms (e.g., depressed mood and mild insomnia) OR some difficulty in social, occupational, or school functioning (e.g., occasional truancy, or theft within the household), but generally functioning pretty well, has some meaningful interpersonal relationships.
   60–51 Moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks) OR moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or coworkers).
   50–41 Serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) OR any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job).
   40–31 Some impairment in reality testing or communication (e.g., speech is at times illogical, obscure, or irrelevant) OR major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood (e.g., depressed man avoids friends, neglects family, and is unable to work; child frequently beats up younger children, is defiant at home, and is failing at school).
   30–21 Behavior is considerably influenced by delusions or hallucinations OR serious impairment in communication or judgment (e.g., sometimes incoherent, acts grossly inappropriately, suicidal preoccupation) OR inability to function in almost all areas (e.g., stays in bed all day; no job, home, or friends).
   20–11 Some danger of hurting self or others (e.g., suicide attempts without clear expectation of death, frequently violent, manic excitement) OR occasionally fails to maintain minimal personal hygiene (e.g., smears feces) OR gross impairment in communication (e.g., largely incoherent or mute).
   10–1