Brief Psychiatric Rating Scale (BPRS-18)
The BPRS includes 18 items that address somatic concern, anxiety, emotional withdrawal, conceptual disorganization, guilt feelings, tension, mannerisms and posturing, grandiosity, depressive mood, hostility, suspiciousness, hallucinatory behaviors, motor retardation, uncooperativeness, unusual thought content, blunted affect, excitement, and disorientation. The scale originally published in 1962 contained only the first 16 items; 2 additional items (excitement and disorientation) were added in 1972. The 18-item BPRS is the most commonly used version.
The Brief Psychiatric Rating Scale (BPRS) is a clinician-rated tool designed to assess change in severity of psychopathology. The BPRS was initially designed to measure symptom change in patients with psychotic illness. Thus, the items on the BPRS focus on symptoms that are common in patients with psychotic disorders, including schizophrenia and other psychotic disorders, as well as those found in patients with severe mood disorders, especially those with psychotic features. The items cover the broad range of symptoms that are commonly seen in psychotic relapse, including hallucinations, delusions, and disorganization, as well as the mood disturbances that may also accompany relapse (e.g., hostility, anxiety, and depression). The BPRS was not designed to comprehensively measure theoretical domains of psychopathology. The scale originally published in 1962 contained only the first 16 items; 2 additional items (excitement and disorientation) were added in 1972. The 18-item BPRS is the most commonly used version.
The BPRS provides a continuous total score that is most often used to assess the effectiveness of treatment interventions. The BPRS is also used to classify patients into subgroups to summarize patient characteristics that may predict treatment response.
The joint reliability of the BPRS varies with the training and experience of the clinicians performing the ratings and the extent to which the results of joint rating sessions are discussed with the goal of improving reliability over time. Good joint reliability can be achieved on the BPRS, but it often requires substantial time and effort. For example, in a review of published research studies of the BPRS that reported interrater reliability, the Pearson correlations (which tend to overestimate reliability compared with the intraclass correlation coefficient [ICC] in common use today) for the total pathology score were 0.80 or greater for 10 out of 13 studies. The median reported Pearson correlation for individual items ranged from 0.63 to 0.83 in 5 studies. In a Danish study of the psychometric properties of the BPRS, the investigators described needing more than 30 joint rating sessions to achieve consistently reliable scoring among seven psychiatrists (ICC > 0.80). In general, it is more difficult to achieve reliable ratings of the observational items (e.g., blunted affect) than of the items that use the patient’s verbal report of symptomatology (e.g., hallucinatory behaviors). The effort often required to achieve acceptable joint reliability has prompted several study sites to develop and use versions of the BPRS with detailed anchor descriptors. For example, an inpatient treatment unit for patients with functional psychosis was able to achieve good joint reliability by nursing staff using a version of the BPRS with detailed anchor descriptors. Staff training was minimal and consisted of an overview of the instrument and routine joint ratings of patients. The weighted kappa coefficient ranged from 0.52 to 0.90 for individual items; the mean value for all items was 0.72. Another research group found improvement in reliability for 15 of the 18 items when moving from original anchors to anchors with detailed descriptors. Assessments of internal consistency have not been reported for most subscales. The simplest definition of positive symptoms and negative symptoms has demonstrated good internal consistency (Cronbach’s alpha of 0.81 and 0.91, respectively)
Numerous studies have compared BPRS results with results from other scales. The reported validity of the BPRS is generally high when compared with that of other measures of general psychopathology. Items from the BPRS that are components of the diagnostic criteria for schizophrenia (i.e., emotional withdrawal, conceptual disorganization, mannerisms and posturing, grandiosity, suspiciousness, hallucinatory behaviors, unusual thought content, and blunted affect) have been found to be correlated (r = 0.63) with scores on two scales designed to measure the severity of positive symptoms (the Scale for the Assessment of Positive Symptoms [SAPS ]) and negative symptoms (the Scale for the Assessment of Negative Symptoms [SANS ]) in a study of 47 patients with schizophrenia or schizoaffective disorder. In addition, in a study of 56 patients with schizophrenia or schizoaffective disorder (Bell et al. 1992), the positive and negative symptom scales of the BPRS were highly correlated with the same scales from the Positive and Negative Syndrome Scale (PANSS) (r = 0.92 and 0.82, respectively). Total scores from the PANSS and the BPRS were also highly correlated (r = 0.84), although the general scale scores were only moderately correlated (r = 0.61). In this same study, individual items from the BPRS were modestly related to similar items from the PANSS. Three items on the BPRS were in excellent agreement (kappa > 0.75 for hallucinatory behaviors, grandiosity, and blunted affect), and eight other items had good agreement (kappa = 0.60–0.74 for unusual thought content, conceptual disorganization, suspiciousness, somatic concern, guilt feelings, depressive mood, motor retardation, and disorientation). Agreement was only fair to poor (kappa < 0.60) for the remaining seven BPRS items (excitement, hostility, anxiety, tension, mannerisms and posturing, uncooperativeness, and emotional withdrawal). Several hundred studies have successfully used the BPRS to measure change in pharmacological and nonpharmacological treatment trials, including recent trials with the atypical antipsychotic medications. Concurrent validity in these studies is demonstrated by similar changes as measured by other tools, including the Clinical Global Impressions (CGI) Scale, the Hamilton Rating Scale for Depression (Ham-D), and the Nursing Observation Scale for Inpatient Evaluation.
Maruish, M. E. (Ed.). (1998). The Use of Psychological Testing for Treatment Planning and Outcomes. Mahwah, NJ: Lawrence Elbaum Associates, Inc.
American Psychiatric Association. Task Force for the Handbook of Psychiatric Measures, A. J. (2000). Handbook of psychiatric measures. American Psychiatric Association.
Bell M, Milstein R, Beam-Goulet J, et al: The Positive and Negative Syndrome Scale and the Brief Psychiatric Rating Scale: reliability, comparability, and predictive validity. J Nerv Ment Dis 180:723–728, 1992
Faustman WO: Brief Psychiatric Rating Scale, in The Use of Psychological Testing for Treatment Planning and Outcome Assessment. Edited by Maruish ME. Hillsdale, NJ, Erlbaum, 1994, pp 371–401