Brief Psychiatric Rating Scale (BPRS)

Assesses psychotic symptoms in patients with schizophrenia and related disorders.

Refer to the text below for more information on the instruments, its scoring and different versions.

Brief Psychiatric Rating Scale (BPRS) is an 18-item scale measuring positive symptoms, general psychopathology, and affective symptoms. It can be used to evaluate the efficacy of treatment in patients who have moderate to severe psychoses.

Its administration, via a clinician’s interview with the patient and observation of the patient’s behaviour over the previous two-three days, can take as little as 20-30 minutes.

The scale is one of the oldest and most widely used tools for assessing psychotic symptoms. It should be administered by a clinician well-versed in the specific symptom domains and in severe mental health disorders.

The items of the test were generated from conducting factor analysis on the Multidimensional Scale for Rating Psychiatric Patients and the Inpatient Multidimensional Psychiatric Scale.

Its intended population is adult psychiatric patients and has been validation for use in elderly patients as well.

Please choose the answer on the scale which best describes the patient’s condition.
1Somatic Concern Degree of concern over present bodily health. Rate the degree to which physical health is perceived as a problem by the patient, whether complaints have a realistic basis or not.
2Anxiety Worry, fear, or over-concern for present or future. Rate solely on the basis of verbal report of patient’s own subjective experiences. Do not infer anxiety from physical signs or from neurotic defense mechanisms.
3Emotional Withdrawal Deficiency in relating to the interviewer and to the interviewer situation. Rate only the degree to which the SCORE patient gives the impression of failing to be in emotional contact with other people in the interview situation.
4Conceptual Disorganization Degree to which the thought processes are confused, disconnected, or disorganized. Rate on the basis of SCORE integration of the verbal products of the patient; do not rate on the basis of patient’s subjective impression of his own level of functioning.
5Guilt Feelings Over-concern or remorse for past behavior. Rate on the basis of the patient’s subjective experiences of guilt as evidenced by verbal report with appropriate affect; do not infer guilt feelings from depression, anxiety or neurotic defenses.
6Tension Physical and motor manifestations of tension “nervousness”, and heightened activation level. Tension should be rated solely on the basis of physical signs and motor behavior and not on the basis of subjective experiences of tension reported by the patient.
7Mannerisms and Posturing Unusual and unnatural motor benavior, the type of motor behavior which causes certain mental patients to stand out in a crowd of normal people. Rate only abnormality of movements; do not rate simple heightened motor activity here.
8Grandiosity Exaggerated self-opinion, conviction of unusual ability or powers. Rate only on the basis of patient’s statements about himself or self-in-relation-to-others, not on the basis of his demeanor in the interview situation.
9Depressive Mood Despondency in mood, sadness. Rate only degree of despondency; do not rate on the basis of inferences concerning depression based upon general retardation and somatic complaints.
10Hostility Animosity, contempt, belligerence, disdain for other people outside the interview situation. Rate solely on the basis of the verbal report of feelings and actions of the patient toward others; do not infer hostility from neurotic defenses, anxiety, nor somatic complaints. (Rate attitude toward interviewer under “uncooperativeness”).
11Suspiciousness Brief (delusional or otherwise) that others have now, or have had in the past, malicious or discriminatory intent toward the patient. On the basis of verbal report, rate only those suspicions which are currently held whether they concern past or present circumstances.
12Hallucinatory Behavior Perceptions without normal external stimulus correspondence. Rate only those experiences which are reported to have occurred within the last week and which are described as distinctly different from the thought and imagery processes of normal people.
13Motor Retardation Reduction in energy level evidenced in slowed movements. Rate on the basis of observed behavior of the patient only; do not rate on the basis of patient’s subjective impression of own energy level.
14Uncooperativeness Evidence of resistance, unfriendliness, resentment, and lack of readiness to cooperate with the interviewer. Rate only on the basis of the patient’s attitude and responses to the interviewer and the interview situation; do not rate on basis of reported resentment or uncooperativeness outside the interview situation.
15Unusual Thought Content Unusual, odd, strange or bizarre thought content. Rate here the degree of unusualness, not the degree of disorganization of thought processes.
16Blunted Affect Reduced emotional tone, apparent lack of normal feeling or involvement.
17Excitement Heightened emotional tone, agitation, increased reactivity.
18Disorientation Confusion or lack of proper association for person, place or time.
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About the BPRS Scale

BPRS is a clinician-administered rating scale for assessing the positive, negative, and affective symptoms of individuals with schizophrenia and related psychotic disorders. It is used to track changes in symptoms over time and with new treatment regimens.

The rater evaluates the level of 18 relevant positive, negative and mood symptom constructs such as hostility, hallucination, and grandiosity.

  1. Somatic concerns;
  2. Anxiety;
  3. Emotional withdrawal;
  4. Conceptual disorganization;
  5. Guilt feelings;
  6. Tension;
  7. Mannerisms and posturing;
  8. Grandiosity;
  9. Depressive mood;
  10. Hostility;
  11. Suspiciousness;
  12. Hallucinatory behaviour;
  13. Motor retardation;
  14. Uncooperativeness;
  15. Unusual thought content;
  16. Blunted affect;
  17. Excitement;
  18. Disorientation.

Its administration, via a clinician’s interview with the patient and observation of the patient’s behaviour over the previous two-three days, can take as little as 20-30 minutes.

It can be used to evaluate the efficacy of treatment in patients who have moderate to severe psychoses.

 

BPRS scoring

Each of the 18 items is rated by a number that ranges from 1 (not present) to 7 (extremely severe), with also an option of rating 0, if the particular area is not assessed.

  • 0 – not assessed
  • 1 – not present
  • 2 – very mild
  • 3 – mild
  • 4 – moderate
  • 5 – moderately severe
  • 6 – severe
  • 7 – extremely severe

The final score is obtained by adding together the scores from the individual items and ranges between 0 and 126. The higher the score, the more severe the pathology.

When scoring the BPRS, raters individually consider how often each symptom is displayed and how much it affects the patient’s health and daily life.

There are no specific, commonly accepted cut-offs when interpreting the clinical significance of the BPRS scores. A 2005 study by Leucht et al. linked the BPRS results with those of the Clinical Global Impression (CGI) instrument on a cohort of 1979 acutely ill patients from seven drug trials.

The study employed the psychometric procedure of equipercentile linking was used to link the BPRS to a clinically meaningful global rating.

The “Mildly ill” interpretation of CGI was found to approximately correspond to a BPRS score of 31, whilst “Moderately ill” CGI to a 41 BPRS and “Markedly ill” CGI to a 53.

In terms of the “Minimally improved” interpretation in the CGI, this was associated with a percentage BPRS reduction 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%.

Please note that the results are only generalisable to patients with schizophrenia and at least moderate positive symptoms.

 

The scale development

BPRS was first published as a 16-item version in 1962 by Drs. John Overall and Donald Gorham and was later enhanced with 2 more items (Excitement and Disorientation).

The items of the test were generated from conducting factor analysis on the Multidimensional Scale for Rating Psychiatric Patients and the Inpatient Multidimensional Psychiatric Scale.

The scale is one of the oldest and most widely used tools for assessing psychotic symptoms. It should be administered by a clinician well-versed in the specific symptom domains and in severe mental health disorders.

Its intended population is adult psychiatric patients and has been validation for use in elderly patients as well.

In order to increase its sensitivity to psychotic and affective disorders as well as to be available for the assessment of patients living in the community, the BPRS was expanded to 24 items.

 

BPRS-E (24-item version)

The 18-item version of the BPRS published in 1967 remains commonly used in research and practice. Whilst the criteria have been redone numerous time since the 60s, there is another expanded version that proves popular, that created by D. Lukoff, Keith H. Nuechterlein, and Joseph Ventura and published in 1993.

It includes 6 more items that are scored on the same Likert scale (0 – 7, from not assessed to extremely severe):

  • Bizarre behavior;
  • Self-neglect;
  • Distractibility;
  • Motor hyperactivity;
  • Elated mood;
  • Suicidality (suicidal feelings or attempts).

The administration of the expanded version ) offers a more detailed semi-structured interview containing more probe questions for each symptom.

 

BPRS versus PANSS

Both scales are commonly used in research and in clinical assessments of symptoms of patients with psychotic disorders, especially schizophrenia, however, they each have certain strength areas.

The PANSS may be more relevant in research settings for more detailed evaluation of negative and positive symptoms of psychosis, schizophrenia and related disorders.

In contrast, the BPRS may provide a better assessment of general symptoms of psychotic conditions and their changes in time or with treatment.

 

References

Original reference

Overall, J. E., Hollister, L. E., & Pichot, P. Major psychiatric disorders: A four- dimensional model. Archives of General Psychiatry, 1967; 16(2), 146-151.

Other references

Overall, J.E. and Gorham, D.R. The Brief Psychiatric Rating Scale. Psychological Report, 10, 1962; 799-812.

Leucht S, Kane JM, Kissling W, Hamann J, Etschel E, Engel R. Clinical implications of Brief Psychiatric Rating Scale scores. British Journal of Psychiatry. 2005; 187(4):366-371.

Zanello A, Berthoud L, Ventura J, Merlo MC. The Brief Psychiatric Rating Scale (version 4.0) factorial structure and its sensitivity in the treatment of outpatients with unipolar depression. Psychiatry Res. 2013; 210(2):626-33.

Specialty: Psychiatry

System: Nervous

Objective: Evaluation

Type: Scale

No. Of Items: 18

Year Of Study: 1967

Abbreviation: BPRS

Article By: Denise Nedea

Published On: September 18, 2024

Last Checked: September 18, 2024

Next Review: September 18, 2029