Descriptive Psychopathology: The Signs and Symptoms of ...

121 Chapter 5: Examination style, structure, and techniqueis similar to the HAMD and the MADRS. There are many depression scales (Taylor andFink 2006, chapter 5), but fewer instruments that measure acute mania. These are similar inform and limitations to the depression scales (Young et al., 1983; Berk et al., 2007).Rating scales have been developed for almost every diagnostic class, and most of themrely on the overly simplified clinical features listed in the classification manuals. The BriefPsychiatric Rating Scale (BPRS) has a 10- and an 18-item versions, both widely usedin schizophrenia research. The BPRS is unsophisticated, offering basic categories only(e.g. hallucinations, agitation) to measure general symptom severity. The BPRS is sensitiveto symptom change and so is also used to monitor treatments (Hafkenscheid 1993).As the BPRS offers only one item specific to negative symptoms, several instruments havebeen developed to assess this aspect of psychopathology. They are helpful in teachingaspects of emotional blunting (see Chapter 8), and several reliable instruments are available(Abrams and Taylor 1978; Berenbaum et al., 1987; Bell et al., 1992). Some of these alsomeasure positive symptoms (e.g. hallucinations, delusions), and replace the BPRS (Andreasen,1982; Bell et al., 1992; Santoret al., 2007).Catatonia rating instruments are now available (Bush et al., 1996; Braunig et al., 2000),and are helpful in teaching the many features of catatonia and in assessing the response ofpatients with suspected catatonia to a lorazepam challenge test (1–2mg IV). A positive testconfirms the diagnosis and indicates treatment (Fink and Taylor, 2003).11 Endicott and Spitzer (1978).12 Mortimer (2007).