Posted by ed_uk on November 17, 2004, at 11:57:32
In reply to Re: Specificity of Anti-psychotics, posted by ed_uk on November 17, 2004, at 7:37:21
Hello, I just wanted to expand a little bit on what I said earlier...
In order to perform a clinical trial to determine the efficacy of a psychiatric drug, a valid measure of symptom severity is needed. It is very difficult, however, perhaps even impossible to design a rating scale which accurately reflects the severity of symptoms in a large number of people. A scale which appears to be a valid measure of symptom severity in one individual may turn out to be a highly insensitive measure of symptom severity in someone else.
Here is the Brief Psychiatric Rating Scale (BPRS)...... It is one of the most popular scales which is used to measure symptom severity in patients suffering from schizophrenia. It has been widely used in clinical trials of anti-psychotic drugs.
This form consists of 24 symptom constructs, each to be rated in a 7-point scale of severity ranging from 'not present' to 'extremely severe' If a specific symptom is not rated, mark 'NA' (not assessed). Circle the number headed by the term that best describes the patient's present condition. The overall score is then calculated.
1.not present 2.very mild 3.mild 4.moderate 5.moderately severe 6.severe 7.extremely severe
1 Somatic concern NA 1 2 3 4 5 6 7
2 Anxiety NA 1 2 3 4 5 6 7
3 Depression NA 1 2 3 4 5 6 7
4 Suicidality NA 1 2 3 4 5 6 7
5 Guilt NA 1 2 3 4 5 6 7
6 Hostility NA 1 2 3 4 5 6 7
7 Elated Mood NA 1 2 3 4 5 6 7
8 Grandiosity NA 1 2 3 4 5 6 7
9 Suspiciousness NA 1 2 3 4 5 6 7
10 Hallucinations NA 1 2 3 4 5 6 7
11 Unusual thought content NA 1 2 3 4 5 6 7
12 Bizarre behaviour NA 1 2 3 4 5 6 7
13 Self-neglect NA 1 2 3 4 5 6 7
14 Disorientation NA 1 2 3 4 5 6 7
15 Conceptual disorganisation NA 1 2 3 4 5 6 7
16 Blunted affect NA 1 2 3 4 5 6 7
17 Emotional withdrawal NA 1 2 3 4 5 6 7
18 Motor retardation NA 1 2 3 4 5 6 7
19 Tension NA 1 2 3 4 5 6 7
20 Uncooperativeness NA 1 2 3 4 5 6 7
21 Excitement NA 1 2 3 4 5 6 7
22 Distractibility NA 1 2 3 4 5 6 7
23 Motor hyperactivity NA 1 2 3 4 5 6 7
24 Mannerisms and posturing NA 1 2 3 4 5 6 7
In schizophrenia, treatment with an antipsychotic is sometimes effective in reducing the BPRS score. It is quite possible, however, for the score to be reduced without any change whatsoever in the patients 'core' psychotic symptoms. To give an example..... anxiety, hostility, excitement, motor hyperactivity, tension and elation may be reduced without any change in more specific symptoms such as hallucinations and delusions. A (possibly) small proportion of psychotic individuals may obtain a 'true' antipsychotic effect from their medication ie. elimination of hallucination and delusions etc.... many others might be expected to do as well on diazepam!What do you think???
Regards,
Ed
poster:ed_uk
thread:416642
URL: http://www.dr-bob.org/babble/20041113/msgs/417085.html