A Review of Psychiatric Rating Scales

Abstract

Considerable attention has been paid during the past twenty years, mainly by research workers in the U.S.A., to the employment of rating scales for the assessment and recording of those characteristics of psychiatric patients which are generally classed as signs and symptoms. As well as being used in the practical problems of diagnostic evaluation of patients, the rating scales are often employed in research endeavours in the area of psychiatric nosology. Their employment and the methodological approach which they represent might well be regarded as complementary to other sorts of activities and interpretative philosophies which might be encountered in any particular psychiatric facility, including those in which comparatively less emphasis may be laid upon considerations of diagnostic differentiation. Rating scales are relatively objective methods of appraisal at least of certain observable aspects of personality, such as overt situational behaviour and appearance, as well as some aspects of the patients' verbal communication. In employing these scales, such personal characteristics are systematically reviewed; usually quantitatively graded; and are recorded in recoverable form. Immediate interpretation of the observed phenomena is not called for. The observations are made in a more or less standardized fashion, and more than one rater may participate in order to minimize subjective differences of appraisal. In this way, then, real life behaviour in a particular situation is assessed, in contrast to the approach involved in some of the more traditional ‘test’ methods, in which the rationale entails that certain aspects of personality are implied symbolically in the test scores or protocol. However, in so far, as certain of the scales may involve some self-report on the part of patients regarding subjective feelings and symptoms, there is clearly some affinity with certain of the older personality inventories, questionnaires, symtom check-lists and the like. The factor analytic treatment of data derived from the use of psychiatric rating scales to assess some of the phenomena of psychopathology has led to fresh suggestive principles of classifying these. From various studies a number of dimensions have emerged in distinction from the usual disease entities though it is possible to make assimilatory links between these two sets, as, for example, Lorr (26) has done. While the nature and number of the ‘factors’ produced are dependent upon the particular patient population studied, several surveys have resulted in some measure of concordance as may be seen in the three lists of factors shown in Table 1. The various scales themselves may be typed according to the extent of involvement of the patient; the areas covered by the particular scale; and the sort of patients for whom it is intended. In this way, the reader will be able to select scales which are appropriate for any particular purpose, such as routine observation and assessment, or research connected with changes of signs and symptoms.