Brief Psychiatric Rating Scale, BPRS Test - the question form
Questions: 18 · 4 minutes
1. Somatic concern. Degree of preoccupation with physical health; how much the person is troubled by physical condition, regardless of whether the complaints have a real basis.
1. Not present: no expressed concern about physical health.
2. Very mild: questionable pathology; observed signs may be within the upper limits of normal.
3. Mild: noticeable concern about health or physical condition.
4. Moderate: expresses thoughts of having a serious physical illness (e.g., cancer or heart disease), but these do not reach delusional intensity.
5. Severe: complaints are unusual or bizarre (e.g., internal organs are rotting), but the person can be talked out of it briefly.
6. Very severe: intermediate gradation.
7. Extremely severe: convinced that organs have rotted or are absent, or that worms are eating the brain; cannot be talked out of it even briefly.
2. Anxiety (psychological). Worry, fear, excessive concern about the present and the future. Rate based solely on the patient’s verbal report of subjective feelings; do not rate from physical signs or defensive neurotic reactions.
1. Not present: the patient does not experience anxiety, a sense of undefined danger, or inner tension.
2. Very mild: questionable pathology; the observed features may be at the upper limit of normal.
3. Mild: the patient is somewhat anxious, tense, or apprehensive about something undefined.
4. Moderate: anxiety, a sense of undefined danger, worry, or inner tension is clearly present, is difficult to control, and may affect everyday activity.
5. Severe: anxiety and a sense of undefined danger at times become very pronounced and are experienced as panic; i.e., anxiety becomes out of control.
6. Very severe: intermediate grade.
7. Extreme: the patient is often described as panicky. The patient cannot be reassured, which markedly affects the interview.
3. Emotional withdrawal
1. Not present: no disturbance of emotional contact is observed.
2. Very mild: questionable pathology; the observed features may be within the upper limits of normal.
3. Mild: the patient maintains some emotional distance but does not avoid looking at the interviewer.
4. Moderate: emotional responses are reduced; the patient also tends to avoid eye contact with the interviewer.
5. Marked: emotional contact is very limited; the patient rarely makes eye contact with the interviewer.
6. Very marked: intermediate rating.
7. Extreme: marked limitation or complete absence of emotional contact; the patient avoids looking at the interviewer.
4. Conceptual disorganization (thought disorder/incoherence). Degree of confusion, fragmentation, and disordered thinking, rated based on the coherence of the patient’s verbal output (not on the patient’s subjective appraisal of their mental functioning).
1. Not present: no thought disturbance observed.
2. Very mild: questionable pathology; the observed features may be at the upper limit of normal.
3. Mild: thinking is somewhat vague, but grammar is not disrupted.
4. Moderate: moderately severe thought disturbance. The patient combines words in a grammatically unusual way that is understandable only to them, or speech seems “empty,” lacking communicative information.
5. Severe: marked thought disturbance. The patient is sometimes difficult to understand; neologisms and abrupt breaks in thought may be observed.
6. Very severe: intermediate grade.
7. Extreme: due to marked disorganization of thinking, only fragments of the patient’s speech are understandable.
5. Guilt feelings
Absent: No feelings of guilt or lowered self-esteem.
Very mild: Questionable pathology; the features may be within the upper limit of normal.
Mild: The patient shows some lowering of self-esteem and vague feelings of guilt, feeling that they have not lived up to expectations and hopes placed on them.
Moderate: Low self-esteem and feelings of guilt are clearly present and are not limited to thoughts of being a burden to the family or having work problems due to current reduced functioning. There are unjustified self-reproaches for minor mistakes or shortcomings (e.g., not fulfilling duties or causing harm to others). These self-accusations are often focused on past events preceding the current condition.
Severe: The patient suffers from marked feelings of guilt and often experiences this suffering as a form of punishment for various past misdeeds. Rate 5 if the patient acknowledges that this belief is unfounded and can be reassured.
Very severe: Intermediate rating.
Extremely severe: Feelings of guilt are constant and persistent and are resistant to any reassurance, reaching a delusional level.
6. Tension: Physical and motor manifestations of tension (nervousness, increased excitability). Rate based solely on physical signs and motor activity; do not base the rating on the patient’s subjective complaints.
Absent: No somatic manifestations of anxiety are observed.
Very mild: Questionable pathology; the observed signs may be at the upper limit of normal.
Mild: The patient occasionally shows mild manifestations of anxiety, such as gastrointestinal symptoms, sweating, or tremor.
Moderate: The patient from time to time experiences somatic manifestations of anxiety, such as gastrointestinal symptoms, sweating, tremor, etc. These symptoms occur spontaneously but are not pronounced.
Severe: Marked somatic manifestations of anxiety are present during almost the entire interview.
Very severe: Intermediate rating.
Extreme: Physiological manifestations of anxiety are numerous, constant, and often make the patient unable to continue the interview.
7. Mannerisms and posturing. Unusual, unnatural behavior that makes the patient stand out. Rate only the unusual quality of movements; do not confuse this with a simple increase in motor activity.
1. Not present: no motor abnormalities are observed.
2. Very mild: questionable pathology; observed signs may be at the upper limit of normal.
3. Mild: minor motor abnormalities are noted intermittently during the interview.
4. Moderate: motor abnormalities are noted during most of the interview.
5. Marked: persistent motor abnormalities that may stop briefly.
6. Very marked: intermediate severity.
7. Extreme: continuous, uncontrolled motor and behavioral abnormalities that interfere with conducting the interview.
8. Grandiosity (elevated self-esteem; beliefs of unusual ability or power). Rate based only on the patient’s statements about self or relationships with others, not on behavior during the interview.
1. Not present: normal self-esteem.
2. Very mild: questionable pathology; the rated signs may be at the upper limit of normal.
3. Mild: slight elevation of self-esteem, e.g., occasional overestimation of ordinary abilities.
4. Moderate: elevated self-esteem is expressed by frequent overestimation of ordinary abilities or by hints of unusual abilities.
5. Severe: the patient claims to have extraordinary abilities, power, or knowledge (scientific, religious, extrasensory, etc.), although the patient can be briefly persuaded otherwise.
6. Very severe: intermediate rating. Delusional grandiose ideas are present in one or two areas and sometimes become clearly fantastic or absurd.
7. Extremely severe: grandiose ideas are not amenable to correction (paraphrenic delusion). Highly fantastic and absurd grandiose ideas pervade all aspects of the patient’s personality.
9. Depressed mood. Low mood, sadness. Rate only the degree of depressed mood. Do not rate this item based on general psychomotor slowing or somatic complaints.
1. Not present: Normal, neutral mood.
2. Very mild: Questionable pathology; the signs being rated may be within the upper limits of normal.
3. Mild: Vague feelings of sadness and low mood are elicited only with directed questioning.
4. Moderate: The patient spontaneously reports low mood and sadness. Some manifestations of depression are evident in the patient’s appearance.
5. Severe: Clear manifestations of depression are observed in the patient’s appearance and behavior (e.g., frequent crying, pallor, a sorrowful facial expression, or a trembling voice). Or there is a loss of interest in all areas of everyday activity.
6. Very severe: Intermediate rating.
7. Extremely severe: Complaints of intense sadness, hopelessness, or depressive features in the patient’s appearance and behavior predominate during the interview. Attempts to cheer the patient up are unsuccessful.
10. Hostility
Absent: no signs of intolerance, irritability, unfriendly attitude toward others, or hostility.
Very mild: questionable pathology; the observed signs may be at the upper limit of normal.
Mild: occasional signs of intolerance or irritability, but the patient is able to maintain self-control.
Moderate: clear signs of intolerance and irritability. The patient maintains self-control with difficulty and may respond to provocation.
Severe: the patient uses verbal insults and threats and may show a tendency toward destructive behavior, but can be calmed verbally.
Very severe: intermediate level.
Extreme: marked anger and aggressiveness with episodes of destructive acts or physical assault on others.
11. Suspiciousness: Belief (delusional or otherwise) that other people are, or previously were, hostile toward or biased against the patient. Rate only suspiciousness present at the time of the interview, regardless of whether it concerns past or current events.
1. Not present: No suspiciousness or distrust of other people.
2. Very mild: Questionable pathology; the features rated may represent the upper limit of normal.
3. Mild: The patient expresses vague ideas of reference (e.g., that “something is going on”), believes others are talking about or laughing at them; can be reassured and persuaded otherwise.
4. Moderate: Vague ideas of reference and unsystematized persecutory ideas, triggered by watching television or reading newspapers.
5. Severe: Persecutory delusions are systematized; the patient is difficult to reassure or persuade otherwise.
6. Very severe: Intermediate rating.
7. Extreme: Extensive, systematized persecutory delusional system; not amenable to correction.
12. Hallucinations. Perceptions occurring without a corresponding external stimulus. Rate only experiences during the past week that, by the patient’s description, are clearly distinct from ordinary thoughts and imagery.
1. Not present: the patient’s condition does not meet the definition of the disturbance.
2. Very mild: questionable pathology; the signs may be at the upper limit of normal.
3. Mild: hypnagogic hallucinations or isolated elementary hallucinations (single sounds/noises, flashes of light).
4. Moderate: infrequent but fully formed hallucinations (clear voices or visions) that do not influence the patient’s behavior.
5. Severe: infrequent hallucinations that influence the patient’s behavior.
6. Very severe: intermediate gradation.
7. Extreme: frequent hallucinations that determine the patient’s thinking and behavior.
13. Motor retardation. Reduced energy level manifested by slowed movements. Rate based on observation of the patient’s behavior only. Do not rate based on the patient’s subjective report of their own activity.
1. Not present: the patient’s condition does not meet the definition of the disturbance.
2. Very mild: questionable pathology; the observed signs may be at the upper limit of normal.
3. Mild: slight but noticeable slowing of movements, speech, and facial expression.
4. Moderate: clear slowing of speech, pauses appear, reduced gestures and facial expressiveness.
5. Severe: the interview is markedly prolonged due to long pauses and brief answers; all of the patient’s movements are slowed.
6. Very severe: intermediate anchor.
7. Extremely severe: unable to complete the interview; the patient’s immobility nearly progresses to (or includes) stupor.
14. Uncooperativeness (poor rapport). Signs of resistance, hostility, rejection of the interview situation, and unwillingness to cooperate (to engage) with the examiner. Rate based solely on the patient’s responses and attitude toward the clinician or the interview situation. Do not rate based on reports of hostility or poor rapport outside the interview.
1. Not present: No impairment in interpersonal contact is observed.
2. Very mild: Questionable pathology; the rated signs may be at the upper limit of normal.
3. Mild: A formal or restrained attitude toward the interview situation. The patient gives brief answers to the clinician’s questions.
4. Moderate: The patient gives evasive answers to some questions and resists further questioning. There is a clearly hostile attitude toward the clinician.
5. Severe: The patient resists the interview, ignores questions or gives responses unrelated to the main topic, and shows open hostility toward the clinician. The interview is difficult to conduct.
6. Very severe: Intermediate rating.
7. Extreme: The interview is impossible because the patient completely ignores the clinician and refuses to answer questions.
15. Unusual thought content. Unusual, odd, peculiar, or eccentric thoughts. Rate the degree of unusualness of the thought content, not the degree of disorganization of the thought process.
1. Not present: No unusual thought content is noted.
2. Very mild: Questionable pathology; the rated features may be at the upper limit of normal.
3. Mild: The patient has overvalued ideas.
4. Moderate: Unusualness of thought content reaches a delusional level.
5. Marked: Delusional ideas determine the content of the patient’s thinking and sometimes influence behavior.
6. Very marked: Intermediate rating.
7. Extreme: Multiple highly implausible or fantastic delusional ideas determine the patient’s thinking and behavior.
16. Blunted affect. Reduced emotional expression; an obvious lack of normal emotional experience or involvement.
1. Not present: emotional reactions are appropriate to the situation.
2. Very mild: questionable pathology; the observed features may be at the upper limit of normal.
3. Mild: emotional reactions are reduced or sometimes inappropriate. Decreased interest in meeting new people and maintaining existing acquaintances is noted.
4. Moderate: definite affective flattening; the patient shows no need to establish closer contact with people outside the family (e.g., coworkers, other patients, medical staff).
5. Marked: emotional indifference is evident even toward close friends and family members.
6. Very marked: intermediate rating.
7. Extreme: the patient appears indifferent to everything, "shut down"; emotional expression is clearly inappropriate to the situation or thought content. Complete emotional isolation is noted, with no desire for any form of human contact.
17. Excitement. Heightened emotional tone, agitation, excitability, increased reactivity (emotional sensitivity).
1. Not present: the patient is calm; no episodes of excitement are noted during the interview.
2. Very mild: questionable pathology; the signs being rated may be at the upper limit of normal.
3. Mild: the patient occasionally becomes somewhat restless, but there are no clearly defined episodes of excitement or marked mood lability.
4. Moderate: obvious restlessness; intermittent outbursts of excitement may be observed.
5. Severe: frequent periods of motor excitement; the patient is extremely restless throughout the interview.
6. Very severe: intermediate rating.
7. Extreme: increased motor activity makes the interview and any interactions with other people virtually impossible.
18. Disorientation: Confusion or an incomplete/incorrect awareness of personal identity, place, and time.
Not present: Fully oriented to place, time, and surroundings.
Very mild: Questionable pathology; signs may be at the upper limit of normal.
Mild: Some difficulty stating home address or the exact date.
Moderate: Does not always recognize people correctly or correctly state the place and time.
Severe: Has difficulty recognizing familiar people; does not know where they are; when asked the date can only roughly state the current year.
Very severe (intermediate rating).
Extreme: Complete loss of orientation to place, time, space, and surroundings.