Scale for Assessing Positive Symptoms, SAPS Test - the question form
Questions: 34 · 7 minutes
1. Auditory hallucinations.
0 – None
1 – Questionable pathology (the presence of hallucinations is doubtful)
2 – Mild – occasionally hears noises or single words
3 – Moderate – voices are clearly present, but no more than once a week
4 – Marked – voices are clearly present and occur frequently
5 – Severe – voices occur daily
2. Commentary voices.
0 – Absent
1 – Questionable pathology
2 – Mild – commentary occurred once or twice
3 – Moderate – commentary voices occur at least once a week
4 – Marked – frequent occurrence of commentary voices
5 – Severe – daily voices with a commentary content
3. Voices conversing with one another.
0 – none
1 – questionable pathology
2 – mild – occurred once or twice
3 – moderate – voices conversing with one another occur at least once a week
4 – marked – frequent occurrence of voices conversing with one another
5 – severe – daily voices conversing with one another
4. Somatic or tactile hallucinations.
0 – Absent
1 – Questionable
2 – Mild – the phenomenon has occurred at least once
3 – Moderate – the phenomenon occurs at least once a week
4 – Marked – frequent somatic or tactile hallucinations
5 – Severe – daily somatic or tactile hallucinations
5. Olfactory hallucinations.
0 – absent
1 – questionable pathology
2 – mild – olfactory hallucinations have occurred at least once
3 – moderate – olfactory hallucinations occur at least once a week
4 – marked – frequent olfactory hallucinations
5 – severe – daily olfactory hallucinations
6. Visual hallucinations.
0 – absent
1 – questionable pathology
2 – mild – the phenomenon occurs at least once
3 – moderate – visual hallucinations occur at least once a week
4 – marked – frequent visual hallucinations
5 – severe – daily visual hallucinations
7. Global Rating of Hallucinations
0 – None
1 – Questionable pathology – the presence of hallucinations is doubtful
2 – Mild – hallucinations are definitely present, but occur very rarely and are sometimes doubted by the patient
3 – Moderate – fairly distinct hallucinations occur periodically and are a source of embarrassment for the patient
4 – Marked – frequent and vivid hallucinations, often determining the patient’s life and behavior
5 – Severe – hallucinations daily, often bizarre or fantastic, very vivid, and completely determine the patient’s behavior
8. Persecutory delusions.
0 – Absent.
1 – Questionable pathology.
2 – Mild – delusional ideas are rudimentary, unstable, and may take various forms; the patient may express doubts about their existence.
3 – Moderate – clear, well-formed delusional ideas accompanied by firm conviction.
4 – Marked – prominent persecutory delusions accompanied by firm conviction and prompting protective actions.
5 – Severe – extensive, systematized persecutory delusions that determine the patient’s behavior most of the time; some aspects of the delusions or delusional behavior may be absurd or bizarre.
9. Jealous delusions.
0 – Absent
1 – Questionable pathology
2 – Mild – delusional conviction is limited; jealous ideas are fragmentary, unstable, and may take various forms; the patient may express doubts about their existence
3 – Moderate – clear and well-formed jealous delusions, accompanied by firm conviction
4 – Marked jealous delusions, accompanied by firm conviction and prompting corresponding actions
5 – Severe – extensive and systematized jealous delusions that determine the patient’s behavior most of the time; some aspects of the delusions or delusional behavior may be absurd or bizarre
10. Delusions of guilt or sin.
0 – Absent
1 – Questionable pathology
2 – Mild – Delusional ideas are rudimentary, unstable, and may take various forms; the patient may express doubts about their existence
3 – Moderate – Clear and well-developed delusional ideas accompanied by firm conviction
4 – Marked – Prominent delusions of guilt or sin accompanied by firm conviction and prompting corresponding actions
5 – Severe – Extensive and systematized delusions of guilt or sin that determine the patient’s behavior most of the time; some aspects of the delusions or delusional behavior may be absurd or bizarre
11. Delusions of grandeur.
0 – Absent
1 – Questionable pathology
2 – Mild – delusions of grandeur are rudimentary, unstable, and may take various forms; the patient may express doubt about them
3 – Moderate – clear and well-developed delusions, with firm conviction
4 – Marked delusions of grandeur, with firm conviction and leading the patient to act accordingly
5 – Severe – elaborate and systematized delusions of grandeur that determine the patient’s behavior most of the time; some aspects of the delusions or delusional behavior may be bizarre or odd
12. Religious delusions.
0 – Absent
1 – Questionable pathology
2 – Mild: delusional ideas are rudimentary, unstable, and may take various forms; the patient may express doubts about their existence
3 – Moderate: clear, well-developed delusional ideas with firm conviction
4 – Marked: prominent religious delusional ideas with firm conviction, leading the patient to act accordingly
5 – Severe: extensive, systematized religious delusional ideas that determine the patient’s behavior most of the time; some aspects of the delusion or delusional behavior may be absurd or bizarre
13. Hypochondriacal delusions.
0 – Absent.
1 – Questionable pathology.
2 – Mild – delusional ideas are rudimentary, unstable, and may take various forms; the patient may express doubt about their existence.
3 – Moderate – clear and well-substantiated delusional ideas accompanied by firm conviction.
4 – Marked – pronounced hypochondriacal delusional ideas accompanied by firm conviction and prompting corresponding actions.
5 – Severe – extensive, systematized hypochondriacal delusional ideas that determine the patient’s behavior most of the time; some aspects of the delusion or delusional behavior may be absurd or bizarre.
14. Delusions (ideas) of reference.
0 – absent
1 – questionable pathology
2 – mild – ideas of reference are slight but definite
3 – moderate – pronounced delusions of reference
4 – marked delusions of reference, occurring at least once per week
5 – severe – frequent delusions of reference
15. Delusions of being controlled.
0 – Absent
1 – Questionable pathology
2 – Mild – the patient feels that their actions are controlled from time to time, but doubts this
3 – Moderate – clear, repeatedly occurring experiences of being influenced by outside forces
4 – Marked – frequent ideas of being controlled that are reflected in the patient’s behavior
5 – Severe – prominent and frequent delusional ideas of being controlled that fully dominate the patient’s personality and influence behavior
16. Delusions of thought broadcasting (mind reading).
0 – Absent
1 – Questionable pathology
2 – Mild – the patient feels that their thoughts have been known (read), but has doubts that this is possible
3 – Moderate – clear experiences of mind reading, recurring several times
4 – Marked and frequent experiences of mind reading, sometimes affecting the patient’s behavior
5 – Severe – marked and frequent experiences of thought openness or mind reading, fully preoccupying the patient and regularly influencing their behavior
17. Thought broadcasting.
0 – Absent
1 – Questionable pathology
2 – Mild – delusional ideas are fragmentary, unstable, and may take various forms; the patient may express doubt that they are true
3 – Moderate – definite, recurrent experiences of thought broadcasting
4 – Marked and frequent experiences of thought broadcasting, sometimes affecting behavior
5 – Severe – marked and frequent experiences of thought broadcasting, fully preoccupying the patient and regularly affecting behavior
18. Delusions of thought insertion.
0 – Absent
1 – Questionable pathology
2 – Mild – the patient senses the insertion of alien thoughts and expresses doubts about whether this is possible
3 – Moderate – clear, repeatedly occurring experiences of thought insertion
4 – Marked – prominent and frequent experiences of thought insertion, sometimes affecting behavior
5 – Severe – prominent and frequent experiences of thought insertion, fully dominating the patient and regularly influencing behavior
19. Delusions of thought withdrawal.
0 – absent
1 – questionable pathology
2 – mild – the patient experiences thought withdrawal by an outside force but expresses doubts that this is possible
3 – moderate – clear, recurrent phenomena of thought withdrawal occurring several times
4 – marked and frequent experiences of thought withdrawal, sometimes affecting the patient’s behavior
5 – severe – marked and frequent phenomena of thought withdrawal that fully dominate the patient’s personality and regularly influence behavior
20. Global rating of delusions.
0 – Absent
1 – Questionable pathology
2 – Mild – Delusional ideas are present, but the patient sometimes questions whether they are real.
3 – Moderate – The patient shows clear conviction in the delusional ideas, which may be brought up frequently and sometimes affect behavior.
4 – Marked – The patient is absolutely convinced of the delusional ideas, which are often brought up and affect the patient’s behavior.
5 – Severe – Delusional ideas are elaborate and systematized, encompass the patient’s entire environment, and almost completely determine behavior; they are often bizarre or fantastic in content, but the patient is absolutely convinced they are true.
21. Clothing and appearance.
0 – absent
1 – questionable pathology
2 – mild – at times, the person’s clothing or appearance seems overly original
3 – moderate – clothing or appearance is clearly odd and draws others’ attention (e.g., shaved head)
4 – marked – frankly bizarre (affected) appearance or manner of dress (examples above)
5 – severe – appearance or clothing is completely bizarre (inappropriate) or extravagant (e.g., dresses like Napoleon)
22. Social and sexual behavior.
0 – Absent.
1 – Questionable pathology.
2 – Mild – occasional instances of strange (conspicuous) behavior.
3 – Moderate – frequent episodes of strange behavior (e.g., talking loudly in public).
4 – Marked – behavior is clearly bizarre (e.g., public masturbation).
5 – Severe – behavior is extremely eccentric or completely bizarre (e.g., urinating into a sugar bowl).
23. Aggressive behavior and agitation.
0 – Absent
1 – Questionable pathology
2 – Mild – isolated incidents of temper outbursts or aggressiveness
3 – Moderate – clear irritability and aggressiveness (e.g., writes angry letters to strangers)
4 – Marked – obvious anger and aggressiveness (e.g., publicly threatens or insults people)
5 – Severe – extremely aggressive and agitated (e.g., abuses animals, gets into fights, etc.)
24. Repetitive or stereotyped behavior.
0 – Absent
1 – Questionable pathology
2 – Mild – infrequent, brief periods of repetitive or stereotyped behavior
3 – Moderate – definite periods of repetitive or stereotyped behavior (e.g., habitual dressing or eating rituals without symbolic meaning)
4 – Marked – pronounced periods of repetitive or stereotyped behavior (e.g., eating and other rituals with symbolic meaning)
5 – Severe – extreme repetitive or stereotyped behavior (e.g., keeps a diary in an incomprehensible language)
25. Global rating of bizarre behavior.
0 – Absent
1 – Questionable pathology
2 – Mild – several episodes of bizarre behavior, with some insight
3 – Moderate – periods of odd behavior clearly deviating from accepted social norms, with some insight possible
4 – Marked – bizarre behavior clearly deviating from accepted social norms, with only vague insight
5 – Severe – behavior extremely absurd or extravagant, with no insight; may be expressed as a single act of an extreme nature (e.g., an attempt at self-mutilation or homicide)
26. Derailment (loose associations).
0 – Absent.
1 – Questionable pathology.
2 – Mild – occasional derailments with minimal deviation from the topic of conversation.
3 – Moderate – multiple episodes of derailment; at times it can be difficult to understand what the patient was trying to say.
4 – Marked – frequent derailments; for much of the interview it is difficult to understand what the patient is saying; the interview is impeded.
5 – Severe – very frequent (virtually continuous) and marked derailments; the patient’s speech is almost completely incomprehensible; a productive interview is not possible.
27. Tangential replies (tangential thinking).
0 – Absent
1 – Questionable pathology
2 – Mild – one or two vague replies to a question
3 – Moderate – several tangential replies
4 – Marked – frequent tangential replies; interviewing the patient is markedly difficult
5 – Severe – replies are so lacking in content that a productive interview is virtually impossible
28. Incoherence (disorganized thinking; “word salad,” schizophasia).
0 – Absent
1 – Questionable pathology
2 – Mild – occasional incoherence in speech
3 – Moderate – frequent incoherence in speech
4 – Marked – a substantial portion of speech is incomprehensible
5 – Severe – most speech is incomprehensible
29. Paralogia
0 – None
1 – Questionable pathology
2 – Mild – occasional evidence of paralogical thinking
3 – Moderate – frequent evidence of paralogical thinking
4 – Marked – a significant portion of speech is illogical
5 – Severe – most speech is illogical
30. Circumstantiality.
0 – absent
1 – questionable pathology
2 – mild – occasional episodes of excessive circumstantiality
3 – moderate – frequent episodes of excessive circumstantiality
4 – marked – a substantial portion of speech is characterized by circumstantial responses
5 – severe – most speech is filled with circumstantial elaboration
31. Pressure of speech (logorrhea).
0 – Absent.
1 – Questionable pathology.
2 – Mild – intermittent logorrhea (i.e., episodic increase in pressure of speech) with slight acceleration of speech and increased loudness.
3 – Moderate – moderately marked logorrhea; the patient needs several minutes to answer a simple question; may speak spontaneously with little participation from the interviewer; speaks rapidly and loudly.
4 – Marked logorrhea; the patient needs at least three minutes to answer a simple question; speaks spontaneously without prompting; difficult to interrupt.
5 – Severe – extremely marked logorrhea; the patient talks continuously and cannot be interrupted; tries to talk over others.
32. Distractibility.
0 – Absent
1 – Questionable pathology
2 – Mild – the patient was distracted once during the interview
3 – Moderate – the patient was distracted 2–4 times during the interview
4 – Marked – the patient was distracted 5–10 times during the interview
5 – Severe – the patient was distracted more than 10 times during the interview
33. Clang associations.
0 – none
1 – questionable pathology
2 – mild – clang associations were noted once during the interview
3 – moderate – clang associations were noted 2–4 times during the interview
4 – marked – clang associations were noted 5–10 times during the interview
5 – severe – clang associations were noted more than 10 times during the interview, or so frequently that understanding the patient is difficult
34. Global rating of formal thought disorder (not attributable to deficit [negative] symptoms).
0 – absent
1 – questionable pathology
2 – mild – occasional manifestations, but the patient’s speech remains understandable
3 – moderate – frequent manifestations; the patient is sometimes difficult to understand
4 – marked thought disorder; the patient is often difficult to understand
5 – severe – thought disorder is so marked that the patient’s speech is incomprehensible