Scale for the Assessment of Prodromal Symptoms, SOPS Test - the question form
Questions: 19 · 4 minutes
1. Unusual thought content / delusional ideas.
0 – Absent.
1 – Questionable: unexpected thoughts, feelings, or movements that draw attention but pass quickly.
2 – Mild: unusual experiences causing puzzlement; a sense that something has changed.
3 – Moderate: unexpected thought disturbances/ideas that do not go unnoticed and cause tension and anxiety; the sense of an unusual mental experience is more distinct and longer-lasting.
4 – Marked: a sense that the experiences are imposed from outside or that pathological beliefs are real, with insight preserved.
5 – Severe but not psychotic level: preoccupation with ideas of external control, with doubts about the reality of the experiences (in contrast to the premorbid state or after reassurance from others).
6 – Severe and psychotic level: delusional experiences that are not amenable to correction, at least intermittent, that determine behavior and influence thinking and social relationships.
2. Suspiciousness / persecutory ideas
0 – Absent
1 – Questionable: guardedness
2 – Mild: doubts about personal safety; excessive vigilance without identifying a source of danger
3 – Moderate: sense that others are behaving in a hostile way; confusion about what is happening and mistrust
4 – Marked: transient ideas of being watched or singled out; beliefs pass quickly; cause anxiety and suspiciousness
5 – Severe (non-psychotic level): preoccupation with ideas of danger; conviction of being the focus of hostile attention; at times overt suspiciousness, but overall behavior changes minimally; insight may be incomplete, but without clear conviction
6 – Severe (psychotic level): paranoid ideas, at least intermittent, that determine behavior
3. Grandiose ideas.
0 – Absent
1 – Questionable: feelings of superiority over others
2 – Mild: ideas of being talented or exceptional; sense of superiority is retained
3 – Moderate: feeling of having special power or abilities; occasional expansiveness
4 – Marked: unstable, quickly passing ideas of special power or wealth
5 – Severe, non-psychotic level: conviction of unnaturally high intelligence, personal attractiveness, strength, or popularity; insight may be incomplete, but the beliefs do not influence behavior
6 – Severe, psychotic level: delusional grandiose beliefs, at least intermittent, that determine behavior
4. Perceptual abnormalities/hallucinations.
0 – Absent.
1 – Questionable: changes in perception; heightened or diminished sensory experiences.
2 – Mild: unusual, vague perceptual disturbances (noises, flashes, etc.) with anxiety/restlessness.
3 – Moderate: unusual, clearly formed perceptual disturbances (images, geometric figures, distinct sounds) with bewilderment and anxiety/restlessness.
4 – Marked: perceptual distortions, illusions, or pseudohallucinations (faces, figures, voices) recognized as not real, without intense fear or preoccupation.
5 – Severe, nonpsychotic level: one or two clear, brief hallucinations; may be accompanied by other mild perceptual disturbances; not determining thinking or behavior.
6 – Severe and psychotic level: hallucinations, at least intermittent (images, voices, or other sensory experiences), are experienced as real and have at least a minimal impact on behavior and thinking.
5. Disorganized communication.
0 – Absent
1 – Questionable: sudden words and phrases that are out of context
2 – Mild: vague, disorganized, empty speech
3 – Moderate: incorrect word use; phrases that are not relevant to the topic; frequent sudden shifts off topic; overly metaphorical speech; speech stereotypies; excessive detail
4 – Marked: stereotyped or paralogical thinking; difficulty controlling thoughts without loss of the associative process; speech is periodically difficult to understand
5 – Severe, non-psychotic level: stereotyped or paralogical thinking; goal-less speech; difficulty directing thoughts; loss of associative links during questioning; speech is at times difficult to understand, evident in answers to questions
6 – Severe, psychotic level: loss of productive speech or marked inappropriateness; incomprehensible or unintelligible statements; loss of speech structure; complex speech disturbance
6. Social isolation and withdrawal.
0 – Absent
1 – Questionable: some social awkwardness with social activity preserved
2 – Mild: decreased interest in social activities, with socialization preserved
3 – Moderate: reluctant participation in social activities; no interest; social passivity
4 – Marked: social contacts largely limited to family; lack of friendships; social apathy; minimal involvement in social activities
5 – Severe: significant difficulties in relationships; no close friends; spends most of the time alone or with first-degree relatives
6 – Extreme: no friends; interactions are only formal; almost always alone
7. Avolition.
0 – Absent
1 – Questionable: reduced capacity for goal-directed activity
2 – Mild: low energy; simple tasks take much more time and effort than would normally be required
3 – Moderate: low motivation for goal-directed activities; reduced initiative in setting and carrying out tasks; completing tasks requires additional external prompting
4 – Moderately severe: minimal motivation for goal-directed activities; requires constant external prompting
5 – Severe: marked lack of drive and energy that interferes with goal attainment; most goal-directed activities are not completed; requires constant external prompting, which is not always effective
6 – Extreme: external prompting is ineffective; no goal-directed activity
8. Decreased emotional expressiveness.
0 – Absent
1 – Questionable: delayed or blunted emotional response
2 – Mild: conversation lacks liveliness; appears unnatural
3 – Moderate: minimal emotional expressiveness while still able to continue the conversation
4 – Marked: difficulty maintaining conversation, monotone speech, minimal empathy, avoids eye contact
5 – Very marked: initiating and maintaining conversation requires active questioning by the other person; affect is flat; complete absence of gestures
6 – Extreme: flat, monotone affect; does not participate in conversation despite active questioning
9. Decreased emotional responsiveness.
0 – Absent.
1 – Questionable: feeling cut off from others; persistent sense of emotional dulling, blunting, or dimness.
2 – Mild: lack of strong emotions or clearly identifiable feelings.
3 – Moderate: emotions are experienced as muted, blunted, or difficult to distinguish.
4 – Marked: feeling “numb,” flattened, or an undifferentiated self-disgust; difficulty experiencing emotions, including intense emotions (joy, grief).
5 – Very marked: feeling of loss of one’s “self,” depersonalization; feeling changed or strange; may feel detached from one’s body, surroundings, or time; these experiences are present constantly.
6 – Extreme: a profound sense of being changed and alien to oneself; complete absence of emotional experience.
10. Reduced ideational fluency.
0 – Absent
1 – Questionable: some difficulty; awkwardness in conversation
2 – Mild: difficulty understanding nuances of conversation; reduced ability to engage in dialogue
3 – Moderate: misinterprets many proverbs; uses simple sentences; skips abstract passages when completing tasks
4 – Severe: periodically loses the thread of the conversation; stereotyped and perseverative speech; limited vocabulary; uses simple words and sentences; concrete thinking
5 – Very severe: difficulty describing events despite a relatively preserved ability to follow questions and respond to simple statements; limited vocabulary; verbal output restricted to simple words and short sentences; may have difficulty interpreting proverbs and making comparisons
6 – Extreme: at times unable to sustain a conversation regardless of its complexity; vocabulary markedly restricted to very simple words or monosyllabic answers (yes/no)
11. Role functioning impairment.
0 – Absent
1 – Questionable: some effort is required to maintain work performance
2 – Mild: difficulties in work or academic functioning that are noticeable to others
3 – Moderate: clear problems completing work tasks or taking/passing exams
4 – Severe: failures in one or more activities; reprimands; probationary period at work
5 – Very severe: truancy and other major problems meeting requirements; absence from work due to problems; inability to work in a team
6 – Extreme: complete non-attendance; dismissal from school; fired for truancy
12. Odd behavior or appearance.
Absent.
Questionable: subtle peculiarities of behavior and appearance.
Mild: behavior and appearance are unusual or odd.
Moderate: odd or unusual behavior, appearance, interests, hobbies, or activities outside cultural norms; may behave inappropriately for the situation.
Marked: behavior and appearance are outside generally accepted norms; may appear confused or poorly coordinated; movements may seem awkward or bizarre.
Severe: significant oddities in behavior and appearance; intermittent preoccupation with internal experiences; responses that are off-topic; affect inappropriate to the situation; others may react negatively.
Extreme: grossly inappropriate or bizarre appearance and behavior (e.g., collecting trash, talking to oneself in public); affect is incongruent with the content of speech.
13. Bizarre thinking
0 – Absent
1 – Questionable: rare, brief bizarre ideas
2 – Mild: occasional unusual ideas, illogic, distortions in thinking
3 – Moderate: persistent unusual ideas, illogic and distortions in thinking that may be characterized as convictions or a philosophical worldview, without exceeding cultural norms
4 – Marked: persistent unusual ideas that preoccupy the individual and go beyond generally accepted religious or philosophical beliefs
5 – Very severe: illogical constructions of strange ideas that are not understandable to others
6 – Extreme: preoccupation with fantastic, absurd, unstructured ideas that are not understandable to others
14. Difficulty with attention, concentration, and focus.
0 – Absent
1 – Questionable: occasional lapses in concentration in the context of mental/physical strain
2 – Mild: occasional attentional difficulties when carrying out everyday tasks
3 – Moderate: persistent problems concentrating, with difficulty sustaining a conversation
4 – Severe: constant distractibility with loss of the thread of conversation
5 – Very severe: can maintain the required level of attention and concentration only with external support
6 – Extreme: unable to concentrate even with external support
15. Impairment in personal hygiene and meeting social expectations for appearance.
0 – Absent
1 – Questionable: reduced attention to personal hygiene while meeting social expectations for appearance.
2 – Mild: reduced attention to personal hygiene; some untidiness, while generally meeting social norms.
3 – Moderate: intermittent, often situational, indifference to social norms regarding appearance and clothing.
4 – Marked: persistent neglect of culturally expected hygiene norms.
5 – Severe: regularly does not bathe; appears unkempt; does not wash clothes; may have an offensive odor.
6 – Extreme: does not attend to appearance at all; does not bathe; has an offensive odor; unkemptness does not improve even with direct prompting from others.
16. Sleep disturbance.
0 – Absent
1 – Questionable: sleep is not restful
2 – Mild: slight difficulty falling asleep or waking during the night with return to sleep
3 – Moderate: daytime sleepiness due to difficulty falling asleep or early morning awakening; sleeping longer than usual
4 – Severe: sleep is markedly disturbed and affects functioning (decline in performance or being late due to sleepiness)
5 – Very severe: marked difficulty falling asleep or early morning awakening becomes daily; sleep–wake reversal may occur; usually misses planned daytime activities
6 – Extreme: unable to fall asleep for more than two days
17. Dysphoric mood
0 – Absent
1 – Questionable: often feels depressed or irritable
2 – Mild: situationally unstable and/or unpredictable periods of sadness, low mood, and gloomy thoughts, which may be accompanied by longing, irritability, or anxiety
3 – Moderate: feelings of sadness, anxiety, and dissatisfaction
4 – Severe: episodic periods of sadness, irritability, or depressed mood
5 – Very severe: persistent combination of depressed mood, anxiety, and irritability; disturbance of drives/impulses (substance misuse)
6 – Extreme: marked combination of depressed mood, irritability, and anxiety that determines behavior (suicidal thoughts/intent/acts; self-injury)
18. Motor disturbances.
0 – Absent
1 – Questionable: some awkwardness in movements
2 – Mild: subjectively and objectively awkward movements
3 – Moderate: impaired coordination, reduced movements, difficulty with fine motor skills
4 – Marked: motor stereotypies, often odd and inappropriate to the situation
5 – Very marked: compulsive movements (neurotic habits), rituals, posturing, grimacing
6 – Extreme: loss of naturalness of movements, catatonic features, echopraxia, dyskinesia
19. Decreased tolerance to stress.
0 – Absent
1 – Questionable: tiredness, exhaustion at the end of the day
2 – Mild: everyday setbacks provoke unexpectedly intense bouts of anxiety
3 – Moderate: confusion in situations involving everyday setbacks
4 – Marked: increased resistance to everyday stress
5 – Severe: avoids stressful situations or feels overwhelmed by everyday irritations
6 – Extreme: behavioral disorganization, panic, apathy, or a refusal response to everyday stress