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Pharmacology Basics | Common Crazy Med Crap Index | Evaluating Research Papers

1.  Who Rates the Raters?

Whenever you read the methods section of a drug study, clinical trial, or really good abstract for either, you’ll find one or more assessment scales used to rate how well a drug performed. These are the tests given to people who are taking a drug (or a placebo). Researchers will ask different types of questions: yes or no, multiple guess, on a scale of one to kill-me-now, and so forth. Based upon the responses the people taking the pills give, the researchers are supposedly able to determine how well a med works. “Supposedly” because some of these tests seem pretty useless. One factor of determining if a study is any good is the rating scale(s) used.

Assessment tools are used to test other subjective things, like pain. Here are a few of the more popular psychiatric assessment scales used in trials and studies, and our opinions about them. All of these are protected by various degrees of copyright, and are presented here just so you can see what tools are used to determine a medication’s efficacy and/or how messed up you are. I’ll note if a scale has a specific copyright notice. I won’t have copies of everything available because you still have to pay for a lot of these and I won’t pirate intellectual property.

1.1  Non-Specific Crazy Rating Scales

  • Sheehan Disability Scale (SDS) has been around for over 30 years, but has only recently been showing up in studies and trials of crazy meds.
    • It has all of 3 evaluations on a 1 - 10 scale of how well you function at work/school, socially, and daily living.
    • And two questions on productivity: how many days you missed at work or school in the last week (or whatever period it’s measuring); and how many days where you showed up, but just went through the motions and didn’t really do much of anything.
    • The SDS can be applied to physical as well as mental disabilities.
    • Even though it is incredibly short, I like it. It gets down to the two basic questions:
      • Are you functional?
      • Are you living, or existing?
  • Clinical Global Impression (CGI), reflects the impression of a skilled observer, fully familiar with the manifestations of schizophrenia, although it is vague enough to apply to any form crazy, about the overall clinical state of the patient. In other words, how loony your doctor thinks you are.
    • While the shortest of all assessment instruments, with all of three measurements, two on a 1 - 7 scale and one on a 4 x 4 matrix, its simplicity is its strength.
    • Because do you really need to know anything more than:
      • How messed up you are.
      • Are you getting better.
      • What is the ratio of how well a treatment works to how much it sucks.
  • Brief Psychiatric Rating Scale (BPRS), a multi-item inventory of general psychopathology originally used to evaluate the effects of drug treatment in schizophrenia, but can be applied to many forms of brain cooties.
    • The BPRS psychosis cluster (conceptual disorganization, hallucinatory behavior, suspiciousness, and unusual thought content) is considered a particularly useful subset for assessing actively psychotic schizophrenic patients.
    • Note the physical exam at the beginning. While harsh-seeming, the key aspect is how mental illness is considered a physical condition and not a character defect.
  • The Positive and Negative Syndrome Scale (PANSS) a 30-item rating instrument evaluating the presence/absence and severity of positive, negative and general psychopathology. The scale was developed from the BPRS and includes other symptoms, such as aggression, thought disturbance, and depression. This is a much more accurate test, if standardized tests are your thing, of insanity. The version I have, from a hospital in Zurich, has some explanations/instructions/refinements in German.
  • Scale for the Assessment of Negative Symptoms (SANS). This test measures the five A’s of negative symptoms:
    • affect flattening (Looking and sounding as if you don’t give a rat’s ass about anything, not making eye contact, etc.)
    • alogia (Poverty of speech, from not saying much, to using simpler words, to not talking at all.)
    • avolition-apathy (Really not giving a shit before you were put on antipsychotics)
    • anhedonia-asociality (Nothing is pleasurable, you don’t like people, i.e. you’re a natural born goth.)
    • attentional impairment (Huh? What did you say?).
      • As negative symptoms are common in the autistic, it should be obvious why schizophrenia was almost as common a diagnosis as mental retardation before “autism” existed as a label; and why there is still occasional misdiagnosing in both directions today.
  • Global Assessment of Functioning (GAF). Literally how functional/sane you are on a scale of 1 to 100. With 1 being “Already dying from self-inflicted wounds.” and 100 being “The only person truly qualified to give this test, except they know better than to do so.” Except there isn’t any difference between a score of 21 and 29, so it may as well be a sanity scale of 1 to 10.
  • Self-Reporting Questionnaire 20 (SRQ-20) A 20 question test you take and mail or otherwise send to the nearest doctor.
    • While designed for developing nations that have one psychiatrist for every 10,000 people, if that, given the way things are going in the US, we’ll probably need something like this in a couple of years.
    • While heavily (and admittedly) biased towards mood disorders and the negative symptoms of schizophrenia, for people living in Liberia or rural West Virginia it’s better than nothing.
  • The Diagnostic Interview Schedule is a shitload of mostly yes/no questions to determine where in the DSM your brain cooties reside.
  • Let’s not forget the MMPI, one of the original assessment tools that is still used.
    • If only by people contracted by the Social Security Administration to determine if you’re too crazy to hold down a real job.
    • I shit ye not.
    • Nobody who actually knows anything about crazy still uses it2.

1.2  Bipolar Mania Rating Scales

  • Young Mania Rating Scale (YMRS) . Whoopee shit. You score 0–60 on all of 11 items assessing irritability, disruptive/aggressive behavior, sleep, elevated mood, speech, increased activity, sexual interest, language/thought disorder, thought content, appearance, and insight.
    • Basically if you didn’t have the bipolar diagnosis already the test would be fairly pointless in trying to figure out if you bipolar, schizophrenic, obsessive-compulsive, or even ADHD.
    • Especially ADD/ADHD.
    • Compare the YMRS with Adult ADHD Self-Report Scale (ASRS-v1.1) and this quiz at Psych Central. Which are you? Hypomanic, ADD or both?
    • Hell, in the short term under the right conditions a freaking placebo can quell the manic symptoms as rated by the YMRS.
    • That’s why longer trials and better metrics are required. In the short run, all sorts of non-med approaches will actually work to bring someone down from a manic high for a day or a week.
    • That’s why Bach Flower Remedies or that Serenity crap appear to work in the short term. And why the miracle drug Placebo will sometimes beat a med in one of its short-duration trials when only the YMRS is used.
    • It’s part of the reason why so many of us fall into the trap of thinking we can deal with our illness without meds, or with dangerously bogus “treatments.”
    • But in the long term failure to deal with mania leads to kindling, and that will lead to a mental meltdown that will put you in the lock ward of the psych hospital.
      • If you’re lucky.
  • The Manic State Rating Scale (MSRS) - 26 behaviors, scored on frequency and intensity.
    • Covers dysphoric and euphoric manias.
    • There’s less cross-over with ADD/ADHD than the YMRS and, as someone who has lived long-term manias and has been around plenty of people in dysphoric and euphoric manias, this is a much better indicator of mania.
    • Does OK as far as standardized tests go in covering mixed states.
    • But, really, if a doctor is going to being giving you a test for bipolar, this is the one to take - of the ones I’ve evaluated - as far as the manic phase goes.
    • Which means it’s not used all that much.
    • It’s especially not used all that much to evaluate the efficacy of meds, because it doesn’t translate well to statistical data.
    • There’s supposedly a 28-behavior version around, but I haven’t seen it.

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1.3  Unipolar or Bipolar Depression Rating Scales

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  • The Hamilton Rating Scale For Depression (HAM-D) - 21 questions where your doctor determines how much your life sucks.
    • Rates suckage on scales of 0 to 2 through 0 to 4.
    • Covers assorted crap that often usually almost always accompanies depression, like anxiety and insomnia.
    • Also comes in a 17 question version.
    • And a 24 question version.
  • Beck Depression Inventory (BDI) - Another 21 questions where you give your opinion on how much your life sucks.
  • The Montgomery-Åsberg Depression Rating Scale (MÅDRS) - For doctors too busy to ask the 21 questions on the HAM-D.
    • I shit ye not.
    • As with the YMRS it’s popular with drug companies because MÅDRS scores improve regardless of the antidepressant used.
    • As with the YMRS it can make a placebo look to be just as effective as their drug.
      • Which helps to explain all of those “Panacea is no better than placebo” reports we keep hearing about.
    • Suckage is rated on a scale of 0 - 6, but there is no odd number anywhere. It’s 0, 2, 4, or 6. Why that’s used instead of 0 to 3 is probably why MÅDRS is extremely popular with drug companies, as it artificially inflates improvement scores.

So which ones are the best for mood disorders? Without a doubt SDS should be used for everything to evaluate the severity of a condition. After that it’s a tough call. The YMRS and MÅDRS are, as far as I’m concerned, worthless. In my utterly untrained and amateur opinion you need, at the very least, a combination of the CGI and an appropriate test or tests for the condition being evaluated. So for bipolar mania CGI, MSRS and PANSS or BPRS would be the way to go.

2.  Assess This!

For all the other scales used that I haven’t put up here or created links to, you’ll probably find them, along with the diagnostic criteria, at the closest thing there is to a compendium of every assessment tool ever created: Shawn Thomas’ treasure trove of psychiatric rating scales on Neurotransmitter.net. He’s got rating scales for:

Plus lots of stuff we don’t cover. If Shawn doesn’t have an assessment tool listed for some for of brain cooties it’s probably not worth using.

There’s also Psychiatric University Hospital Zurich’s page of Rating Instruments and Questionnaires (with both English and German questionnaires). As well as the Family Practice Notebook’s page on Psychological Testing. I like how the FPNotebook’s page is organized with the same specificity reflecting how the tests are used in the field, which makes it a lot easier to call bullshit on things like using the MMPI and fucking Rorschach inkblots to test for psychosis.3

Just don’t go downloading a bunch of these to self-diagnose. That’s just wasting your doctor’s time because you probably have a bad case of cyberchondria. The exception being the SDS to evaluate if you’re crazy enough to need meds.

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< Pharmacology Basics | Common Crazy Med Crap Index | Evaluating Research Papers

1 Sure, the person being tested could be a sociopath or have some other personality disorder, but they could still be highly functional, which is all the GAFs evaluate.

2 Scientology's personality test is a reworded variant of the MMPI. That should tell you how useless both tests are.

3 All this time I thought the asshat who evaluated me for SSDI was an incompetent fucktard for giving me an MMPI. Now I know he was just an asshat fucktard who was following some out-of-date standard procedure.

Rating Psychiatric Rating Scales by Jerod Poore is copyright © 2010 Jerod Poore

Last modified on Monday, 27 July, 2015 at 11:00:43 by JerodPoorePage Author: Jerod PooreDate created: 17 November, 2010

All drug names are the trademarks of someone else. Look on the appropriate PI sheets or ask Google who the owners are. The way pharmaceutical companies buy each other and swap products like Monopoly™ real estate, the ownership of any trademarks may have changed without my noticing.

Page design and explanatory material by Jerod Poore, copyright © 2003 - 2015. All rights reserved. See the full copyright notice for full copyright details.
Don’t automatically believe everything you read on teh Intergoogles. No warranty is expressed or implied in this information. Consult one or more doctors and/or pharmacists before taking, or changing how you take any neurological and/or psychiatric medication. Your mileage may vary. What happened to us won’t necessarily happen to you. For more details see the Crazymeds big-ass disclaimer.

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