A Comparison of Measures of Psychiatric Symptom ...

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Timothy J. Avery, B.S.1,5; Will Barone, M.A.2,5; Samuel H. Barkin, M.S.3,5; Graham Danzer, LCSW, M.R.A.S.4,5; David Sugarbaker, M.S., M.P.H.1,5; Joseph ...
 A  Comparison  of  Measures  of  Psychiatric  Symptom  Change:  GAF  and  BPRS-­‐E   Timothy  J.  Avery,  B.S.1,5;  Will  Barone,  M.A.2,5;  Samuel  H.  Barkin,  M.S.3,5;  Graham  Danzer,  LCSW,  M.R.A.S.4,5;  David  Sugarbaker,  M.S.,  M.P.H.1,5;  Joseph  Walker,  M.D. 5;  Doug  Cort,  Ph.D.5   1PGSP-­‐Stanford  Psy.D.  ConsorEum  at  Palo  Alto  University;  2John  F.  Kennedy  University;  3Columbia  University’s  Teachers  College;  4California  School  of  Professional  Psychology;  5John  George  Psychiatric  Pavilion   BPRS-­‐E  Improvement  vs.  GAF  Improvement  

Abstract  

Discussion  

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ρ=-­‐.226   p=.029  

Grandiosity  Improvement  

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BPRS-­‐E  Improvement  

We compared the Global Assessment of Functioning (GAF) with a standardized measure of psychiatric symptom severity, the Brief Psychiatric Rating Scale-Expanded Version (BPRS-E). There was no overall correlation between changes in BPRS-E and GAF, although some item level correlations were significant and possibly clinically meaningful.

Grandiosity  Item  Improvement  vs.  GAF  Improvement  

4   3   2   1   0   0  

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-­‐1   -­‐2   -­‐3   -­‐4   -­‐5  

GAF  Improvement  

Suspiciousness  Item  Improvement  vs.  GAF  Improvement   Suspiciousness  Improvement  

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IntroducNon   Measuring symptom change is an important part of evaluating psychiatric care. Two ways of measuring patient symptom change during inpatient psychiatric care entail pre and post hospitalization measures of the Global Assessment of Functioning (GAF) and the Brief Psychiatric Rating Scale Expanded Version (BRPS-E). The BPRS-E consists of 24 items that attempt to cover a wide range of psychiatric signs and symptoms. While the GAF is a fast and easy measure for psychiatrists and psychologists to evaluate the impact of symptoms on functioning before and after inpatient treatment, its utility in research suggests uneven and even low levels of reliability and validity. Although it is a potentially longer semi-structured interview, a more reliable evaluation of symptomatic change may come from administration of the BPRS-E at the same intervals. Aim: This study sought to compare measures of change gathered by psychiatrists’ use of pre and post hospitalization GAF scores with evaluations of BPRS-E symptomatic change for the same patients at the same intervals.

GAF  Improvement  

Methods  and  Materials   Sample Characteristics •  Acute Serious Mental Illness Inpatients •  Diagnoses: Schizophrenia, Undifferentiated (n=29); Schizoaffective (n=29); Psychotic Disorder NOS (n=15); Bipolar I (n=21); Depressive Disorder NOS (n=4) •  N= 98 •  59 Males, 39 Females •  19-67 years of age Methods •  BPRS-E Administered within four days of entering the hospital unit, and within two days of discharge. •  GAF determined upon admission and upon discharge. Statistical Analysis •  Spearman’s rho was used to compare GAF change and BPRS-E change. GAF change scores were non-parametric.

ρ=-­‐.205   p=.047  

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GAF  Improvement  

Results   Correlation analyses (Spearman’s rho) did not reveal significant correlation between changes in GAF scores from intake to discharge compared with changes for the same patients in BPRS-E total scores for the same interval. There were, however, negative correlations between GAF improvement and two BPRS item improvements: •  Grandiosity (ρ = -.226, p = .029) •  Suspiciousness (ρ = -.205, p = .047). Further, there was no significant correlation between changes for GAF and BPRS-E scores for any sub-sample of specific diagnoses.    

Given the high level of reliability and validity of the BPRS-E, these results call into question the validity of GAF scores in evaluating change in this population. The BPRS-E may be of greater utility for understanding symptom changes given the psychometric properties and specific symptoms evaluated. Given that GAF scores have not been found to correlate with the more robust BPRS-E, clinicians may choose to discontinue use of the GAF for the more specific BPRS-E. This is congruent with the decision to no longer include the GAF in the DSM-5 diagnosis format. A possible explanation for the negative correlation between GAF improvement and improvement in BPRS-E grandiosity and suspiciousness, is that grandiosity and suspiciousness provide some coping mechanism that supports functioning for severely mentally ill patients, which may lead to a determined higher score in the GAF.  

Conclusions     Assessed GAF change does not correlate with overall symptom change as measured by the BPRS-E among acute serious mental illness patients. Further studies with a larger sample sizes would be needed to ascertain the validity and reliability of these findings.  

Acknowledgments   Guy  C.  Qvistgaard,  M.S.,  M.F.T.,  Administrator,      John  George  Psychiatric  Hospital   The  treatment  teams  at  John  George      Psychiatric  Hospital