Brief Psychiatric Rating Scale (BPRS)

Abstract

The Brief Psychiatric Rating Scale (BPRS) is a widely used clinician-administered instrument developed in the early 1960s by Overall and Gorham. Utilizing factor analysis during its creation, the BPRS was primarily designed to quantify the severity of symptoms in patients, especially those presenting with schizophrenia, allowing clinicians and researchers to quickly and reliably track changes in patient state over time. The scale consists of 18 items, each representing a discrete symptom area, rated following a clinical interview. Ratings use a 7-point Likert scale, resulting in total scores ranging from 18 to 126.

Keywords

Brief Psychiatric Rating Scale, BPRS, Schizophrenia, Psychopathology, Symptom Severity, Clinician-Administered Rating Scale, Factor Analysis, Psychometrics, Outcome Measurement

Authors

John E. Overall, Donald R. Gorham

Purpose

The primary purpose of the BPRS is to provide a standardized, rapid method for assessing the severity of psychiatric symptoms, particularly within the context of schizophrenia and related psychotic disorders. It is intended for use by clinicians to evaluate treatment efficacy and monitor patient improvement or deterioration across 18 distinct symptom domains.

The scale’s design emphasizes efficiency, requiring only an approximately 18-minute clinical interview followed by a quick rating process. This allows for expedient assessment in busy clinical settings and makes it a valuable tool for comparative research of outcome data across different studies and populations.

Construct

The BPRS measures the overarching construct of general psychopathology through the assessment of 18 discrete symptom areas. These symptoms cover a range of affective, thought, and behavioral disturbances commonly observed in psychiatric populations. The structure of the scale requires the rater (clinician) to integrate information gathered from both direct behavioral observation and the patient’s verbal report.

The 18 items are differentiated based on the method of information gathering: five items are strictly observational (e.g., tension, motor retardation), while the remaining 13 items rely heavily on the patient’s subjective report (e.g., guilt feelings, hallucinatory behavior). The scoring system, utilizing a 7-point Likert scale (1=Not Present to 7=Extremely Severe), allows for a nuanced quantification of symptom intensity.

Validity

The validity of the BPRS has been extensively studied, demonstrating robust utility in differentiating between patient groups. Specifically, the scale shows strong ability to differentiate between inpatient and outpatient populations, supporting its sensitivity to severity differences.

Convergent reliability has been reported as high, reaching up to 0.93 when compared against other measures assessing similar constructs. However, the divergent reliability is considered questionable regarding its use for definitive differential diagnosis, despite the existence of earlier scoring weights intended for 13 specific diagnostic types. Researchers generally advise against using the BPRS alone to distinguish between specific diagnostic categories.

Reliability

The BPRS demonstrates acceptable to strong levels of inter-rater reliability, which is essential for a clinician-administered scale. For individual items, reliability coefficients range from 0.56 (for the item tension) to 0.87 (for guilt feelings and hallucinatory behavior).

The overall inter-rater reliability scores for the total scale scores range broadly from 0.67 to 0.95 across various studies and settings. This variability suggests that while the scale is generally reliable, achieving consistency requires comprehensive training in the operational definitions of the items and regular refresher sessions to mitigate rater drift.

Factor Analysis

The BPRS was initially developed using factor analysis, which lent methodological soundness to its structure by ensuring that the 18 items represented distinct, non-redundant symptom areas. Subsequent research across different populations (including forensic and deaf populations) has continued to explore the underlying factor structure of the scale, confirming its multidimensional nature.

While the original structure was robust, variations, such as expanded versions of the BPRS, have been developed and evaluated using factor analysis in specific samples, such as forensic psychiatric patients, to confirm structural validity in diverse clinical contexts.

Instrument

Test Type: Clinician-Administered Rating Scale

Format: Structured clinical interview followed by rater scoring.

Language Available: Widely translated and validated (e.g., validated in the Netherlands and Scandinavia).

Population Group: Psychiatric Patients (primarily those with psychotic disorders like schizophrenia).

Age Group: Adult populations (typically).

Population Details: The scale has been successfully used and/or validated across diverse settings and special populations, including:

• Inpatient psychiatric units
• Community care settings
• Research settings
• Drug & alcohol populations
• Forensic populations
• Deaf populations (with considerations for language and thought correlates)

Test Methodology: The scale involves an 18-minute clinical interview. The rater then scores the 18 items on a 7-point Likert scale (1 = not present, 7 = extremely severe). The total score is the sum of the item scores (range 18 to 126).

Keywords

Psychiatric Assessment, Symptom Measurement, Clinical Research Tool, Rater Drift, Psychosis, Affective Symptoms, Behavioral Observation, Inter-rater reliability

Authors

Author ORCID Identifier: Not provided in source content.

Affiliation Email addresses: Not provided in source content.

Correspondence Address: Not provided in source content.

Permissions & Fee and Test Year

The Brief Psychiatric Rating Scale (BPRS) was first published in 1962. Information regarding current permissions and associated fees must be sought directly from the original publication source or authorized distributors. The scale is widely considered to be in the public domain for research use, though specific standardized versions may require licensing.

Reference’s

Andersen, J., Larsen, J. K., Schultz, V., Nielsen, B. M., Korner, A., Behnke, K., . . . Bech, P. (1989). The Brief Psychiatric Rating Scale. Dimension of schizophrenia–reliability and construct validity. Psychopathology, 22(2-3), 168-176. doi: 10.1159/000284591

Dingemans, P. M., Winter, M.-L. F.-d., Bleeker, J. A. C., & Rathod, P. (1983). A cross-cultural study of the reliability and factorial dimensions of the Brief Psychiatric Rating Scale (BPRS). Psychopharmacology, 80(2), 190-191. doi: 10.1007/bf00427968

Hafkenscheid, A. (1991). Psychometric evaluation of a standardized and expanded Brief Psychiatric Rating Scale. Acta Psychiatrica Scandanavica, 84(3), 294-300. doi: 10.1111/j.1600-0447.1991.tb03147.x

Horton, H. K., & Silverstein, S. M. (2011). Factor structure of the BPRS in deaf people with schizophrenia: Correlates to language and thought. Cognitive Neuropsychiatry, 16(3), 256-283. doi: 10.1080/13546805.2010.538231

Leucht, S., Kane, J. M., Kissling, W., Hamann, J., Etschel, E. V. A., & Engel, R. (2005). Clinical implications of Brief Psychiatric Rating Scale scores. The British Journal of Psychiatry, 187(4), 366. Retrieved from http://bjp.rcpsych.org/content/187/4/366.abstract

Ligon, J., & Thyer, B. A. (2000). Interrater reliability of the Brief Psychiatric Rating Scale used at a community-based inpatient crisis stabilization unit. Journal of Clinical Psychology, 56(4), 583-587. doi: 10.1002/(SICI)1097-4679(200004)56:4<583::AID-JCLP12>3.0.CO;2-U

McGorry, P. D., Goodwin, R. J., & Stuart, G. W. (1988). The development, use, and reliability of the brief psychiatric rating scale (nursing modification) — an assessment procedure for the nursing team in clinical and research settings. Comprehensive Psychiatry, 29(6), 575-587. doi: 10.1016/0010-440X(88)90078-8

Morlan, K. K., & Tan, S. Y. (1998). Comparison of the Brief Psychiatric Rating Scale and the Brief Symptom Inventory. Journal of Clinical Psychology, 54(7), 885-894. doi: 10.1002/(SICI)1097-4679(199811)54:7<885::AID-JCLP3>3.0.CO;2-E

Overall, J. E., & Gorham, D. R. (1962). The Brief Psychiatric Rating Scale. Psychological Reports, 10(3), 799-812. doi: 10.2466/pr0.1962.10.3.799

van Beek, J., Vuijk, P. J., Harte, J. M., Smit, B. L., Nijman, H., & Scherder, E. J. (2015). The factor structure of the Brief Psychiatric Rating Scale (expanded version) in a sample of forensic psychiatric patients. International Journal of Offender Therapy and Comparative Criminology, 59(7), 743-756. doi: 10.1177/0306624×14529077

Items of the Brief Psychiatric Rating Scale (BPRS)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

The BPRS consists of 18 items, each designed to represent a discrete symptom area, rated on a 7-point scale from 1 (Not Present) to 7 (Extremely Severe). The items are categorized based on the method of assessment:

Items based on Observation of the Patient (5 items):

• tension
• emotional withdrawal
• mannerisms and posturing
• motor retardation
• uncooperativeness

Items based on Patient’s Verbal Report (13 items):

(The source content does not list the remaining 13 specific items, but notes they are based on verbal report, covering areas such as guilt feelings and hallucinatory behavior.)

The scale items are summed to provide a total score reflecting overall symptom severity.