Calculators / Psychosis and global severity

BPRS-A

Brief Psychiatric Rating Scale, Anchored (18 items). Psychosis and general symptom severity.

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The BPRS-A calculator is in the Library.

Every rating scale calculator comes with the Library, along with the prescribing guides, medication handouts, DSM-5 criteria and sheets, and the Guide Builder.

Use it for

  • Rating the severity of psychotic and related symptoms at baseline.
  • Following response to treatment over weeks, with the same rater.
  • Describing a person's syndrome in five groups: anxiety and depression, anergia, thought disturbance, activation, and hostility and suspiciousness.

Do not use it for

  • Diagnosis.
  • Rating suicide risk. The 18-item BPRS has no suicide item.
  • Use without rater training. The anchors reduce drift, and the ratings still depend on the interviewer's technique.

Interview the person and observe them, then rate each item for the past week. Some items rest on what the person reports and some on what you observe. The note under each item says which.

Ratings are 1 not present, 2 very mild, 3 mild, 4 moderate, 5 moderately severe, 6 severe, 7 extremely severe. The level-by-level anchors in the published scale are abbreviated here. Use the full anchors for research.

1Somatic concernReport. Preoccupation with physical health, fear of physical illness, hypochondriasis.
2AnxietyReport. Worry, fear, or overconcern for the present or the future.
3Emotional withdrawalObservation. Deficiency in relating to the interviewer and to the interview situation: lack of spontaneous interaction, isolation, deficiency in relating to others.
4Conceptual disorganizationObservation. How confused, disconnected, vague or disorganized the speech is. Include tangentiality, derailment, incoherence, blocking and neologisms.
5Guilt feelingsReport. Self-blame, shame, remorse for past behavior.
6TensionObservation. Physical and motor signs of tension, nervousness and heightened activation. Rate only physical signs and motor behavior, not the person's report of feeling tense.
7Mannerisms and posturingObservation. Unusual and unnatural motor behavior of the kind that makes a person stand out in a crowd. Do not rate simple increased activity here.
8GrandiosityReport. Exaggerated self-opinion, conviction of unusual power or abilities.
9Depressive moodReport and observation. Despondency, sadness. Rate the mood itself, not inferences drawn from slowing or bodily complaints.
10HostilityReport. Animosity, contempt, belligerence and disdain for other people outside the interview.
11SuspiciousnessReport. Mistrust, belief that others have malicious or discriminatory intent.
12Hallucinatory behaviorReport. Perceptions without a normal external stimulus.
13Motor retardationObservation. Reduced energy shown in slowed movement. Rate from what you see, not from the person's impression.
14UncooperativenessObservation. Resistance, unfriendliness, resentment and lack of readiness to cooperate with the interviewer. Rate the attitude shown in the interview only.
15Unusual thought contentReport. Unusual, odd, strange or bizarre thought content, including delusions. Rate how unusual, not how disorganized.
16Blunted affectObservation. Reduced emotional tone and intensity of feeling, flatness.
17ExcitementObservation. Heightened emotional tone, agitation, increased reactivity.
18DisorientationObservation. Confusion or lack of proper association for person, place or time.

BPRS-A

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More about the BPRS-A

About the BPRS-AWhat it is and what it is for

The BPRS rates the main symptoms of serious mental illness in one short interview. Overall and Gorham (1962) built it, and Woerner and colleagues (1988) added anchor descriptions for every level of every item, which is the BPRS-A. Eighteen items are each rated from 1 (not present) to 7 (extremely severe), so the total runs from 18 to 126. A person with no symptoms scores 18.

It is used mostly in schizophrenia and other psychotic disorders, to rate severity at baseline and follow change on treatment. It sits beside the PANSS as the older, shorter alternative. It does not give a diagnosis.

How to use itGiving it and scoring it

Interview the person and observe them for the past week. Rate each of the 18 items from 1 to 7, using the anchors. Items marked as observation are rated from what you see in the interview and items marked as report from what the person says.

Add the 18 items. The minimum is 18 and the maximum is 126.

Interpreting the scoreScore ranges and what they suggest
ScoreWhat it suggestsUsual response
18 to 25Minimal or borderlineClose to the floor of 18. About not ill or borderline on the CGI-S.Continue treatment and plan relapse prevention.
26 to 35About mildly illNear the score that matches mildly ill on the CGI-S (about 31).Review adherence and side effects, and add psychosocial treatment.
36 to 46About moderately illNear the score that matches moderately ill on the CGI-S (about 41).Confirm adherence and an adequate trial, and consider adjusting treatment.
47 to 126Markedly ill or worseAt or above the score that matches markedly ill on the CGI-S (about 53).Active treatment, a safety review and a decision on the level of care.

Equivalence points are from a linking study of CGI-S and BPRS totals in schizophrenia trials (Leucht 2006): mildly ill about 31, moderately ill about 41, markedly ill about 53. The bands here split the distance between those points. They are approximate, not validated cutoffs.

Pearls and pitfallsTips and common mistakes
  • Rate each item independently. A person's overall impression should not pull every item the same way.
  • Score hallucinatory behavior and unusual thought content on the person's report. Score conceptual disorganization on what you hear in the interview.
  • Baseline first. Without a baseline, percent change means nothing.
  • Keep the same interviewer when you can.
  • Pair it with the CGI-S and CGI-I, so the numbers have a clinical anchor.
EvidenceAccuracy and reliability
  • Overall and Gorham (1962) introduced the BPRS. Woerner and colleagues (1988) added anchor definitions for every level of every item (the BPRS-A) to improve reliability.
  • A linking study of seven drug trials (n = 1,979) matched CGI-S levels to BPRS totals: mildly ill about 31, moderately ill about 41 and markedly ill about 53 (Leucht 2006).
  • In the same program of work, a fall of about 25% in the BPRS or PANSS matched minimally improved and about 50% much improved. A drop of 10 BPRS points matched minimal improvement.
Source, license and referencesWhere it comes from

The Brief Psychiatric Rating Scale was published by Overall and Gorham (1962). The anchored version (BPRS-A) was published by Woerner, Mannuzza and Kane (1988). Item definitions here are condensed from the published scale. Use the original anchors for research.

  1. Overall JE, Gorham DR. The Brief Psychiatric Rating Scale. Psychol Rep. 1962;10:799-812.
  2. Woerner MG, Mannuzza S, Kane JM. Anchoring the BPRS: an aid to improved reliability. Psychopharmacol Bull. 1988;24(1):112-117.
  3. Leucht S, Kane JM, Etschel E, Kissling W, Hamann J, Engel RR. Linking the PANSS, BPRS, and CGI: clinical implications. Neuropsychopharmacology. 2006;31(10):2318-2325.
  4. Correll CU, Malhotra AK, Kaushik S, McMeniman M, Kane JM. Early prediction of antipsychotic response in schizophrenia. Am J Psychiatry. 2003;160(11):2063-2065.

Clinical decision support, not a diagnosis. Each calculator scores a published scale the way its authors intended. A score informs a clinical interview and examination and never replaces them. If you are a patient using this page, please review the result with your clinician. In an emergency, call 911 or call or text 988 in the United States.