The Brief Psychiatric Rating Scale (BPRS) is one of the most commonly used measures for assessing psychopathy in patients diagnosed with schizophrenia, particularly disorganized speech (Leucht et al., 2005). Conceptually derived from classical ideas originating in German psychopathology, the term disorganized speech, has come to be defined as “switching from one topic to another” in terms of an individual’s manner of communicating, responding to questions in an “obliquely related or completely unrelated” way, or less frequently, speaking in a way that is so severely disorganized that one’s verbalizations are “nearly incomprehensible” and linguistically resembles receptive aphasia (American Psychiatric Association, 2013). Though, despite this definition, difficulties continue to arise with respect to precisely conceptualizing disorganized speech, and the inversely associated formal thought disorder, due to the variableness of its etiology (Park et al., 2018).
The BPRS has been proposed as an evaluative measure for assessing the aforementioned atypical patterns. Regarded as one of the most commonly used measures for assessing psychopathology, this instrument has been frequently used to evaluate disorganized speech in patients diagnosed with schizophrenia (Park et al., 2018). Specifically, the conceptual disorganization item on this rating scale has been used to assess this symptom; however, its ability to accurately detect disorganized speech remains highly controversial (Park et al., 2018). Though, despite this controversy, very few studies have investigated the capacity for the BPRS to accurately distinguish this core symptom.
Thus, in an attempt to assess the psychometric validity of this measure and/or its conceptual disorganization item, Park et al. (2018) recruited a total of 3,744 patients diagnosed with schizophrenia via the REAP-AP study to participate in their investigation. A final total of 1,494 subjects from survey centers spanning across 5 different Asian countries participated. Those who were recruited, were selected based on the following inclusion criteria: diagnosis of schizophrenia, use of neuroleptics and/or psychotropic medications, and availability of a completed 18-item BPRS (Park et al., 2018). However, given differences in their languages, the English version of the BPRS was used to assess for disorganized speech and other psychopathy in each participant (Park et al., 2018). After adjusting for differences noted between patients who displayed this core symptom versus those without, results of their investigation showed that subjects with disorganized speech had significantly higher scores for emotional withdrawal, conceptual disorganization, mannerism and posturing, hostility, suspiciousness, hallucinations, uncooperativeness, unusual thought content, blunted affect, and excitement (Park et al., 2018). Similarly, when accounting for any degree of variability, conceptual disorganization, uncooperativeness, and excitement were shown to be independently associated (Park et al., 2018). Furthermore, results that were yielded from ROC curve analyses showed that scores from each of these scale (four) items, with their “defined optimum cut-off values,” accurately differentiated patients diagnosed with schizophrenia who exhibited disorganized speech from those who did not (Park et al., 2018, p. 118).
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington VA: American Psychiatric Publishing.
Leucht, S., Kane, J. M., Kissling, W., Hamann, J., Etschel, E., & Engel, R. (2005). Clinical implications of Brief Psychiatric Rating Scale scores. British Journal of Psychiatry, 187(4), 366-371. doi: 10.1192/bjp.187.4.366
Park, Y. C., Kanba, S., Chong, M. Y., Tripathi, A., Kallivayalil, R. A., Avasthi, A., Grover, S., Chee, K. Y., Tanra, A. J., Maramis, M. M., Yang, S. Y., Sartorius, N., Tan, C. H., Shinfuku, N., Park, S. C. (2018). To use the brief psychiatric rating scale to detect disorganized speech in schizophrenia: Findings from the REAP-AP study. Kaohsiung Journal of Medical Sciences, (34), 113-119. doi: 10.1016/j.kjms.2017.09.009
Shirreka Mackay, LPC
Practicum Student, Western State Hospital