Clinical scales for inpatient psychiatry

[Pershing]

Are there any self-report clinical scales that you have found clinically useful in the inpatient psychiatry setting? Or are there any self-report clinical scales used in the inpatient setting that impact outcomes?

I have not run into any self-report scales that have been useful in the inpatient setting in my clinical experience or that have demonstrated impact on outcome measures in studies. I'm trying to figure out what scales, if any, to implement on our ward. Also, I'm referring to scales for every admitted patient, not necessarily a scale tailored to the patient's diagnosis/problem.

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[nitemagi]

Not really sure what a "general" scale would measure. Scales are useful in tracking something you're trying to change. Is there something common to all inpatients? I'm not aware of anything. I suppose you could do a QoL measure like the SF-36, but I'm not sure why you'd do it.

 

[smalltownpsych]

An assesment device won't impact outcomes, it would be more accurate to say measure outcomes. Shikima is spot on with the question about what you want to measure. That's the starting point. It is really hard for me to imagine a scale that would be a useful outcome measure for the psychotic patients and the depressed patients and the borderline patients and the bipolar patients. If you have a psychologist there, I would suggest you talk with them about it. Designing and implementing measures like this is our forte.

 

[MacDonaldTriad]

That is what irritates me about psychologists. Here we are, lots of people trying hard to make a difference in people’s lives. We spend hours convincing our patients that they have been helped by us and along comes those darn psychologists with their objective measures to prove us wrong. Why do you shatter our shared illusions? We were both happy in our ignorance. Now back to my non-evidenced based, Aitkin’s friendly, gluten free, free range witch doctoring. 😉

 

[erg923]

Also, I'm referring to scales for every admitted patient, not necessarily a scale tailored to the patient's diagnosis/problem.

That's really not very good idea if you are trying to track treatment specific outcomes that are actually valid.

 

[Pershing]

That's really not very good idea if you are trying to track treatment specific outcomes that are actually valid.

That is and has been my perspective as well. That is why I said "I'm trying to figure out what scales, IF ANY, to implement on our ward." The admin types are asking us about implementing a battery of scales that would be helpful, but I couldn't think of anything that would be widely applicable to most or all of our inpatients or that would be clinically useful.

 

[Pershing]

An assesment device won't impact outcomes, it would be more accurate to say measure outcomes. Shikima is spot on with the question about what you want to measure. That's the starting point. It is really hard for me to imagine a scale that would be a useful outcome measure for the psychotic patients and the depressed patients and the borderline patients and the bipolar patients. If you have a psychologist there, I would suggest you talk with them about it. Designing and implementing measures like this is our forte.

I agree that the use of most scales do not impact outcomes. However, the example that I was thinking of was the Columbia-Suicide Severity Rating Scale (C-SSRS). I don't think there are controlled studies, but there are reports that suicide rates have been reduced by implementation of the C-SSRS as screening in the outpatient setting (see: http://www.cssrs.columbia.edu/news_cssrs.html). Theoretically, it's not just the implementation of the scale that impacts the outcome, but what is done with the scale or in addition to the use of the scale. Again, this is not particularly good level of evidence and I question it, but it is something. I could not find any similar data, even if very weak, for the inpatient setting.

 

[notdeadyet]

Broset Violence Checklist.

 

[Pershing]

Broset Violence Checklist.

Thanks. This is the first time that I've heard of this. The data on the use of this checklist in inpatient wards seems to be pretty good.

 

[deleted314290]

The APA has numerous scales and measures on their website if you have access. There are numerous screening tools, and some more in-depth ones for specific symptoms.

 

[Comanaprocil]

We used the Modified Overt Aggression Scale (MOAS) on inpatient child psych when I was a resident. I found it an interesting tool to try to objectively quantify level of aggression and track it over the course of an inpatient admission. You can get a PDF of it from Dr. Google.

 

[thoffen]

I've found that doing YBOCSs on patients has been very interesting for some diagnostically uncertain cases. Either illuminates OCD or gives you many opportunities to explore a thought disorder. Have used Bush-Francis catatonia scales on inpatients to track progress. Various depression scales also, although I'm not entirely sure of the utility there. BPRS can help get you a picture of how sick someone is.