Reliability of a procedure for measuring and classifying "present psychiatric state"

Prolactin stimulating effects of amoxapine and loxapine in psychiatric patients

The effects of acute and chronic administration of a new antidepressant, amoxapine, on serum prolactin levels were compared to the effects of loxapine, its parent compound, which is a widely used neuroleptic. Serum prolactin levels were significantly elevated after amoxapine. These elevations were not significantly different from those of patients given loxapine. This suggests that amoxapine, in contrast to most other antidepressants, can block dopamine receptors at the anterior pituitary, which usually is associated with blockade of dopamine receptors in the striatum and limbic system, leading to extrapyramidal side effects and antipsychotic properties, respectively. The implications of these findings for the clinical use of amoxapine are discussed.

Effect of chlorpromazine on H-reflex recovery curves in normal subjects and schizophrenic patients

This study sought to determine the effect of chlorpromazine (CPZ) on a physiological measure, the H-reflex recovery curve (HRRC) and to determine whether the effect is different in normal subjects and schizophrenic patients. Eleven normal control subjects and 14 patients were administered 12.5 and 25.0 mg CPZ by IM injection. On the average. HRRCs measured 90 min after the injections were lower compared to pre-injection levels in both groups, at both doses. In general, the higher dose was more effective in both groups. Half of the patients, however, failed to respond to 12.5 mg, indicating that some schizophrenics are less sensitive than normals to CPZ. These results indicate that excessive dopamine activity or sensitivity may underlie abnormally high HRRCs in unmedicated psychotic patients.

Anhedonia and schizophrenia

Data from Chapman's anhedonia and perceptual aberration scales are presented for groups of schizophrenics and hospital staff control subjects. Differences between the two groups are found for both anhedonia scales and for the perceptual aberration scale, but the difference for physical anhedonia is only marginally significant. The anhedonia scales do not differentiate between the two groups sufficiently well to be useful diagnostically.

Evaluation of data-base

The records of 421 psychiatric patients were analysed by a consistent method, allowing an optimal use of indicant-patterns. It was assumed that such a procedure would give a satisfactory predictive capacity, even for operational criteria as for example choice of treatment, duration of stay in hospital, or a global evaluation of outcome. The study demonstrates, however, that fundamental changes in the data-base are necessary. Problems of reliability, validity, sensitivity and specificity are discussed and some suggestions are offered for the future improvement of psychiatric data-bases.

Psychiatric interviewing techniques. VI. Experimental study: eliciting feelings

Four experimental interview styles, designed to differ in the extent of their use of active fact-oriented and active feeling-oriented techniques, were compared in relation to their use in the initial diagnostic interviews with the mothers of children referred to a psychiatric clinic. All four styles proved to be effective in eliciting emotions and feelings, but the findings suggested that each was effective for different reasons. It appeared that emotional expression could be encouraged by the interviewer's response to emotional cues, by a reflective style with little factual cross-questioning, by the use of direct requests for self-disclosures, by the optimal (but not necessarily maximal) use of interpretations. and expressions of sympathy, and by direct requests for feelings.

Life events and schizophrenia: the "triggering" hypothesis

The present paper reviews the life event research specific to schizophrenia with the goal of assessing the extent to which recent empirical studies have implicated life stress variables as precipitants of acute episode of the disorder (i.e. the "triggering" hypothesis). Different methodological strategies used in life event research are reviewed along with the substantive findings from quasi-experimental and controlled studies of schizophrenic patients. It is concluded that stressful life events have been found to be part of the pool of factors associated with the onset of acute schizophrenic episodes, but evidence is still lacking to indicate that this association is necessary or direct one. Recommendations are made regarding the types of future studies required to fill the gaps in the existing literature.

Psychiatric interviewing techniques V. Experimental study: eliciting factual information

Four experimental interview styles, each recommended by experts in the field, were compared for their efficiency in eliciting factual information during the initial diagnostic interviews with the mothers of children referred to a psychiatric out-patient clinic. If encouraged to talk freely, mothers tended to mention most (but not all) key issues without the need for standardized questioning on a pre-determined range of topics. However, systematic questioning was essential in order to obtain good quality factual data. Better data were obtained when interviewers were sensitive and alert to factual cues and chose their probes with care. Clinically significant factual information, idiosyncratic to the family and outside the range of standard enquiry was common, but was obtained satisfactorily with all four styles. No one style was generally preferred by informants. The advantages of systematic questioning for obtaining factual information were not associated with any disadvantages with respect to the eliciting of emotions and feelings.

Psycho-demographic study of anxiety in Egypt: the PSE in its Arabic version

This is the first attempt to study the socio-demographic aspects of anxiety disorders in Egypt and to apply the Arabic version of the PSE in evaluating the profiles of clusters and symptoms of anxiety in a sample of 120 patients with anxiety. There were significant differences in some presentations between males and females, between illiterate and educated groups, and between those exposed to mild and severe crowding. Structured interviews like PSE will help in transcultural comparisons of clinical psychiatric disorders.

Psychiatric interviewing techniques. IV. Experimental study: Four contrasting styles

The development and definition of four contrasting interview styles is described. The four styles were designed using different permutations of techniques which, on the basis of an earlier naturalistic study, appeared to be most effective in eliciting either factual information or feelings. A 'sounding board' style utilized a minimal activity approach; an 'active psychotherapy' style actively sought to explore feelings and to bring out emotional links and meanings; a 'structured' style adopted an active cross-questioning approach, and a 'systematic exploratory' style aimed to combine a high use of both fact-oriented and feeling-oriented techniques. Quantitative measures based on video-tape and audio-tape analysis showed that two experienced interviewers could be trained to adopt these four very different styles and yet remain feeling and appearing natural. An experimental design to compare the four styles is described.

Development of brief measures of psychological adjustment to medical illness applied to cancer patients

The interrater reliability and validity of brief interview rated measures of psychosocial adjustment were examined in four sequential studies. A total of 25 videotaped interviews with cancer patients were rated by 105 social workers, nurses, physicians, and specialists in psychosocial oncology. The Rating of Psychosocial Function (RPF), Coping Adequacy Rating (CAR), and Global Adjustment to Illness Scale (GAIS) were used by various rating groups with an indication of interrater agreement. Agreement on ratings was not influenced by the length of interview (15 vs. 30 minutes) but appeared to the affected by the structure of the interview and profession of the raters. All three instruments showed a measure of matching with clinical impressions in addition to demonstrating a measure of both convergent and divergent construct validation. The GAIS was chosen as most adequately reflecting their clinical impression by a majority of raters. With a degree of training, any of the three instruments could be used to assess psychosocial adjustment with some measure of confidence in the validity of the rating.

Emotional disturbance in multiple sclerosis patients: validity of the General Health Questionnaire (GHQ)

The 28-item General Health Questionnaire (GHQ) was found to be a valid and sensitive instrument for detecting emotional morbidity in patients attending a multiple sclerosis clinic.

Psychiatric interviewing techniques: I. Methods and measures

An account is given of the overall strategy and measures used in a three-phase study of styles and techniques employed in the initial diagnostic interviews with the parents of children referred to a child psychiatric clinic. The measures of interview style included interviewer activity and talkativeness, directiveness, types of questions and statements, interventions designed to elicit or to respond to feelings, and non-verbal qualities. The informant's response and the interview 'outcome' were assessed through measures of the quantity and quality of factual information obtained, and of the extent of expression of emotional feelings by the informant. Good inter-rater reliability was achieved with most measures. Some difficulties were experienced in achieving comparable thresholds for the recognition of expressed emotions.

Descriptive studies of H-reflex recovery curves in psychiatric patients

The rate of recovery of the H-reflex, an electrical evoked monosynaptic spinal cord reflex, was abnormally high (fast) in over 20% of unmedicated psychotic patients of all major diagnostic classes. A few patients had significantly lower H-reflex recovery curves. Chronic neuroleptic treatment produced relatively lower recovery curves, whereas fluoxetine, a specific serotonin uptake blocker, produced relatively higher curves.

On establishing the validity of 'objective' data: can we rely on cross-interview agreement?

It has been proposed that a high level of agreement between informants' reports about events and happenings ('objective' data) is a sound basis for establishing (a) the validity of the measure which is based on the reports, and (b) the nature of objective reality. In this paper it is argued that such agreement may not be an adequate basis for validation since the accounts may not be independent. Likewise, low across-interview agreement may not signify the inaccuracy of either report because of the phenomenon of 'object-variation'. It is concluded that, although this method of validation can be significantly improved, it should be supplemented, wherever possible, by other approaches.

The reliability of a Survey Psychiatric Assessment Schedule for the elderly

The Survey Psychiatric Assessment Schedule (SPAS) was used in a survey of elderly people living at home and in institutions to examine its reliability in determining mental state. A psychiatrist assessed the same subjects using the Geriatric Mental State Schedule (GMSS) and classified psychiatric disorder into three broad groups: organic disorders, schizophrenia and paranoid disorders, and affective disorders and psychoneuroses. The agreement between the psychiatrist's classification of mental state and the classification derived from SPAS was found to be satisfactory for organic disorders and less satisfactory for functional disorders. The limitations of this method of identifying psychiatric illness are examined.

A comparison of information sources in the study of psychotic illness

The clinical features shown by 50 psychotic patients were documented by interviews held with the patient and next-of-kin, brief videotaped interviews and nurse rating in addition to the hospital case record. Three raters studied all the available material and made master ratings. Comparison of the ratings made at mental state interview with these master ratings showed that this interview missed a great deal of the pathology agreed to be present. The interview with the next-of-kin was helpful in identifying manic symptoms. Nurse rating based on an 8-hour period of observation was less effective overall, but highly significant associations with the master ratings were achieved in 29/57 areas studied. In four areas (uncooperative behaviour, concern for others, agitation and distractibility) it was superior to either interview.

Comparative reliability of categorical and analogue rating scales in the assessment of psychiatric symptomatology

The reliability of 26 items from the ninth edition of the Present State Examination (PSE) was assessed using both the conventional categorical scales and separately constructed analogue scales. Reliability was also calculated when the analogue responses were rescaled down to 2, 3 and 4 categories. The levels of inter-rater agreement obtained were comparable to those achieved in previous studies of PSE reliability, although as expected the levels of agreement on audiotapes were greater than those for independent interviews performed on the same day. These levels were not significantly affected by any of the changes in scale format, but there were apparent differences in reliability depending on the statistics used. In selecting or constructing a psychiatric rating scale, the question of reliability should not influence the choice of a categorical or continuous scale, or the number of scored points in the scale.

The distinction between the affective psychoses and schizophrenia

In an attempt to demonstrate a valid boundary between schizophrenia and the affective psychoses, discriminant function analyses have been carried out with history, mental state and follow-up data in two populations of patients. A bimodal distribution of discriminant scores was obtained in one of them (a general psychotic sample of 128 patients), using a discriminant function derived from the same sample; but when the function was applied to the second population (a schizoaffective sample of 106 patients) the distribution was ambiguous. Functions derived from the schizoaffective sample produced highly skewed distributions of discriminant scores in the general psychotic sample. Kraepelin's hypothesis that the functional psychoses consist of two distinct disease entities receives some support from our findings, but there is still no compelling evidence that the universe of psychotic patients falls naturally into these two groups.

Psychiatry's identity crisis: a critical rational remedy

Psychiatry has several partial identities reflecting its biologic, psychoanalytic, and social subspecialities. It has, however, no encompassing professional identity. This identity requires three features: (a) a common language and procedure for assessing psychopathology, (b) a common method for evaluation and use of knowledge from outside psychiatry, and (c) a common set of values regarding clinical and research activities. The authors discuss the clinical, biologic, and sociocultural psychiatric traditions to identify the roots and consequences of psychiatry's fragmented state. Psychiatry's identity problems cannot be solved by ignoring them or simply becoming more "medical." Rather, the authors propose a remedy--critical rationality--to help resolve the crisis. Critical rationality requires a discimplined approach to psychiatric knowledge that underscores the necessity of methodologic rigor, practicality, and mid-range theorizing (rationality); and the equal necessity for systematic self-criticism, reform, self-awareness, and attention to the ethical dimensions in teaching, practice, and research (critical).

The sensory filter in schizophrenia: a study of habituation, arousal, and the dopamine hypothesis

The possible failure of a notional sensory filter in schizophrenia was studied by means of habituation of the orienting response. Non-paranoid schizophrenics failed to habituate, but paranoids habituated normally. Paranoids, however, showed a different impairment: they responded to a dishabituating tone as if the novel stimulus were somewhat familiar. The failure of habituation in non-paranoids could not be explained in terms of arousal when the index was the rate of skin conductance fluctuation. Neurotic controls showed considerably higher levels than either group of schizophrenics. Non-paranoid schizophrenics had lost the normal inverse relationship between habituation and level of arousal as manifested in the rate of spontaneous skin conductance fluctuation.

The atypical psychoses

The psychiatric literature contains numerous accounts of psychoses found worldwide that do not fit classic definitions of schizophrenia, manic-depression, or organic brain syndrome. These vaguely defined 'atypical psychoses' are under scrutiny because of growing knowledge and more rigorous methodology in descriptive and cross-cultural psychiatry. The authors trace the history of atypical psychosis concepts from the contributions of Kraepelin, Jaspers, and Freud to contemporary European and Anglo-American viewpoints. Studies of the atypical psychoses are reviewed in the light of current validation methods in psychiatry. Several methodologic problems plague this area: inadequate definitions, etiologic prejudice, poor premorbid and follow-up assessment, as well as certain naive notions about psychopathology in different cultures. Consequently, knowledge of atypical psychosis is limited and largely impractical. The authors suggest several possibilities for interpreting present and future evidence about these disorders and certain strategies for future studies.

Definitions of schizophrenia: concordance and prediction of outcome

The study reports a comparison of 10 definitions of schizophrenia (Feighner's, Taylor's, Schneider's, Longfeldt's, Spitzer's, Carpenter's, Astrachan's, 2 from Forrest & Hay and Catego) in respect of their reliability, concordance and prediction of outcome. Some (including Feighner's) proved too strict, and others (including Schneider's) were weak predictors of clinical and social state. Four definitions (Spitzer's, Langfeldt's, Carpenter's and Catego) emerged as relatively effective and these also had a somewhat more satisfactory mutual concordance.

The concept of a 'case' in psychiatric population surveys

A series of in-patients, a series of out-patients and a series of women from a general population sample, all aged under 65, and all living in the same area of south-east London, were examined using the ninth edition of the Present State Examination (PSE). An 'index of definition' (ID), based on number, type and severity of PSE symptoms, was constructed in order to define a threshold point above which sufficient information was available to allow classification into one of the functional psychoses or neuroses. The index specified 8 levels of definition of disorder; the threshold point for a 'case' lying between levels 4 and 5. The identification of 'cases' by this means in the general population series was highly concordant with global clinical judgement. When the 3 series were compared, the in-patient series contained the most definite cases, the outpatient series was intermediate, and the general population series was characterized mainly by below-threshold conditions. Disorders above the threshold point were classified using the CATEGO program. The clinical severity of the depressive disorders and anxiety states identified in this way in the 3 series was compared on the basis of symptom and syndrome profiles and PSE scores. As expected, the inpatients had the most severe, and the general population 'cases' the least severe disorders. It is suggested that the PSE-ID-CATEGO techniques can be used to help standardize certain aspects of case-finding and case-description in both referred and non-referred populations and thereby make the results of surveys more comparable.

The Comprehensive assessment and Referral Evaluation (CARE)--rationale, development and reliability

The Comprehensive Assessment and Referral Evaluation (CARE) is a new assessment technique which is intended to reliably elicit, record, grade and classify information on the health and social problems of the older person. The CARE is basically a semi-structured interview guide and an inventory of defined ratings. It is designated comprehensive because it covers psychiatric, medical, nutritional, economic and social problems rather than the interests of only one professional discipline. The style, scope and scoring of the CARE makes it suitable for use with both patients and non-patients, and a potentially useful aid in determining whether an elderly person should be referred, and to whom, for a health or social service. The CARE can also be employed in evaluating the effectiveness of that service if given.

Further studies on interviewer training and inter-rater reliability of the Present State Examination (PSE)

The Present State Examination (PSE) is discussed with regard to its use in surveys of subjects who are not psychiatric patients. Although the PSE was originally developed for use by psychiatrists with patients with obvious mental illness, the interview also contains sections dealing in considerable detail with the commoner and less severe complaints and symptoms that are found in a significant proportion of 'normal subjects'. A shortened version of the PSE (8th edition) is described, limited to these sections, which has been used in population surveys, by interviewers who are not psychiatrists, The training of such interviewers is described, and information on a reliability and repeatability study is presented. This shows that with proper training, non-psychiatric interviewers can achieve standards of inter-rater reliability that are comparable to those previously reported between psychiatrists.

Reliability of the PSE (ninth edition) used in a population study

A random sample of 237 women in a south-east London area were seen by non-medical interviewers, trained to use a standard technique (the Present State Examination) to elicit and record psychiatric symptoms. Ninety-five were interviewed a second time by psychiatrists, who also rated audiotape recordings. The reproducibility of the techniques is adequate though not as high, in some respects, as that obtained from out-patient or in-patient samples. This is true at the level of symptom, syndrome, total score, and index of definition of psychiatric disorder. It is concluded that non-medical interviewers can obtain as high reproducibility as psychiatrists on most of the non-psychotic sections of the PSE if they have appropriate training. Repeatability is lower than reproducibility, partly due to fluctuations in clinical condition, partly to environmental changes between interviews, and partly to differential responses to medical and non-medical interviews. Over a short period of time, such as a week, repeatability is satisfactory.

A technique for studying psychiatric morbidity in in-patient and out-patient series and in general population samples

Many surveys of general populations have suggested a high untreated psychiatric morbidity, vairously referred to as mental illness, pre-clinical neurosis, minor neurosis, untreated depression, etc. An Index of Definition psychiatric disorders is described which incorporates cut-off points on the basis of symptoms rated in the Present State Examination. Eight degrees of definition are specified. At the "borderline disorder" level and above, disorders are sufficiently well defined to apply the CATEGO program of clinical classification. This procedure enables in-patients, out-patients and samples of the general population to be compared. Data from surveys in south-east London are presented in order to illustrate the technique. The main conclusion at this stage is that it is possible to identify, by strictly defined and repeatable procedures, a substantial proportion of people in the general population who have "borderline disorders" that can be tentatively classified in terms of the ICD. Whether it is clinically useful to do so requires further investigation. It is also suggested that techniques of this kind can be scientifically useful in comparing the level of morbidity in various populations, both referred and non-referred, and in testing theories concerned with the causes and treatment of various types of psychiatric disorders.

A comparison of amitriptyline and a fluphenazine/nortriptyline preparation in anxiety-depressive states

Patients suffering from mixed anxiety/depressive reactions, referred to the out-patient department of a large psychiatric hospital, were treated with either amitriptyline tablets or fluphenazine with nortriptyline (f/n) tablets for a period of four weeks. The study utilized a double-blind, completely randomised design, and patients' progress was assessed by means of the Wing Present State Examination, the Wakefield Self-Assessment Depression Inventory, and a side effects inventory. Both the symptom rating scales showed that purely depressive symptomatology improved significantly in each treatment group, but the patients' self-ratings showed that only f/n produced a significant alleviation of anxiety symptoms and panic attacks. The patients receiving f/n rated themselves as significantly (p less than 0.05) less irritable, as well as less anxious, after 4 weeks treatment, than those receiving amitriptyline. The PSE schedule did not differentiate between the 2 treatment groups, but self-rating, which is a more sensitive method of eliciting drug effectiveness in patients suffering from mild psychiatric disorders, did demonstrate patient preference for f/n. This should have important implications for compliance with treatment.

Diagnosis of functional psychoses. Comparison of clinical and computerized classifications

The results of a comparison between the clinical diagnoses of 115 probands with functional psychoses, made on the basis of careful clinical history-taking, interviewing and examinations, and those made by computerized evaluation (CATEGO) on the basis of the present state examination (PSE) were presented. The clinical diagnoses of the project psychiatrist and the provisional classification resulting from the application of the CATEGO program to the PSE symptom profiles were in an overall concordance of 82%. In a second step the 20 cases with differences in diagnoses were reevaluated on the basis of the full history and psychopathology and a syndrome checklist was completed. This reevaluation led to a practically full diagnostic agreement.

A semi-structured clinical interview for the assessment of diagnosis and mental state in the elderly: the Geriatric Mental State Schedule. II. A factor analysis

One hundred geriatric psychiatric patients were examined with the Geriatric Mental State Schedule in New York and London, and a correlation procedure involving both clinical and statistical operations was carried out on the psychopathological data thus collected. Twenty-one factors were produced, including three dealing with cognitive impairment. Although it was found that elderly depressives show a profile of psychopathology quite different from that shown by patients with organic disorder, it was also found that patients with an apparently functional disorder may sometimes be diagnosed as an organic disorder, that subjective complaints of intellectual impairment are not good indicators of organic disorders, and may be associated with a depressive factor, and that complaints that could be dismissed as attributes of aging may actually be indicative of a depressive disorder in the elderly. The methodological implications, as well as the limitations of the sample size, are discussed.

A semi-structured clinical interview for the assessment of diagnosis and mental state in the elderly: the Geriatric Mental State Schedule. I. Development and reliability

A standardized, semi-structured interview for examining and recording the mental state in elderly subjects is described. It allows the classification of patients by symptom profile and can demonstrate changes in that profile over time. It is believed that good reliability is demonstrated between psychiatric raters both for psychiatric diagnosis made on the basis of the schedule findings and for individual items. The Geriatric Mental State Schedule (GMS) consists mainly of items from the eighth edition of the PSE (Wing et al. 1967), together with additional items from the PSS (Spitzer et al. 1964), and extra sections dealing with disorientation and other cognitive abnormalities. Modifications have been introduced to facilitate interviewing elderly subjects.

Problems in the interpretation of cognitive abnormalities in schizophrenia

This study compared matched groups of patients with acute schizophrenia and with depression on three tests used in the assessment of schizophrenic thinking disorder. Most measures derived from these tests significantly differentiated the groups; however, within the schizophrenic group there were no significant correlations between scores on the three tests. Further data were available from a choice reaction-time card-sorting task, from which estimates of distractability, stimulus decision time, response decision time, and movement time, were obtained. Only one significant relation was found between these measures and scores on the clinical tests. The possible confounding effects of intelligence and responsiveness are discussed. It is argued that more direct measures of the latter are preferable to interpreting tests of thinking disorder in terms of information processing deficits.

[Critical remarks on the symptom of "thought insertion" (author's transl)]

"Thought insertion" is one of Kurt Schneider's first rank symptoms of schizophrenia. Earlier, Karl Jaspers had made a finer distinction, differentiating between "thought insertion in a narrower sense" and "made thoughts." However, most German and English writers have dispensed with the Jasperian criteria for this differentiation and consequently their use of the term "thought insertion" is broader. Such authors, including Kurt Schneider and Weitbrecht, usually speak of "thought insertion", "made thoughts", and "influencing of thoughts" as if they were identical phenomena. In contrast, Jaspers' differentiation offers us the possibility of more clearly distinguishing such symptoms and thus his distinction should not be neglected. Furthermore, the Jasperian criteria can be logically and usefully extended to all "made and passivity experiences" enabling one to recognise four aspects of such phenomena. Some general differential diagnostic considerations with respect to "thought insertion" are then presented.

Assessment of drugs in schizophrenia. Diagnosis and patient selection

It would seem that some set of operational definitions are required for the spectrum of psychotic patients often embraced by the rubric schizophrenia. The problems of acute (first-admission) and chronic patients have been described. At the present time 'relapse re-admissions' would seem to constitute the best population for drug evaluations. The importance of factors such as age, sex, ethnics, geography and length of history has been emphasized. Finally the importance of carefully excluding patients who would be at risk from pre-existing disease or hypersensitivity has been emphasized.

Research Report. The Biometrics Research Unit of the New York State Department of Mental Hygiene

The 1955–56 Annual Report of the Department of Research Psychology at the New York State Psychiatric Institute begins by noting that –Dr. Joseph Zubin, who had been Associate Research Scientist in this department since September, 1938, resigned January 15th, 1956 to become Principal Research Biometrician, heading a new Department [now Unit] of Biometrics Research…” While this move soon proved to be a stimulus for the development of significant new avenues of research, it by no means marked a sharp break with previous work. As Zubin has often noted, the late Carney Landis, when he was head of the Department of Research Psychology, actively fostered a variety of biometric studies, and indeed the annual reports of that department had eventually come to contain a separate section devoted to biometrics, in which the work of Zubin and his colleagues figured prominently. Much of this work would serve as the foundation of the new unit's research programme. In particular, an extensive study of prognosis in early and chronic schizophrenia had already been in progress for several years. In addition to interviews, a battery of tests was employed to sample a range of levels in the patients' functioning: psychophysical, psychophysiological, psychomotor, perceptual, behavioural, and conceptual.

The geriatric mental status interview (GMS)

The Geriatric Mental Status interview (GMS) is a semi-structured interview technique for assessing psychopathology in elderly patients. It is administered by a trained interviewer in a session of less than one hour. Between 100 and 200 question are asked and almost 500 items are rated. Twenty-one factor scores have been identified and the reliability of the ratings has been established. The interview is acceptable to the patient and is useful for making diagnostic distinctions and evaluation progress