Clinician ratings vs. global ratings of symptom severity: A comparison of symptom measures in the bipolar disorder module, phase II, Texas Medication Algorithm Project

This study compares ratings obtained with an itemized, clinician-rated, symptom severity measure - the 24-item Brief Psychiatric Rating Scale (BPRS₂₄) - to a Physician Global Rating Scale (PhGRS), a Patient Global Rating Scale (PtGRS) and the clinician-completed Multnomah Community Ability Scale (MCAS) in patients with bipolar disorder (BPD). A total of 69 patients (25 inpatients and 44 outpatients) with BPD were enrolled in a feasibility study of the use of medication algorithms in the treatment of BPD. Clinicians at each visit completed the BPRS₂₄, PhGRS and MCAS, and patients completed the PtGRS. Analyses compared the BPRS₂₄ and BPRS subscales with the PtGRS, PhGRS and MCAS. PtGRS scores correlated poorly with BPRS₂₄ and with PhGRS scores at baseline, although PtGRS change scores correlated moderately with BPRS₂₄ change scores. Baseline BPRS₂₄ and PhGRS scores correlated moderately at baseline with somewhat stronger correlations found on change scores for the two measures. MCAS scores showed moderate correlations with BPRS₂₄ scores both at baseline and with change over time. Global assessments by patients or physicians only moderately or poorly reflected BPRS₂₄ scores. Itemized symptom measures to gauge severity of illness or change over time are preferred over patient or physician global judgments.