Diagnostic Rating Scales

Abstract

In measurement-based care, the target syndrome, i.e. the case profile of the individual patient under consideration for treatment, is not necessarily the DSM-5 category.

Appendices

Appendix 1

7.1.1 1.1 Major (ICD-10) Depression Inventory

The following questions ask about how you have been feeling over the past 2 weeks. Please put a tick in the box which is closest to how you have been feeling. A higher number signifies a higher degree of depression.

Depression Inventory MDI: Scoring Key

The diagnostic demarcation line is indicated at the top. The total score of the ten items is filled in below.

7.1.2 1.2 Major Depression Inventory (MDI): Scoring Instructions

A: As a Diagnostic Instrument for DSM-5 Major Depression

To be used in accordance with the DSM-5 algorithm of major depression, the first three symptoms should have been present at least “most of the time” during the past 2 weeks, while the other symptoms should have been present during “more than half” of the period. For symptoms 4 and 5, only the highest score should be used, as the DSM-5 contains only nine of the ten MDI symptoms, and as symptoms 4 and 5 belong to the same category in the DSM-5. For symptoms 8, 9, and 10, only the one of the two alternatives (a or b) with the highest score is considered.

Major depression is diagnosed if five or more of the nine symptoms (items 4 and 5 combined) have been present in the past 2 weeks and if symptom 1 or symptom 2 is included in these five symptoms.

B: As a Depression Rating Scale

As a severity measure, the MDI score ranges from 0 to 50, since each of the ten items can be scored from 0 (at no time) to 5 (all the time). Again, for items 8, 9, and 10, alternative a or b with the highest score is considered.

Mild depression	MDI total score of 21–25
Moderate depression	MDI total score of 26–30
Severe depression	MDI total score of 31 or more

Appendix 2

7.1.1 2.1 Newcastle Diagnostic Depression Scale (1965)

Manual

Newcastle Diagnostic Depression Scale (1965)

• Item 1 Deviant personality

  The patient’s personality is considered deviant if there is information on earlier nervous breakdowns, severe neurotic symptoms, or important problems in social adjustment.

  2::

  Deviant personality is clearly present

  1::

  When in doubt

  0::

  Adequate personality

• Item 2 Psychological stressors

  Psychological stressors are understood as any situation or event which the interviewer considers to be stressful to the patient. The situation or event may have appeared within the last 6 months, and may or may not still be present and maintain the episode of illness. The stressful situation, for example, may be worries concerning one’s health, worries concerning the health of near relatives or friends, a death, interpersonal conflicts, or worries over job or financial situation. The same event will of course be a very different experience for the different persons involved, and the patient’s subjective experiences and feelings must be taken into consideration, but the interviewer’s evaluation is decisive.

  2::

  Psychological stresses have been or are present

  1::

  If in doubt

  0::

  Psychological stresses have not been present

• Item 3 The quality of depression

  The decisive factor is whether the patient describes his or her actual depressive state as qualitatively different from “ordinary” sadness or tristesse as experienced in adverse situations, e.g. death within the family or circle of friends.

  2::

  Evident/positive

  1::

  The interviewer or patient questions the qualitative difference

  0::

  The actual depressive condition by and large is experienced similar to ordinary situational tristesse

• Item 4 Weight loss

  2::

  The patient indicates a weight loss of 3 kg or more related to the actual episode or 0.5 kg or more per week during the last 3 weeks

  1::

  Less pronounced weight loss

  0::

  No weight loss related to actual episode

• Item 5 Previous depressive episodes

  A previous depressive episode is understood as a period of depression lasting at least 2 weeks which stands out clearly in the patient’s past history. The lowering of mood shall have been constant during the episode. The patient should have asked for or have been referred to treatment or assistance during the episode or demonstrated impairment in family relations or other social functions.

  2::

  No reduced sleep length

  1::

  Duration sleep slightly reduced

  0::

  Duration of sleep clearly but still only moderately reduced, i.e. still less than a 50 % reduction

• Item 6 Motor activity

  This includes both motor retardation and motor agitation. The item includes more than the mere subjective feeling of being slow or restless. At this item, the interviewer will be prone to concentrate on the patient’s appearance during the interview, but if the interviewer commands sufficient information on the patient’s condition during the present episode, this information must be included in the final evaluation.

  2::

  If the patient clearly has marked changes in motor activity

  1::

  If in doubt

  0::

  If neither retardation nor agitation has been or is present

• Item 7 Anxiety

  The patient’s behaviour during the interview is decisive at this item

  2::

  If the patient during the interview has been clearly anxious (tense, sweating, tremulous, etc.)

  1::

  If in doubt

  0::

  If the patient does not appear to be anxious

• Item 8 Nihilistic delusions

  This denotes the experience of need, destruction, and misery. It includes (a) somatic nihilism, or the assumption that the body no longer exists (e.g. the stomach and/or intestines have withered away), and/or (b) economic/financial nihilism, or the assumption that he or she or the whole family will end in misery and disaster.

  2::

  If the assumption is vigorously maintained even after it has been tried to correct the assumption

  1::

  If the patient’s points of view may be modified

  0::

  If the item is not present

• Item 9 Accusations of others

  The patient is easily angered and blames others for things gone wrong, e.g. that others are responsible for the patient’s present problems.

  2::

  If this is clearly expressed

  1::

  If in doubt

  0::

  If the item is not present

• Item 10 Feelings of guilt

  The patient is tormented by feelings of guilt, e.g. the patient expresses that the present suffering is a form of punishment due to/caused by former misdeeds.

  2::

  When the patient stresses the events prior to the present episode as misdeeds

  1::

  If it is doubtful whether the patient harbors feelings of guilt

  0::

  Of the item is not present.

Appendix 3

7.1.1 3.1 Anxiety Symptom Scale (ASS)

The following questions ask about how you have been feeling over the past 2 weeks. Please put a tick in the box that is closest to how you have been feeling.

Appendix 4

7.1.1 4.1 The Items Defining the Diagnostic Apathia Scale

Manual

The Diagnostic Apathia Scale

1	Difficulties in concentration and memory
	The patient has neither more nor less difficulty in concentration and/or memory than usual	0
	It is doubtful whether the patient has difficulty in concentration and/or memory	1
	Even with a major effort, it is difficult for the patient to concentrate on his daily routine work	2
	More pronounced difficulties with concentration, memory, or decision making. For example, has difficulty reading an article in a newspaper or watching a television program in its entirety. Scores 3 as long as the loss of concentration or poor memory has not clearly influenced the interview	3
	The patient shows difficulty in concentration and/or memory, and/or decisions are reached with considerable delay during the interview	4
2	Difficulties in concentration or decision making
	Has difficulty concentrating or making decisions almost every day	0 (No)
		1 (Yes)
3	Work and interests
	No problems	0
	Slight problems with usual daily activities (at home or outside home)	1
	More pronounced insufficiency but still only moderate	2
	Problems managing routine tasks, only completed with major effort. Clear signs of helplessness	3
	Completely unable to go through with routine activities without aid, i.e. extreme helplessness	4
4	Somatic, general (fatigue and muscle pains)
	Absent	0
	Slight fatigue, muscle pains or perhaps headache	1
	Moderate or pronounced fatigue or muscle pains	2
5	Tiredness, lack of energy
	Feels tired or without energy almost every day	0 (No)
		1 (Yes)
6	Sleep problems (insomnia or hypersomnia)
	Has trouble sleeping nearly every night (difficulty falling asleep, waking up in the middle of the night, early morning awakening or sleeping excessively)	0 (No)
		1 (Yes)
	Total score:

Appendix 5

7.1.1 5.1 The Bech-Rafaelsen Melancholia Scale (MES)

The MES scales with the items included in the HAM-D₆ and apathia subscales

Manual

The Bech-Rafaelsen Melancholia Scale (MES)

• Item 1 Depressed mood

  0::

  Not depressed

  1::

  Slight tendencies to lowered spirits

  2::

  More clearly preoccupied with unpleasant feelings although without clear hopelessness

  3::

  Markedly lowered mood. Feelings of hopelessness clearly present and/or clear non-verbal signs of lowered mood

  4::

  Severe degrees of lowered mood. Pronounced degree of hopelessness

• Item 2 Tiredness

  0::

  Not present

  1::

  Very mild feelings of tiredness

  2::

  More clearly in a state of tiredness or weakness, but still no impairment on the daily life activities

  3::

  Marked feelings of tiredness which occasionally interfere with the daily life activities

  4::

  Extreme feelings of tiredness which interfere more constantly with the daily life activities

• Item 3 Work and interests

  0::

  No difficulties in social life (work) activities or interests

  1::

  Slight problems with usual daily activities (at home or outside home)

  2::

  More clearly insufficiency in social life activities or interests but without helplessness

  3::

  Difficulties in performing even daily routine activities, which are carried out with great effort. Tendencies to helplessness

  4::

  Completely unable to go through with routine activities without aid from others, i.e. extreme helplessness

• Item 4 Concentration difficulties

  0::

  Not present

  1::

  Very mild tendencies to concentration disturbances

  2::

  More clearly difficulties in concentration or problems in decision making but still without impact on daily life activities

  3::

  Difficulties in concentration, even things that usually need no effort (reading a newspaper, watching a television program)

  4::

  It is clear even during the interview that there is difficulty in concentration

• Item 5 Sleep disturbances

  This item covers the subjective experience of reduced sleep length. The rating should be based on the three preceding nights, irrespective of the administration of hypnotics or sedatives. The score is the average of the past three nights

  0::

  No reduced sleep length

  1::

  Duration sleep slightly reduced

  2::

  Duration of sleep clearly but still only moderately reduced, i.e. still less than a 50 % reduction

  3::

  Duration of sleep reduced with 50 % or more

  4::

  Duration of sleep extremely reduced, e.g. as if not having been sleeping at all

• Item 6 Psychic anxiety

  0::

  Not present

  1::

  Very mild tendencies to worry, feeling fear or apprehension

  2::

  More clearly in a state of worrying, feeling insecure, or afraid, which however, is still possible to control

  3::

  The psychic anxiety or apprehension is at times more difficult to control. On the edge of panic

  4::

  Extreme degree of anxiety, interfering greatly with the daily life activities

• Item 7 Emotional introversion

  0::

  Not present

  1::

  Very mild tendencies to draw back for emotional contact with other people, e.g. colleagues

  2::

  More clear emotionally introverted to other people apart from close friends or family members

  3::

  Moderately to markedly introverted even towards close friends or family members

  4::

  Is isolated or emotionally introverted to an extreme degree

• Item 8 Worthless and guilt

  0::

  No loss of self-esteem, no self-deprecation or guilt feelings

  1::

  Is concerned with the experience of being a burden to family, friends, or colleagues due to reduced interests or introversion

  2::

  Focussing on negative events in the past prior to the current episode of depression. However, still to a mild degree

  3::

  More clearly focussed on negative events in the past accompanied with the feeling that the current depression is a kind of punishment for previous omissions or failures However, can intellectually still see that this view is unfounded

  4::

  The guilt feelings have become paranoid ideas

• Item 9 Suicidal thoughts

  0::

  Not present

  1::

  Feels that life is not worthwhile, but expresses no wish to die

  2::

  Wishes to die (“it would be a relief not to wake up next morning”) but has no plans to take own life

  3::

  Probably has plans to take own life

  4::

  Has definitely plans to take own life

• Item 10 Decreased verbal activity

  0::

  Not present

  1::

  Very mild problems in verbal formulation

  2::

  More pronounced inertia in conversation, e.g. a trend to longer pauses

  3::

  Interview is clearly influenced by brief responses or longer pauses

  4::

  Interview is clearly prolonged due to decreased verbal formulation activity

• Item 11 Decreased motor activity

  0::

  Not present

  1::

  Very mild tendencies to decreased motor activity, e.g. facial expression slightly reduced

  2::

  Moderately reduced motor activity, e.g. reduced gestures

  3::

  Markedly reduced motor activity, e.g. all movements slow

  4::

  Severely reduced motor activity, approaching stupor

Appendix 6

7.1.1 6.1 Major Depression

7.1.2 6.2 Generalized Anxiety Disorder (GAD)

7.1.3 6.3 Panic Disorder

7.1.4 6.4 Agoraphobia

7.1.5 6.5 Social Anxiety Disorder

7.1.6 6.6 Obsessive-Compulsive Disorder (OCD)

7.1.7 6.7 Schizophrenia