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Assessment Tools for Measuring Outcomes in Psychosis

Psychotic Symptoms – Symptom Severity 

  1. Revised Behavior and Symptom Identification Scale (BASIS-R). The BASIS-R is a 24-item self-report instrument with six scales: psychosis, depression/functioning, interpersonal problems, alcohol/drug use, self-harm, and emotional lability. 
  2. Symptom Checklist-90-Revised (SCL-90-R). The SCL-90-R is a 90-item self assessment tool that measures psychoticism and paranoid ideation in addition to seven other symptom scales. 
  3. Brief Symptom Inventory (BSI). The BSI is a 53-item self-administered scale developed from the SCL-90-R. The BSI has good psychometric properties and is an acceptable brief alternative to the SCL-90-R. 

Psychotic Symptoms – Medication Adherence 

  1. Count missed doses 
  2. Drug Attitude Inventory. Assesses attitudes toward medications rather than adherence behavior. 
  3. Medication Possession Ratio (MPR). MPR assesses the extent to which dispensed medications provide coverage for a given interval (e.g., 6 months). 
  4. Gap measure. Gap measure is based on gaps in medication prescribing or failure to refill prescriptions. 

Psychotic Symptoms – Use of Clozapine 

Use instruments described above to identify patients who may benefit from clozapine (i.e., are medication adherent and have persistent high levels of psychosis).

Medication Side-Effects 

  1. Body Mass Index. BMI is calculated from height and weight, and is the most commonly recommended metric for monitoring weight gain. A BMI of 18.5 to 24.9 is normal, 25.0 to 29.9 is overweight, and 30 or higher is obese. 
  2. Fasting glucose values    
  3. HgA1c 
  4. Lipids 
  5. Liverpool University Neuroleptic Side Effect Rating Scale (LUNSERS). The LUNSERS covers extrapyramidal and other side-effects but is limited in its assessment of sexual side-effects. 
  6. Arizona Sexual Experience Scale (ASEX). The ASEX is a 5-item scale commonly used to assess sexual dysfunction. 

Comorbid Drug and Alcohol Use 

  1. Michigan Alcoholism Screening Test (MAST). The MAST is a 25-item yes/no questionnaire used to identify alcohol abuse disorders. 
  2. CAGE. The CAGE is a 4-item screen for subjective negative consequences of alcohol abuse. 
  3. Alcohol Use Disorders Identification Test (AUDIT). The AUDIT is a 10-item questionnaire that screens for alcohol abuse by identifying harmful personal and social consequences of alcohol use. 
  4. AUDIT-C. The AUDIT-C is a brief version of the AUDIT consisting of the three consumption-related items of the AUDIT. 
  5. T-ACE. The T-ACE is a 4-item, self-report alcohol screen. 
  6. TWEAK. The TWEAK is a 4-item, self-report alcohol screen that consists of items from the MAST, the CAGE, and the T-ACE. 
  7. Drug Abuse Screening Test (DAST). The DAST is a leading self-administered drug abuse screen. 
  8. Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). The ASSIST is an 8-item scale used to detect substance abuse in a primary care setting 
  9. Two-Item Conjoint Screen (TICS). The TICS has been used in primary care to identify patients with current alcohol or drug problems. 

Comorbid Depression and Suicidality 

  1. Beck Depression Inventory - II (BDI-II). The BDI – II is a 21-item scale with good reliability and validity. 
  2. BDI - Primary Care Version (BDI – PC). The BDI – PC is a 7-item depression screening device designed for use in primary care settings. 
  3. Patient Health Questionnaire-9 (PHQ-9). The PHQ-9 is a 9-item, self-report scale that assesses frequency of depressive symptoms over the past 2 weeks. 
  4. Beck Scale for Suicidal Ideation (BSI). The BSI is a 21-item, self-report measure that screens for suicidality. 
  5. Clinical Suicidality Assessment scale (CSA). The CSA is a 2-item suicidiality screen. 

Family and Caregivers 

  1. Family Environment Scale (FES). The FES is a 90-item, true/false questionnaire measuring family cohesion, conflict, and expressiveness. 
  2. Family Attitude Scale (FAS). The FAS is a 30-item measure of family stress and expressed anger. 
  3. Level of Expressed Emotion scale (LEE). The LEE is a 60-item measure of expressed emotion. 
  4. Patient Rejection Scale (PRS). The PRS an 11-item measure of relatives’ hostile and critical attitudes toward their ill family member. 
  5. FACES IV. FACES IV is a 42-item measure that yields scores in a number of domains, including family cohesion, adaptability, communication, and satisfaction. 
  6. McMaster Family Assessment Device. The McMaster Family Assessment Device is a 53-item measure that assesses the health of family functioning. 
  7. Quality of Life Interview (QOLI). Items from the QOLI can be used to assess frequency of family contact and satisfaction with family relationships. 

Vocational Functioning 

  1. Self-report. Following data should be collected…Employment status (i.e., competitive employment, sheltered employment, unemployed); Number of hours worked per week; Number of paid work days in the past 30 days; Job tenure; Salary per hour. 
  2. Indiana Job Satisfaction Scale (IJSS). The IJSS is a brief job satisfaction questionnaire developed for individuals with severe mental illness. 
  3. Social Attainment Scale – II (SAS-II). (SAS-II) has a patient self-report version that can be utilized to measure missed days of work, objective and subjective performance adequacy, interpersonal friction, distress, and satisfaction. For patients who are unemployed, an item from the SAS-II can be used to measure desire to work. 
  4. Quality of Life Interview (QOLI). The QOLI includes a number of items assessing employment status and satisfaction. 

Community Tenure and Housing 

  1. Residential Follow-Back Calendar. The Residential Follow-Back calendar records days of stable community housing, institutional days, homeless days, and marginal homelessness. 
  2. Schizophrenia Outcomes Module. The Schizophrenia Outcomes Module includes valid measures of housing status. 
  3. Quality of Life Interview (QOLI). The QOLI includes items assessing housing status.