Overview of assessments and scales used by the Service

Scales Completed by All Patients Assessed

All patients

  1. EuroQol 5-D (EQ-5D; Brooks, 1996)
  2. MOS SF-36 (McHorney, Ware, Lu, et al, 1994; McHorney, Ware & Raczek, 1993)

Depression

  1. Hamilton Depression Rating Scale – 17-item version (HRSD-17; Hamilton, 1960)
  2. Montgomery-Asberg Depression Rating Scale (MADRS; Montgomery & Åsberg, 1979)
  3. Inventory of Depressive Symptoms (IDS; Rush et al, 1996)

Obsessive-Compulsive Disorder

  1. Yale-Brown Obsessive Compulsive Scale (Y-BOCS; Goodman, Price, Rasmussen, et al, 1989a; Y-BOCS; Goodman, Price, Rasmussen, et al, 1989b)

References

Brooks, R. (1996) EuroQol: the current state of play. Health Policy, 37, 53-72.
Goodman, W. K., Price, L. H., Rasmussen, S. A., et al (1989a) The Yale-Brown Obsessive Compulsive Scale. II. Validity. Archives of General Psychiatry, 46, 1012-1016.
---- (1989b)The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Archives of General Psychiatry, 46, 1006-1011.
Hamilton, M. (1960) A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry, 23, 56-62.
McHorney, C. A., Ware, J. E., Jr., Lu, J. F., et al (1994) The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Medical Care, 32, 40-66.
McHorney, C. A., Ware, J. E., Jr. & Raczek, A. E. (1993) The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Medical Care, 31, 247-263.
Rush, A. J., Gullion, C. M., Basco, M. R., et al (1996) The Inventory of Depressive Symptomatology (IDS): psychometric properties. Psychological Medicine, 26, 477-486.

NMD Patients Only

The following information gives an overview of the rating scales and assessments that are completed for individuals undergoing ablative neurosurgery or Vagus Nerve Stimulation.

Clinical Assessments: Self Report Measures

Symptom Assessments

  1. Beck Depression Inventory (BDI; Beck, Ward, Mendelson, et al, 1961)
  2. Yale-Brown Obsessive Compulsive Scale (Y-BOCS; Goodman, Price, Rasmussen, et al, 1989a; Y-BOCS; Goodman, Price, Rasmussen, et al, 1989b)
  3. Beck Anxiety Inventory (BAI; Beck, Epstein, Brown, et al, 1988)
  4. Hospital Anxiety and Depression Scale (HADS; Zigmond & Snaith, 1983)
  5. State/ Trait Anxiety Inventory (STAI; Spielberger, 1983)
  6. Maudsley Obsessive Compulsive Inventory (MOCI; Hodgson & Rachman, 1977)

Quality of Life Measures

  1. EuroQol 5-D (EQ-5D; Brooks, 1996)
  2. MOS SF-36 (McHorney, Ware, Lu, et al, 1994; McHorney, Ware & Raczek, 1993)
  3. Social Functioning Scale (SFS; Birchwood, Smith, Cochrane, et al, 1990)

Personality

  1. Eysenck Personality Inventory (EPI; Eysenck & Eysenck, 1968)
  2. Inventory of Interpersonal Problems – Personality Disorder (IIP-PD; for an overview, see Kim, Pilkonis & Barkham, 1997)

Other

  1. Inventory of Interpersonal Problems (IIP-64; Horowitz, Alden, Wiggins, et al, 2000)
  2. Brief Symptom Inventory (BSI; Derogatis & Melisaratos, 1983)

Clinical Interview Assessments

  1. Hamilton Depression Rating Scale – 17-item version (HRSD-17; Hamilton, 1960)
  2. Montgomery-Asberg Depression Rating Scale (MADRS; Montgomery & Åsberg, 1979)
  3. Yale-Brown Obsessive Compulsive Scale (interview version) (Y-BOCS; Goodman, Price, Rasmussen, et al, 1989a; Goodman, Price, Rasmussen, et al, 1989b)
  4. Personality Assessment Schedule (PAS; Tyrer, Alexander, Cicchetti, et al, 1979)
  5. A structured review of adverse effects
  6. Categorical Rating Scales (e.g. Pippard Postoperative Rating Scale (Pippard, 1955), Clinical Global Impression; CGI (National Institute of Mental Health, 1970)
  7. Lancashire Quality of Life Profile (LQoLP; Oliver, Huxley, Priebe, et al, 1997)
  8. Positive and Negative Symptom Scale (PANSS; Kay, Fiszbein & Opler, 1987)

References

Beck, A. T., Epstein, N., Brown, G., et al (1988) An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clinical Psychology, 56, 893-897.
Beck, A. T., Ward, C. H., Mendelson, M., et al (1961) An inventory for measuring depression. Archives of General Psychiatry, 4, 561-571.
Birchwood, M., Smith, J., Cochrane, R., et al (1990) The Social Functioning Scale. The development and validation of a new scale of social adjustment for use in family intervention programmes with schizophrenic patients. British Journal of Psychiatry, 157, 853-859.
Brooks, R. (1996) EuroQol: the current state of play. Health Policy, 37, 53-72.
Derogatis, L. R. & Melisaratos, N. (1983) The Brief Symptom Inventory: an introductory report. Psychological Medicine, 13, 595-605.
Eysenck, H. J. & Eysenck, S. B. G. (1968) Manual for the Eysenck Personality Inventory. San Diego, CA: Educational and Industrial Testing Service.
Goodman, W. K., Price, L. H., Rasmussen, S. A., et al (1989a) The Yale-Brown Obsessive Compulsive Scale. II. Validity. Archives of General Psychiatry, 46, 1012-1016.
---- (1989b) The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Archives of General Psychiatry, 46, 1006-1011.
Hamilton, M. (1960) A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry, 23, 56-62.
Hodgson, R. J. & Rachman, S. (1977) Obsessional-compulsive complaints. Behaviour Research and Therapy, 15, 389-395.
Horowitz, L. M., Alden, L. E., Wiggins, J. S., et al (2000) IIP - Inventory of Interpersonal Problems Manual. San Antonio, TX: The Psychological Corporation.
Kay, S. R., Fiszbein, A. & Opler, L. A. (1987) The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13, 261-276.
Kim, Y., Pilkonis, P. A. & Barkham, M. (1997) Confirmatory factor analysis of the personality disorder subscales from the Inventory of Interpersonal Problems. Journal of Personality Assessment, 69, 284-296.
McHorney, C. A., Ware, J. E., Jr., Lu, J. F., et al (1994) The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Medical Care, 32, 40-66.
McHorney, C. A., Ware, J. E., Jr. & Raczek, A. E. (1993) The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Medical Care, 31, 247-263.
Montgomery, S. A. & Åsberg, M. (1979) A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382-389.
National Institute of Mental Health (1970) CGI: Clinical Global Impressions. In Manual for the ECDEU Assessment Battery (eds W. Guy & R. R. Bonato)  (2nd edn), pp. 217-222: National Institute of Mental Health.
Oliver, J. P., Huxley, P. J., Priebe, S., et al (1997) Measuring the quality of life of severely mentally ill people using the Lancashire Quality of Life Profile. Social Psychiatry and Psychiatric Epidemiology, 32, 76-83.
Pippard, J. (1955) Rostral leucotomy: a report on 240 cases personally followed up after one and one half to five years. Journal of Mental Science, 101, 756-773.
Spielberger, C. D. (1983) State-Trait Anxiety Inventory (Form Y) Manual. Redwood City, CA: Mind Garden.
Tyrer, P., Alexander, M. S., Cicchetti, D., et al (1979) Reliability of a schedule for rating personality disorders. British Journal of Psychiatry, 135, 168-174.
Zigmond, A. S. & Snaith, R. P. (1983) The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67, 361-370.

Clinical Neuropsychology Battery

  1. National Adult Reading Test (NART; Nelson & Willison, 1991)

The NART was designed as a tool to estimate the premorbid level of intelligence in individuals with cognitive impairment. The subject is asked to read aloud fifty words which do not obey typical phonetic rules of pronunciation, such as ‘drachm’ and ‘syncope’. The ability to read such words is a reliable indicator of premorbid intelligence (Crawford, Parker, Stewart, et al, 1989) and intellectual functioning (Crawford, Deary, Starr, et al, 2001), and is relatively robust to factors such as stroke or head injury. There is some uncertainty over effects of mood upon score, but it appears to be unaffected by mania (Lebowitz, Shear, Steed, et al, 2006), and similar assumptions have been made about depression.

  1. Wechsler Adult Intelligence Scale – III – Revised (WAIS-III-R; Wechsler, 1981)

The WAIS-III-R is a widely-used assessment of intelligence in adults between the ages of 16 and 74 years. Two subtests covering verbal ability (Arithmetic and Comprehension), and two covering performance (Block Design and Digit Symbol), are used. Whilst Arithmetic and Comprehension are unaffected by frontal lesions, Block Design is relatively sensitive to frontal lobe dysfunction (Stuss & Benson, 1984).

  1. Wechsler Memory Scale – Revised (WMS-R; Wechsler, 1987)

The WMS-R is intended for use in adults between the ages of 16 and 74 years. A number of subtests are used:

  • Digit Span
  • Logical Memory (Immediate and Delayed Recall)
  • Verbal Paired Associates (Immediate and Delayed Recall)
  • Visual Reproduction (Immediate and Delayed Recall

  1. Rey Complex Figure Test (RCFT; Meyers & Meyers, 1995)

Designed as a measure of visual memory and visuospatial construction ability, the subject is presented with a complex shape and is required to copy it onto a blank sheet of paper. The shape is then removed and after a three minute delay, the subject must reproduce it from memory. After a further thirty minutes, the subject must again reproduce the figure from memory.

  1. Verbal Fluency Test/ Controlled Oral Word Association Test (COWAT; Ruff, Light, Parker, et al, 1996)

Believed to be related to frontal lobe function (McCarthy, Blamire, Rothman, et al, 1993), the COWAT is a test of verbal fluency. The task shows greater activation of left-prefrontal areas on fMRI (Schlösser, Hutchinson, Joseffer, et al, 1998) and demonstrates particular impairments in left-sided lesions (Benton, 1968), although not all studies show impairment after frontal lesions (Vilkki & Holst, 1994).

The subject has to generate words according to a specific rule, for example naming as many animals as possible in one minute. Alternative formats require the subject to produce as many words in one minute beginning with the letter ‘F’, followed by one-minute trials with the letters ‘A’ and ‘S’. The current format of the COWAT uses the letters ‘C’, ‘F’, and ‘L’.

  1. Trail-Making Test (TMT; Reitan & Wolfson, 1993)

A paper-and-pen test, the TMT exists in two forms: ‘Trails A’ and ‘Trails B’. In ‘Trails A’ the subject must connect 25 numbered circles, scattered in random order on the page, in numerical order and it is primarily a test of visuomotor speed. In ‘Trails B’, the circles are identified by numbers and letters, and the subject must connect them by alternating between number order and letter order. Although visuomotor speed is important, ‘Trails B’ requires more attention and cognitive set-shifting and has been shown to be impaired in depressed patients (Austin, Mitchell, Wilhelm, et al, 1999).

  1. Stroop Neuropsychological Screening Test (Trenerry, Crosson, De Boe, et al, 1989)

First described by J. Ridley Stroop (1935), the Stroop phenomenon demonstrates the effect of interference. In the first part of the test, the subject must read the name of a list of colours, whilst the second trial requires them to state the colour of the word (which does not always match the word). In order to name the colour instead of the word, the subject must inhibit a more automatic response and initiate another, and a conflict arises when we have to pay attention to the colour of the word only.

The anterior cingulate cortex is activated during the Stroop test, and is most activated during the incongruous condition of the test (Pardo, Pardo, Janer, et al, 1990). The test is thought to be dependent on anterior cingulate function, and lesions to the prefrontal cortex tend to impair performance on the Stroop task (Stuss, Floden, Alexander, et al, 2001; Vendrell, Junque, Pujol, et al, 1995), although this is not a universal finding (Fellows & Farah, 2005).

References

Austin, M. P., Mitchell, P., Wilhelm, K., et al (1999) Cognitive function in depression: a distinct pattern of frontal impairment in melancholia? Psychological Medicine, 29, 73-85.
Benton, A. L. (1968) Differential behavioral effects in frontal lobe disease. Neuropsychologia, 6, 53-60.
Crawford, J. R., Deary, I. J., Starr, J., et al (2001) The NART as an index of prior intellectual functioning: a retrospective validity study covering a 66-year interval. Psychological Medicine, 31, 451-458.
Crawford, J. R., Parker, D. M., Stewart, L. E., et al (1989) Prediction of WAIS IQ with the National Adult Reading Test: Cross Validation and Extention. British Journal of Clinical Psychology, 28, 267-273.
Fellows, L. K. & Farah, M. J. (2005) Is anterior cingulate cortex necessary for cognitive control? Brain, 128, 788-796.
Lebowitz, B. K., Shear, P. K., Steed, M. A., et al (2006) Stability of estimated IQ across mood state in patients with bipolar disorder. Bipolar Disorders, 8, 81-84.
McCarthy, G., Blamire, A. M., Rothman, D. L., et al (1993) Echo-Planar Magnetic Resonance Imaging Studies of Frontal Cortex Activation During Word Generation in Humans. Proceedings of the National Academy of Sciences USA, 90, 4952-4956.
Meyers, J. E. & Meyers, K. R. (1995) Rey Complex Figure Test and Recognition Trial. Test Manual. Odessa, FL: Psychological Assessment Resources, Inc.
Nelson, H. E. & Willison, J. R. (1991) The Revised National Adult Reading Test (Part II) Manual. Windsor, Berks: Nfer-Nelson.
Pardo, J. V., Pardo, P. J., Janer, K. W., et al (1990) The anterior cingulate cortex mediates processing selection in the Stroop attentional conflict paradigm. Proceedings of the National Academy of Sciences USA, 87, 256-259.
Reitan, R. M. & Wolfson, D. (1993) The Halstead-Reitan neuropsychological test battery: Theory and clinical interpretation (2nd edn). Tucson, AZ: Neuropsychology Press.
Ruff, R. M., Light, R. H., Parker, S. B., et al (1996) Benton controlled oral word association test: Reliability and updated norms. Archives of Clinical Neuropsychology, 11, 329-338.
Schlösser, R., Hutchinson, M., Joseffer, S., et al (1998) Functional magnetic resonance imaging of human brain activity in a verbal fluency task. Journal of Neurology, Neurosurgery and Psychiatry, 64, 492-498.
Stroop, J. R. (1935) Studies of interference in serial verbal reactions. Journal of Experimental Psychology, 28, 643-662.
Stuss, D. T. & Benson, D. F. (1984) Neuropsychological studies of the frontal lobes. Psychological Bulletin, 95, 3-28.
Stuss, D. T., Floden, D., Alexander, M. P., et al (2001) Stroop performance in focal lesion patients: dissociation of processes and frontal lobe lesion location. Neuropsychologia, 39, 771-786.
Trenerry, M. R., Crosson, B., De Boe, J., et al (1989) The Stroop Neuropsychological Screening Test. Odessa, FL: Psychological Assessment Resources.
Vendrell, P., Junque, C., Pujol, J., et al (1995) The role of prefrontal regions in the Stroop task. Neuropsychologia, 33, 341-352.
Vilkki, J. & Holst, P. (1994) Speed and flexibility on word fluency tasks after focal brain lesions. Neuropsychologia, 32, 1257-1262.
Wechsler, D. (1981) Wechsler Adult Intelligence Scale - Revised. Manual. New York, NY: The Psychological Corporation.
---- (1987) Wechsler Memory Scale - Revised. Manual. San Antonio, TX: The Psychological Corporation.

CANTAB

The CANTAB (CANTAB, 1999) is a computerised set of tests which allow a variety of cognitive functions to be assessed in a language-independent, visually-focused environment, affording immediate feedback on the subject’s activities. The tests have been shown to be sensitive to the changes caused by a number of CNS disorders. One of the advantages of such a system is that it has been designed for repeat testing, with parallel test batteries being available.

The 13 tests in the CANTAB are divided into four types of task:

  1. Training and screening
    1. Motor Screening
    2. Big/ Little Circle
    3. Reaction Time
  2. Attention and memory
    1. Matching to Sample Visual Search
    2. Delayed Matching to Sample
    3. Pattern Recognition Memory
    4. Spatial Recognition Memory
    5. Spatial Span
  3. Non-strategic learning and memory
    1. Paired Associates Learning
    2. Sustained attention
    3. Rapid Visual Information Processing
  4. Frontal/ executive tasks
    1. Spatial Working Memory
    2. ID/ED Shift
    3. Stockings of Cambridge

References

Cambridge Neuropsychological Test Automated Battery [Computer Program] (1999). Version 1.0.0.2 for Microsoft Windows™. Cambridge, UK: CeNeS Ltd. (now Cambridge Cognition). http://www.cantab.com/.