The applicability and the inter-rater reliability of the Comprehensive Psychopathological Rating Scale in an elderly clinical population.
van der Laan NC, Schimmel A and Heeren TJ;
Commented by , 19 Feb 2005
Background
The Comprehensive Psychopathological Rating Scale (CPRS) was developed in 1978 by Asberg et al. to assess the present psychiatric state; severity of symptoms; and change in symptoms over time. It consists of 65 items covering psychotic, mood and neurotic disorders, takes about 50 minutes to administer, and can be used by mental health professionals of different disciplines after relatively little training. Hitherto, it has been used in samples of young psychiatric populations.
Aims
This study sought to establish whether features of ageing, such as mild cognitive decline, or sensory impairment, effected the applicability and reliability of the CPRS, ie., whether it can be used in an elderly clinical population.
Methods
The study population consisted of 62 consecutive admissions, 60 years and older, admitted to a Dutch ward for elderly patients with functional psychiatric disorders. Exclusion criteria were Mini Mental State Examination (MMSE) score below 16, delirium, mental handicap, and hospitalization less than one week.
The two trained raters completed the CPRS within 2 weeks of admission; inter-rater reliability was assessed with weighted Kappa coefficients, comparing the agreement between the two raters with that expected by chance.
Results
95 patients were admitted during the study period, the commonest cause of the 33 exclusions was MMSE <16. Of the 62 inclusions, mean age was 70 years, 68 % were women. The study populations had a spread of common primary psychiatric conditions:
- depression (34)
- schizophrenia (10)
- bipolar (5)
- anxiety (4)
- organic psychiatric syndrome (4)
- others (5)
6 patients were too disordered to be given a CPRS assessment. The mean and median time for administering the test for the others was 50 minutes, irrespective of cognitive dysfunction.
More than two-thirds of the CPRS items had a "sufficient - good" or "nearly perfect" reliability in terms of Kappa coefficient.
Dr Seymour's comments
This study found that the CPRS was equally well tolerated and applicable in this clinically representative population (of older people with moderate-severe functional psychopathology in the acute phase of their illness) as in previously published studies of younger populations.
Similarly, inter-rater reliability was equivalent to studies in younger populations, and was not significantly effected by mild cognitive dysfunction.
Why is this of significance? Old Age Psychiatry is blighted by a lack of reliable and valid outcome measures - it is difficult to prove to sceptical commissioners that our interventions are effective, and tools developed specifically for older people seem to carry little credence.
The CPRS covers a wide range of psychopathology and can be used to monitor progress longitudinally. Moreover, it has been previously and widely validated in younger populations. Potentially, therefore, commissioners of psychiatric services could utilise the same tool as an outcome measure on both general adult psychiatry wards and elderly (functional illness) wards.
References
For more on the CPRS, see for instance the following:
1. Asberg M and Schalling D. Construction of a new psychiatric rating instrument, the Comprehensive Psychopathological Rating Scale (CPRS). Prog Neuropsychopharmacol. 1979; 3 (4); 405-412
2. Asberg M, Montgomery SA, Perris C, Schalling D and Sedvall G. A comprehensive psychopathological rating scale. Acta Psychiatrica Scandinavica Suppl. 1978; (271); 5-27