THE PSYCHIATRIC IMPAIRMENT RATING SCALE (PIRS)
The SABS new definition for catastrophic impairment will take effect in June 2016. They will be introducing a new rating method to combine physical and mental impairments in the 6th edition of the AMA Guides.
This new method derives three scores to evaluate the client using three different scales.
- Brief Psychiatric Rating Scale (BPRS)
- The Global Assessment of Functioning Scale (GAF)
- The Psychiatric Impairment Rating Scale (PIRS)
In this post, we will explore the Brief Psychiatric Rating Scale (BPRS) in more detail. Check out our other blog posts for information about the GAF and the PIRS.
BPRS Symptom Evaluation
This scale was first published in 1962. It is one of the oldest and most widely used scales to measure psychotic symptoms. The BPRS was created and has been modified to be reliable and offer validity.
The BPRS is a 24-item scale that measures various psychiatric symptoms such as depression, anxiety, hallucinations, and unusual behaviour. The 24 items include the following:
- Somatic concern
- Anxiety
- Depression
- Suicidality
- Guilt
- Hostility
- Elated mood
- Grandiosity
- Suspiciousness
- Hallucinations
- Unusual thought content
- Bizarre behaviour
- Self-neglect
- Disorientation
- Conceptual disorganization
- Blunted affect
- Emotional withdrawal
- Motor retardation
- Tension
- Uncooperativeness
- Excitement
- Distractibility
- Motor hyperactivity
- Mannerisms and posturing
Each of these items is rated on a scale from 1 (not present) to 7 (extremely severe). The sum of all 24 items is calculated to a maximum score of 168. The higher the score, the more psychiatrically impaired the client is.
BPRS Rating Measurements
The scores are based on a clinician’s interview with the client and observation of the client’s behaviour over a 2-3 day period. The client’s family will also provide a report on the client’s behaviour to assist with determining the scores.
It should be noted that some items on this scale are specific to bipolar or psychotic disorders. These do not relate to clients in motor vehicle accidents and therefore eliminates 7 of the 24 items (49 points) from the maximum of 168.
To increase the reliability of ratings, it is recommended that clients be interviewed jointly by two clinicians. The clinicians can either make independent ratings to be later compared, or make ratings together through discussion and a consensus.
The strength of the BPRS scale is that it is sensitive to change. It has a broad evaluation of a number of different symptoms. Psychometric properties and underlying factor structure are well-established in this scale.
Conversely, there are some limitations of the BPRS. The scale mostly focuses on symptoms instead of the client’s function. In addition, it is often a tool to measure the severity of symptoms of schizophrenia or psychotic disorders. These do not relate to motor vehicle accident clients.
The final score out of 168 is converted to a Whole Person Impairment (WPI) score using the guidelines in the 6th edition of the AMA Guides. A client requires a score of at least 3 on the 17 items that do not deal with a psychotic disorder (a summed score of 51) to receive a WPI of 30%.
The WPI obtained from the BPRS is then used in combination with the PIRS and GAF to obtain the median WPI rating. This is then combined with the physical WPI rating to obtain the total WPI. This will then help decide a client’s CAT designation.
If you have any questions about these scales or the upcoming changes to the SABS, please contact us. We would be happy to provide you with more information.
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