Use of the Brief Psychiatric Rating Scale to Facilitate Differential Diagnosis at Acute Inpatient Admission

Background: The advent of managed care hasnecessitated strategies for quickly and accurately diagnosingpsychiatric disorders. The aim of the present study was toascertain whether the Brief Psychiatric Rating Scale-Anchored(BPRS-A) would be a useful adjunct to more traditional diagnosticstrategies at acute inpatient admission.

Method: Using a sample of 207 inpatientsadmitted during an 8-month index period, we examined the utilityof the BPRS-A in predicting whether patients were more likely tobe diagnosed with schizophrenia, bipolar disorder, or majordepression (DSM-IV).

Results: Discriminant function analyses wereused to correctly predict 68%, 60%, and 74% of patients diagnosedwith schizophrenia, bipolar disorder, and major depression,respectively. The main predictors of diagnostic category, indescending order, were BPRS-A depressed mood item, BPRS-Apositive symptoms scale, BPRS-A excitement item, BPRS-A guiltfeelings item, BPRS-A mannerisms and posturing item, and numberof previous episodes.

Conclusion: As efforts are directed towardcontinuous quality improvement within mental health settings, anemphasis must be placed on improving the efficiency and accuracyof diagnostic procedures. The BPRS-A shows promise as atime-efficient assessment instrument that may be useful infacilitating differential diagnosis at inpatient admission andmay increase the likelihood that efficacious prereleaseinterventions and appropriate aftercare services are implemented.