Clinical setting

in Psychological
testing
Presented To: Sir Arbab
Presented by: Ayesha, Laiba,
Arib, Fatima and Rafia
 Y(BOCS): The
Yale-Brown
Obsessive
Compulsive Scale
Presented by: Ayesha Ashmal
 Characteristics of OCD and Y(BOCS)
• Obsession: a recurring and persistent thought that interferes with normal behaviour.
• Compulsion: a recurring action a person is forced to enact.
1. Washing hands repeatedly.
2. Checking repeatedly
3. Doubting
4. Touching repeatedly
5. Ordering and organizing
6. Repeating words
• Obsession may lead to compulsion.
• The patient may feel the need to perform the compulsion(s) to reduce anxiety or prevent some devastating
events/circumstances from occurring.
 DSM-5 Criteria for OCD diagnosis
• Presence of obsessions or compulsions or both.
• The obsessions and compulsions are time-consuming, taking more than 1 hour daily
• These recurrent persistent activities may interfere with one social aspect of life.
• Compulsions are defined by repetitive behaviors that the individual feels driven to perform. These behaviours
aimed to preventing or reducing anxiety or distress.
 Y(BOCS): The Yale-Brown Obsessive compulsive scale
• One of the most valid and reliable screening instruments for OCD.
• Most popular one.
• 10 items in 4 point scale.
• 0-7= Subclinical while 32-40= extreme
• Semi-structured interview.
• Part 1-67 symptoms; can be either current, past or absent. This assists the diagnosing party with finding clusters of
symptoms and treating the patient.
• Part 2-19 items patients complete about self.
• Part 1 and 2 scores are transferred to a grid. Then, the individual is given an obsession score out of 20, and a compulsion
score out of 20. 9 other items are recorded on a 1-4 Likert scale. There is also a children version of test.
 Continued….
• Using Y-BOCS, symptoms are operated into clusters or groups (6 in total).
1. Aggressive Obsession: “Harming someone impulsively”
2. Contamination Obsession: “ Feeling constantly unclean”.
3. SexualObsession: “ sexually intrusive thoughts, that are unpleasant and provoke guilt”.
4. Hoarding Obsession: feeling some catastrophic will happen so collecting and hoarding different products.
5. Religious Obsession: “significant fear related to religion” eg thinking that one is worshipping th devil which could make
one end up in hell.
6. Symmetry or exactness obsession: “exacting everything again and again like pillows on the couch or pencil On the desk
etc.
 Beck’s
Depression
Inventory
(BDI)
Presented By: Laiba Zahra
 BECKS DEPRESSION INVENTORY (BDI)
1. BDI was created by AARON T. BECK and published in 1961.
2. The Beck Depression Inventory (BDI) is a 21-item, self-rated scale that evaluates key symptoms of depression including
mood, sense of failure, self-dissatisfaction, guilt, punishment, self-dislike, self-accusation, suicidal ideas, crying,
irritability, social withdrawal, indecisiveness, body image change, work difficulty, insomnia, loss of appetite, weight loss.
 Purpose of BDI
1. The BDI was originally developed to provide a quantitative assessment of the intensity of depression.
2. Because it is designed to reflect the depth of depression, it can monitor changes over time and provide an objective
measure for judging improvement and the effectiveness or otherwise of treatment methods.
 Types of BDI
1. There are two types
2. BDI-1: The original BDI was based on clinical observations and patient description
3. BDI-2: contains items that reflect the cognitive, affective, somatic, and vegetative symptoms of depression
 BDI TEST SCORE
1. The BDI-II is scored by summing the ratings for the 21 items.
2. Each item is rated on a 4-point scale ranging from 0 to 3.
3. The maximum total score is 63. Special attention must be paid to the correct scoring of the Changes in Sleeping Pattern
(Item 16) and Changes in Appetite (Item 18) items.
4. . Measures of 0–9 indicates that a person is not depressed,
5. 10–18 indicates mild-moderate depression,
6. 19–29 indicates moderate-severe depression
7. 30–63 indicates severe depression.
DASS-21
Presented By: Areeba keyani
 General description of the scales
1. The DASS is a set of three self-report scales designed to measure the negative emotional states of depression, anxiety and
stress.
2. The DASS was constructed not merely as another set of scales to measure conventionally defined emotional states, but to
further the process of defining, understanding, and measuring the ubiquitous and clinically significant emotional states
usually described as depression, anxiety and stress.
3. The DASS should thus meet the requirements of both researchers and scientist-professional clinicians.
 Items

1. Each of the three DASS scales contains 14 items, divided into subscales of 2-5 items with similar content.
2. The Depression scale assesses dysphoria, hopelessness, devaluation of life, self-deprecation, lack of interest/involvement,
anhedonia, and inertia.
3. The Anxiety scale assesses autonomic arousal, skeletal muscle effects, situational anxiety, and subjective experience of
anxious affect.
4. The Stress scale is sensitive to levels of chronic non-specific arousal. It assesses difficulty relaxing, nervous arousal, and
being easily upset/agitated, irritable/over-reactive and impatient.
5. Subjects are asked to use 4-point severity/frequency scales to rate the extent to which they have experienced each state
over the past week.
1.Cut-off scores of 60 and 21 are used for the total
DASS score and for the depression subscale
respectively.
2. Scores ≥60 (for DASS-total) and ≥21 (for the
depression subscale) are labeled as “high” or
“severe”.
 Characteristics of high scorers on each DASS scale
• apprehensive,
panicky
• self-disparaging • unable to
• trebly, shaky
• dispirited, relax
gloomy, blue • aware of • touchy,
• convinced that
life has no dryness of the easily upset
meaning or value mouth,
• pessimistic about
breathing • irritable
the future
• unable to difficulties, • easily
experience
DEPRESSION enjoyment or pounding of startled
satisfaction ANXIETY the heart, STRESS • nervy,
• unable to
become sweatiness of jumpy,
interested or
involved the palms fidgety
• slow, lacking in • worried about • intolerant of
initiative
performance interruption
and possible or delay
loss of control
 DASS in research

1. The DASS may be administered either in groups or individually for research purposes. The capacity to discriminate
between the three related states of depression, anxiety and stress should be useful to researchers concerned with the
nature, etiology and mechanisms of emotional disturbance.

2. As the essential development of the DASS was carried out with non-clinical samples, it is suitable for screening normal
adolescents and adults. Given the necessary language proficiency, there seems no compelling case against use of the
scales for comparative purposes with children as young as 12 years. It must be borne in mind, however, that the lower age
limit of the development samples was 17 years.
 Clinical use of DASS

1. The principal value of the DASS in a clinical setting is to clarify the locus of emotional disturbance, as part of the broader
task of clinical assessment. The essential function of the DASS is to assess the severity of the core symptoms of
depression, anxiety and stress. It must be recognized that clinically depressed, anxious or stressed persons may well
manifest additional symptoms that tend to be common to two or all three of the conditions, such as sleep, appetite, and
sexual disturbances. These disturbances will be elicited by clinical examination, or by the use of general symptom check
lists as required.

2. The DASS may be administered and scored by non-psychologists, but decisions based on particular score profiles should
be made only by experienced clinicians who have carried out an appropriate clinical examination. It should be noted also
that none of the DASS items refers to suicidal tendencies because items relating to such tendencies were found not to load
on any scale. The experienced clinician will recognise the need to determine the risk of suicide in seriously disturbed
persons.
Beck’s Anxiety
Inventory
(BAI)
Presented By: Fatima Ikram
Scoring.
PANSS used
for
schizophrenia
PRESENTED BY: RAFIA NADEEM
PANSS:
Stands for: Positive and
Negative Syndrome Scale
Definition:
PANSS is a medical scale used for
measuring symptoms severity of patients
with schizophrenia.
*It was published in 1987 by Stanley
Kay, Lewis Opler and Abraham fiszbein.
*It is widely used in the study of
antipsychotic therapy.
*The scale is known as the “gold
standard”.
 Schizophrenia:
• Schizophrenia is a mental disorder characterized by continuous or relapsing episode of psychosis.
• Major symptoms include: hallucinations, delusions, Paranoia and disorganized thinking/speech.
• Other Symptoms include: social withdrawal, decreased emotional expression and apathy.
• Symptoms typically come on gradually, begin in young adulthood and in many cases never resolve.
• Besides observed behavior, doctors will also take a history that includes the person’s reported experiences and reports of
others familiar with the person, when making a diagnosis.
• To diagnose someone with schizophrenia, doctors are supposed to confirm that symptoms and functional impairment are
present for 6 months/ one month.
• Many people with schizophrenia have other mental disorders especially substance use disorder, depressive disorders,
anxiety disorders and obsessive compulsive disorders.
General Rating Instructions:
• Data gathered from this assessment procedure are applied to the PANSS ratings. Each of the 30 items is accompanied by a
specific definition as well as detailed anchoring criteria for all seven rating points. These seven points represent increasing
level of psychopathology as follows:
1. Absent
2. Minimal
3. Mild
4. Moderate
5. Moderate severe
6. Severe
7. Extreme
Continue…
1. A rating of 2 (minimal) denotes questionable, subtle or suspected pathology or it also may allude to the extreme end of the
normal range.
2. A rating of 3 (mild) is indicative of a symptom whose presence is clearly established but not pronounced and interferes
little in day-to-day functioning.
3. A rating of 4 (moderate) characterises a symptom which, though representing a serious problem, either occurs only
occasionally or intrudes on daily life to a moderate extent.
4. A rating of 5 (moderate severe) indicates marked manifestations that distinctly impact on one’s functioning but are not all-
consuming and usually can be contained at will
5. A rating of 6 (severe) represent gross pathology that is present very frequently, proves highly disruptive to one’s life, and
often calls for direct supervision.
6. A rating of 7 (extreme) refers to the most serious level of psychopathology, whereby the menifestations drastically
interfere in most of all major life functions typically necessitating close supervision and assistance in many areas.
 PANSS rating form

General
Positive scale Negative scale psychopathology

• P1, P2,P3, P4, P5, P6 • N1,N2, N3, N4, N5, • G1, G2, G3, G4, G5,
or P7 N6 or N7 G6, G7, G8, G9, G10,
G11, G12, G13, G14,
G15 or G16
Scoring instructions: Of the 30 items included in the PANSS, 7
constitute a positive scale, 7 a negative scale and the remaining 16 a
general psychopathology scale. The scores for these scales are arrived at
by summation of ratings across component items. Therefore the potential
range are 7 to 49 for the positive and negative scales, and 16 to 112 for the
general psychopathology scale.
In addition to these measures, a composite scale is scored by subtracting
the negative score from positive scores. This yield a bipolar index that
ranges from -42to+42 which is essentially a difference score reflecting the
degree of predominance of one syndrome in relation to other.
See manual
for rating
scale…