What the BPRS measures
The Brief Psychiatric Rating Scale was published by John Overall and Donald Gorham in 1962. A rater scores each symptom from an interview and direct observation, so it is not a self-report questionnaire.
The 18-item version is the one most often used today. The form in the ECDEU Assessment Manual (Guy, 1976) rates each of the 18 symptom constructs on a seven-point scale from 1 (not present) to 7 (extremely severe).
How to use this calculator
- Pick a rating from 1 to 7 for every item. Arrow keys move between the numbers.
- The result updates as you go and lists any items you have not rated yet.
- Once all 18 are rated you get the total, the five subscale scores, and where the total falls against the published anchors.
- Copy result puts the total, subscales and every item rating on your clipboard.
Scoring formula
Total = item 1 + item 2 + … + item 18
With 18 items rated 1 to 7, the total ranges from 18 to 126. Someone with no symptoms at all still scores 18.
| Rating | 1 | 2 | 3 | 4 | 5 | 6 | 7 |
|---|---|---|---|---|---|---|---|
| Meaning | Not present | Very mild | Mild | Moderate | Moderately severe | Severe | Extremely severe |
The five subscales
The ECDEU manual groups the 18 items into five factors, based on a 1974 analysis of pretreatment scores from 3,596 people diagnosed with schizophrenia. A subscale score is the sum of its items.
| Subscale | Items | Range |
|---|---|---|
| Anxiety-depression | 1. Somatic concern, 2. Anxiety, 5. Guilt feelings, 9. Depressive mood | 4-28 |
| Anergia | 3. Emotional withdrawal, 13. Motor retardation, 16. Blunted affect, 18. Disorientation | 4-28 |
| Thought disturbance | 4. Conceptual disorganization, 8. Grandiosity, 12. Hallucinatory behavior, 15. Unusual thought content | 4-28 |
| Activation | 6. Tension, 7. Mannerisms and posturing, 17. Excitement | 3-21 |
| Hostile-suspiciousness | 10. Hostility, 11. Suspiciousness, 14. Uncooperativeness | 3-21 |
Interpreting the total
The BPRS has no official diagnostic cut-off. The reference most people cite is Leucht et al. (2005), who linked BPRS totals with Clinical Global Impression (CGI) severity ratings from seven drug trials in 1,979 acutely ill patients with schizophrenia.
| CGI severity | Approximate BPRS total |
|---|---|
| Mildly ill | 31 |
| Moderately ill | 41 |
| Markedly ill | 53 |
The calculator only tells you which of these anchors the total sits between. The anchors come from acutely ill patients with prominent positive symptoms, so they do not transfer directly to other groups. Change in the same person, rated under the same conditions, usually tells you more than a single total.
Worked example
These are the ratings loaded by "Fill sample ratings". They are made-up numbers for practice, not a real patient record.
| Item | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | 17 | 18 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Rating | 3 | 4 | 2 | 3 | 2 | 4 | 1 | 2 | 3 | 2 | 4 | 5 | 1 | 2 | 4 | 2 | 1 | 1 |
- Total: 3+4+2+3+2+4+1+2+3+2+4+5+1+2+4+2+1+1 = 46
- Anxiety-depression (items 1, 2, 5, 9): 3+4+2+3 = 12
- Anergia (items 3, 13, 16, 18): 2+1+2+1 = 6
- Thought disturbance (items 4, 8, 12, 15): 3+2+5+4 = 14
- Activation (items 6, 7, 17): 4+1+1 = 6
- Hostile-suspiciousness (items 10, 11, 14): 2+4+2 = 8
The five subscales add back up to 46, which sits between the moderately ill (about 41) and markedly ill (about 53) anchors.
Other versions to watch for
- 0-6 scoring: some forms rate each item 0 (not present) to 6, giving totals of 0-108. With the same items and anchors, that equals the 1-7 total minus 18. This calculator uses 1-7.
- 24-item expanded BPRS (BPRS-E): Lukoff, Nuechterlein and Ventura (1986) added six items. Scored 1-7 it runs from 24 to 168, so its totals cannot be compared directly with 18-item totals.
- Record the version and scoring with the score, for example "18-item, 1-7, total 46/126", so readers know what the number means.
Sources
- Overall JE, Gorham DR. The Brief Psychiatric Rating Scale. Psychological Reports. 1962;10:799-812.
- Guy W. ECDEU Assessment Manual for Psychopharmacology, Revised 1976. Scale 047, BPRS: 18 items rated 1-7, total range 18-126, five-factor composition.
- Leucht S, et al. Clinical implications of Brief Psychiatric Rating Scale scores. British Journal of Psychiatry. 2005;187:366-371.
- Lukoff D, Nuechterlein KH, Ventura J. Manual for the Expanded Brief Psychiatric Rating Scale. Schizophrenia Bulletin. 1986;12:594-602.
Frequently asked questions
What is the BPRS score range?
On the 18-item version scored 1-7, totals run from 18 to 126. A person with no symptoms still scores 18, because every item starts at 1.
What BPRS score counts as severe?
There is no official diagnostic cut-off. Leucht et al. (2005) linked BPRS totals with CGI severity ratings in acute schizophrenia trials: about 31 matched mildly ill, about 41 moderately ill, and about 53 markedly ill. Treat these as reference points for that population only.
How do I score a form that uses 0-6?
With 0-6 scoring the total runs from 0 to 108. If the items and anchors are the same, it equals the 1-7 total minus 18. This calculator uses 1-7, so add 1 to each 0-6 rating before entering it.
How is the 24-item BPRS-E different?
The expanded BPRS by Lukoff, Nuechterlein and Ventura (1986) has 24 items. Scored 1-7 its total runs from 24 to 168, so it cannot be compared directly with 18-item totals. This calculator covers the 18-item version only.
What if an item was not assessed?
The total and interpretation appear only when all 18 items are rated. Entering 1 for a missing item would record it as not present, so leave it unrated in the record. The ECDEU form marks unrated items as 0 (not assessed).
Are my ratings stored anywhere?
No. Everything is calculated in your browser. Ratings are never sent to a server and disappear when you close the page.