부산대학교 도서관

The earliest forms of psychiatric assessment were based on direct interviews with patients, on reported observations by those who knew the patient, and on direct observations by attendants—later nurses—in the care setting. Attempts to codify these forms of assessment had begun over 90 years ago, as illustrated by the ‘Behavior Chart’ of Kempf. The present range of structured psychiatric assessment methods grew from the 1950s in association with the introduction of neuroleptic medication and the development of psychiatric rehabilitation programmes. The two most frequently used types of systematic and structured assessment used in both clinical practice and research continue to be questionnaires and ratings. Their value lies in the systematic coverage of relevant content, and the potential for comparing scores across individuals and groups and over time. This section covers assessment methods that are appropriate for both self-report by patients and others—questionnaires—and observations and judgements made by others about the patient and their immediate circumstances—rating methods. This section will also briefly describe behavioural approaches to assessment of clinical relevance. Questionnaires offer the respondent a preset range of written questions covering the area of clinical interest, such as depression. The questions are usually completed by marking one of a set of provided response categories (forced-choice questions), but may be completed by the patient writing their own response in free text. Self-report and ‘self-monitoring’ methods are similar to the latter form of questionnaire, in that the patient completes a diary or pre-marked sheets. These are more open-ended, and any associated thoughts of the patient may be included. Self-report measures are used widely in cognitive behavioural interventions. Ratings are judgements about the quality or characteristics of a defined attribute or behaviour, completed subjectively, or on the basis of direct observation of the behaviour in question. While questionnaires are usually self-completed, ratings may be completed by one person with respect to another person. In psychiatric practice, ratings include those made by professional staff, often a nurse or care worker, or by a family member or informal carer, about a patient. Ratings and behavioural measures have a special use in the assessment of disturbed or bizarre behaviour, where the patient may have little insight or knowledge of the nature or degree of their disturbance, which may pose a major ongoing management problem, or a barrier to their placement in the community. An example of such a measure is the Aberrant Behavior Checklist. This is a 58-item behavioural rating scale completed by an informant, with the content covering five subscales: irritability, agitation, and crying; social withdrawal and lethargy; stereotyped behaviour; hyperactivity and non-compliance; and inappropriate speech.