THE BRIEF PSYCHIATRIC RATING SCALE SYSTEM

1. THE BRIEF PSYCHIATRIC RATING SCALE SYSTEM Senior Project by John Newman

2. The Brief Psychiatric Rating Scale System • Purposes: • 1) To process B.P.R. Scale scores • 2) To provide a diagnosis • 3) To chart an individual’s psychiatric progress • 4) To provide treatment population stats

3. The Design Objectives • 1) Build a SQL/Access database. • 2) Build a Visual Basic 6 "front end" with functionality described below. • 3) Install this application in Window 98 operating system.

4. Functionality • The software will provide input boxes for relevant treatment factors for a recipient of services in the MORC, Inc., treatment program. • Takes input from option boxes in a "pop-up" user entry grid for the 20 scores of the Brief Psychiatric Rating Scale (BPRS ) that range from 1 to 7. • Process these scores for each individual displaying the total BPRS score, sub scale scores, and a single-point graph of the diagnostic profile.

5. Functionality (continued) • Describes the general severity of symptoms in the words; "Mild", "Moderate" or "Severe", according to the total Brief Psychiatric Rating Scale (BPRS) score. • The VB 6 front end highlights and explains the Diagnostic Statistical Manual diagnosis that most closely corresponds to the individual's graphed diagnosis. The explanation will be done by means of text displayed below the diagnosis to which the mouse is pointing. • The software will have the capability of comparing the individuals' single-point plot to the plots of the diagnoses. It will also allow the user to compare several evaluation points on the same screen. These points will be connected by lines to chart an individual's psychiatric progress.

6. Error Reduction • The user's access to various parts of the program will be limited during certain “machine states” such as editing and saving, in order to reduce user error. This will be accomplished by enabling or disabling menu items depending on the edit mode. • The user is required to complete all associated data before being allowed to save an evaluation, thereby obtaining a relatively complete picture of the person’s life factors and maintaining data integrity. Method: The database checks the medication, symptom qualifiers, and staff intervention tables for entries associated with the multiple key index of Case Number and Profile Number. These tables have one-to-one relationships with the BPRS evaluation tables.

7. Connectivity • The connectivity will be MS Jet OLEDB.3.51 for Access 97. The program utilizes ActiveX Data Objects in the form of ADO Data Controls. • The plan is to allow connectivity to other types of databases by enabling selection of database provider.

8. The Brief Psychiatric Rating Scale SystemTest Cases (1 - 3) • 1) A password entry box will appear that requires the user to enter a password to access the database. • 2) When the program begins, the first diagnostic point will be graphed for the first person’s data. • 3) The single-point graph that represents an individual's symptom profile appears on the same graph as the standard diagnoses plots.

9. Test Cases (4 - 5) • 4) The software determines the standard diagnostic point that is closest to the plot of the individual's symptom profile. It highlights, with bold font at the right of the graph, the diagnosis from the psychiatric Diagnostic Statistical Manual (D.S.M.), that corresponds to that closest diagnostic reference point. • 5) After pointing the mouse on the DSM diagnosis, the user will see "help" text displayed that describes the symptoms associated with that diagnosis according to the D.S.M.

10. Test cases (6 - 7) • 6) There is a toggle button on the BPRS Profiles screen that gives the user the option of selecting sequential graphing of several evaluations on the same graph versus graphing a single evaluation at one time. The user will be able to graph sequential profiles on the same graph without connecting them with lines. • 7) During the sequential graphing, the user has the option via a second toggle button to "connect the dots", thereby displaying the progress over more than one evaluation. The user will be able to graph sequential profiles on the same graph and “connect the dots.”

11. Test Cases (8 - 10) • 8) The user can see the words "Mild", "Moderate" or "Severe" displayed, when the total BPRS score is calculated. (i.e. This is a one-word verbal description of the individual's total BPRS score based on certain ranges.) • 9) The user will be able to see approximately according to a progress bar, how far the user has moved through the database. • 10) The user will be able to see exactly the relative position in the database of the row being displayed by words such as “5 of 17” in a label.

12. Test Cases (11 - 14) • 11) The records will be ordered alphabetically by last name and then by increasing profile number. • 12) The user will be able to edit records, e.g., the user can update the individual's name. (I.e., This is needed if it was spelled incorrectly when entered initially.) • 13) When the user is in record Edit or Add New record mode, the editable boxes will change color. • 14) In Add New mode, the user will be limited from accessing all menu items.

13. Test Cases (15 - 17) • 15) The user will be required to enter symptom qualifier data, staff interventions data, and medication data to accompany the BPRS evaluation profile. • 16) The user will be able to delete a record. • 17) The user will be able to select from one of a list of English descriptions of SQL queries that will be listed in a drop down box. After clicking the “Run Standard Query button”, the user will be able to see the query, that he/she selected, appear in the Ad Hoc Query text box in SQL. (I.e., The software provides this edit feature in the Ad Hoc query box to facilitate changing of the date range or other selection criteria.)

14. Test Cases (18 - 20) • 18) The user will see the results of the query in the Query Results Grid. • 19) The user can perform then ad hoc SQL queries of the database by editing the text in the Ad Hoc Query text box. The user can clear the text in the Ad Hoc query box, type a new ad hoc query, and obtain the results by clicking the “Run Ad Hoc Query” button. • 20) The user will be able to see in the “Record Count” box a count of the number of rows returned by the query.

15. SUMMARY Value to Scientific Inquiry • This software enables within a relational database for the first time a detailed analysis of how level of staffing, the medications, the type of day program interventions, a person’s physical problems, and their personality disorders /Axis 2 diagnosis affect progress. • It also allows one to analysis the relative health or illness of the treatment population over time.

16. Unique Attributes • The author took a creative approach engineering solutions with functions such as a Distance Finder to determine the closest, reference diagnostic point to the individual’s graph. • The software conveys with a simple graphical display the changes in a person’s psychiatric condition.

17. Robustness • In many places, the software prohibits user impairment of program operation by: • 1) Validating input • 2) Facilitating correct user input with default suggestions • 3) Controlling access of user to only those areas needed during specific operations

18. New Technology • Utilizes Microsoft’s ActivX Data Objects(ADO) primarily in the form of Activx Data Object Data Control (ADODC), which makes this program amenable to development as a web-based program with OLEDB connectivity.

19. Extraordinary Experience Utilized in the Development • The author utilized 20 years of masters level clinical background in psychiatric social work, knowledge of statistics obtained as part of Masters in Social Work and a Bachelors in Psychology, as well as statistics studied in chemical quantitative analysis in making this program. His extensive contacts in the field of psychiatry and his own clinical experience were extremely valuable in facilitating clinically relevant functionality.

20. The End