The Factor Structure of the Brief Psychiatric Rating Scale (Expanded Version) in a Sample of Forensic Psychiatric Patients

Abstract

Severe behavioral problems, aggression, unlawful behavior, and uncooperativeness make the forensic psychiatric population both hard to treat and study. To fine-tune treatment and evaluate results, valid measurement is vital. The Brief Psychiatric Rating Scale-Extended (BPRS-E) is a widely used scale for assessing psychiatric symptoms, with a stable factor structure over various patient groups. For the first time, its usefulness for forensic psychiatric patients was studied by means of an exploratory factor analysis on 302 patients in a penitentiary psychiatric center. A five-factor solution fitted the data best and showed large overlap with previous research done in both in- and outpatient populations with schizophrenia and mixed diagnoses. Around 45% of the patients did not fully comply. Items relying most on self-report caused the most non-adherence, possibly because of difficulty with verbalizing distress. These items loaded on the factors psychosis and affect. The BPRS-E is a suitable instrument for forensic use. Future research and clinical practice should focus on alignment with forensic patients to improve measurement, understanding, and eventually therapeutic interventions.

Ethnic variations regarding clinical profiles and symptom representation in prisoners with psychotic disorders

“…Disregarding variations in psychopathology and symptom representation may have an adverse effect on treatment outcome. 50 For example, in research with patients with schizophrenia in regular mental healthcare, more severe hallucinations and delusions have been associated with worse response to treatment. 51 To prevent the risk of recidivism in the already vulnerable group of (untreated) detained psychiatric patients, 52 knowledge regarding differences in symptomatology between ethnic groups is essential when adequately treating forensic patients with psychotic disorders.…”

“…Disregarding variations in psychopathology and symptom representation may have an adverse effect on treatment outcome 50 . For example, in research with patients with schizophrenia in regular mental healthcare, more severe hallucinations and delusions have been associated with worse response to treatment 51 .…”

Ethnic variations in psychotic disorders in the criminal justice system: A systematic review

“…Additionally, psychotic disorders can occur with a multitude of different clinical profiles, which might request different treatment approaches (Van Beek et al, 2014). Nevertheless, none of the described studies compared psychotic disorders on the level of symptom profiles or symptom severity.…”

Checking the Math: Do Restrictive Housing and Mental Health Need Add Up to Psychological Deterioration?

“…This 24-item rating scale hones in on rapidly changing symptoms of serious psychiatric disorder to include “somatic concern,” “anxiety,” “depression,” “suicidality,” “guilt,” “hostility,” “elevated mood,” “grandiosity,” “suspiciousness,” “hallucinations,” “unusual thought content,” “bizarre behavior,” “self-neglect,” “disorientation,” “conceptual disorganization,” “blunted affect,” “emotional withdrawal,” “motor retardation,” “tension,” “uncooperativeness,” “excitement,” “distractibility,” “motor hyperactivity,” and “mannerisms and posturing.” All 24 items are rated on a 7-point scale (1 = not present , 7 = extremely severe ) and the ratings summed to produce a score that can range from 24 to 168. The BPRS has been found to be sensitive to psychological status in incarcerated forensic samples (Greenwood & Burt, 2001; van Beek et al, 2015). Six-month test–retest reliability ranged from .43 to .55 and internal consistency was good when the BPRS was completed during Time Periods 1 (α = .80), 3 (α = .79), and 5 (α = .79) of the current study.…”