CGI-SCH

CLINICAL GLOBAL IMPRESSION SCALE SCHIZOPHRENIA VERSION USERS GUIDE

Developed by: Josep Maria Haro1, Diego Novick2, Susana Ochoa1, Padraig Wright2, Venetsanos Mavreas3, Peter Jones4
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Sant Joan de Du-Serveis de Salut Mental, Sant Boi de L, Barcelona, Spain Eli Lilly and Co, Erl Wood, UK 3 University of Ioannina, Greece 4 University of Cambridge, UK Investigators interested in using this rating scale should contact Josep Maria Haro; Research and Development Unit; Sant Joan de Du-Serveis de Salut Mental; Dr. Antoni Pujades, 42; 08830 Sant Boi de Llobregat (Barcelona); Spain; e-mail : 27652jha@comb.es Reference: Haro JM, Kamath SA, Ochoa S, Novick D, Rele K, Fargas A, Rodriguez MJ, Rele R, Orta J, Kharbeng A, Araya S, Gervin M, Alonso J, Mavreas V, Lavrentzou E, Liontos N, Gregor K, Jones PB. The Clinical Global Impression-Schizophrenia scale: a simple instrument to measure the diversity of symptoms present in schizophrenia. Acta Psychiatr Scand Suppl. 2003 (416):16-23.

1. OVERVIEW The CGI-SCH is a simple measure to assess illness severity and degree of improvement in schizophrenia. The CGI-SCH has been designed to evaluate the different groups of symptoms (positive, negative, cognitive and depressive) that can be present in schizophrenia and the overall severity of the disorder. The CGI-SCH can be used in treatment trials to help assess how effective a particular treatment, or combination of treatments, have been for schizophrenia or for each of its groups of symptoms. When using the CGI-SCH to evaluate the effect of treatments, the CGI-SCH should be evaluated before and after each medication or treatment trial. The scale should be completed after conducting a clinical interview. The ratings should be based, not only in the information from the clinical interview, but also on all other available information.

2. BASIC RATINGS There are two basic ratings and five dimensions for each rating. The basic ratings are: Severity of illness: Rate illness severity in the past week. Degree of change: Rate degree of change (improvement or worsening) compared to the week prior to starting the current treatment.

The dimensions of each rating are: Dimension Positive symptoms Content Represent an abnormal mental functioning (e.g. hallucinations, delusions, bizarre behaviour, grandiosity) Represent a deficit of a mental function that is normally present (e.g. affective flattening, avolition, anhedonia, emotional withdrawal, poor rapport) Sadness, depressed mood or hopelessness. Impaired attention, concentration or memory, conceptual disorganization, difficulty in abstract thinking. Consider severity of symptoms and interference with functioning

Negative symptoms

Depressive symptoms Cognitive symptoms

Overall severity

For the first four ratings (positive, negative, depressive and cognitive symptoms), the assessment should focus on the severity of symptoms only. Additionally, for overall severity rating, both severity of symptoms and interference with functioning should be considered.

3. ANCHOR POINTS Severity of illness

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Normal, not ill Minimally ill

Normal, not at all ill. Few or mild symptoms of illness with effective functioning or very little interference in patients usual and occupational roles.1 Low levels of illness symptoms with little impairment in patients usual social and occupational roles.1 Some prominent symptoms with some interference in the level of daily functioning.1 Significant illness symptoms with very substantial interference in the patient usual roles.1 Very marked illness symptoms. Patient is unable to function in most areas of daily activities.1 Extreme illness symptoms. Patient is completely incapacitated and requires extra care and supervision.1

Mildly ill

Moderately ill

Markedly ill

Severely ill

Among the most severely ill

For positive, negative, depressive and cognitive symptoms, only symptom severity should be assessed.

Degree of improvement

Very much improved

All better or nearly all better; minimal residual symptoms; very good level of functioning; represents a very substantial change.1 Notably better with significant reduction of symptoms, but some symptoms remain; increase in the level of functioning.1 Slightly better with little or no clinically meaningful reduction of symptoms. Represents very little change in basic clinical status, level of care, or functional capacity.1 Symptoms and functioning remain essentially unchanged.1 Slightly worse but not clinically meaningful and represents very little change in basic clinical status or functional capacity. 1 Notably worse with significant increase in symptoms and loss of functioning in several areas of usual social or occupational roles.1 Distinctly worse with severe exacerbation of symptoms and loss of functioning.1 No previous evaluation or no information on previous state.

Much improved

Minimally improved

No change

Minimally worse

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Much worse

Very much worse

Not applicable

When rating degree of improvement, give more weight to the endpoint (i.e., most recent level of symptoms) than to the magnitude of the improvement. For example, if patient is all better, rate change as (1) Very much improved regardless of the initial severity of illness.
For positive, negative, depressive and cognitive symptoms, only symptom severity should be assessed.
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Clinical Global Impression Scale - Schizophrenia Version (CGI-SCH)

I. SEVERITY OF ILLNESS
Considering your total clinical experience with patients with schizophrenia, how severely ill has been the patient during the last week? Normal, not ill 1. POSITIVE Symptoms (e.g. hallucinations, delusions, bizarre behaviour) 2. NEGATIVE Symptoms (e.g. affective flattening, avolition or anhedonia) 3. DEPRESSIVE Symptoms (e.g. sadness, depressed mood or hopelessness) 4. COGNITIVE Symptoms (e.g. impaired attention, concentration or memory) 5. OVERALL SEVERITY 1 Minimally ill 2 Among the Mildly Moderately Markedly Severely most severely ill ill ill ill ill 3 4 5 6 7

II. DEGREE OF CHANGE

Compared to the previous evaluation*, how much the patient has changed? Rate improvement whether or not, in your judgement, is due entirely to treatment. Very much Much Minimally No Minimally improved improved improved Change worse 1. POSITIVE Symptoms (e.g. hallucinations, delusions, bizarre behaviour) 2. NEGATIVE Symptoms (e.g. affective flattening, avolition or anhedonia) 3. DEPRESSIVE Symptoms (e.g. sadness, depressed mood or hopelessness) 4. COGNITIVE Symptoms (e.g. impaired attention, concentration or memory) 5. OVERALL SEVERITY 1 2 3 4 5 Much worse 6 Very much worse 7 N/A 9

* In treatment trials with several evaluation points, use: Compared to the phase immediately preceding this treatment
trial instead of Compared to the previous evaluation