SCAN

Last updated

Schedules for Clinical Assessment in Neuropsychiatry (SCAN) is a set of tools created by WHO aimed at diagnosing and measuring mental illness that may occur in adult life. It is not constructed explicitly for use with either ICD-10 or DSM-IV but can be used for both systems. The SCAN system was originally called PSE, or Present State Examination, but since version 10 (PSE-10), the commonly accepted name has been SCAN. The current version of SCAN is 2.1.

Contents

Interview items

The entire SCAN interview consists of 1,872 items, spread out over 28 sections. Most patients, however, will only need parts of the interview, and it is assessed in the beginning of each section if the section is actually relevant. The sections are as follows:

Section 0 - Face sheet and sociodemographic items

The first section in the SCAN interview is concerned with sociodemographic items such as age, gender, education, etc.

Section 1 - Beginning the Interview

In section 1 (the second section), the interviewer starts to ask the respondent or patient about what kinds of symptoms has been experienced. This section is not used in diagnosis, but it is intended as a help for the interviewer to determine which items in the interview to emphasize on. As such, it is a screening tool for part 1 of the interview (sections 2 to 13).

Section 2 - Somatoform and dissociative symptoms

Section 2 is primarily centered on somatoform and dissociative symptoms and is rated both by using direct questions and by observing the patient.

Section 3 - Worrying, tension, etc.

Section 3 explores the degree of worrying and tension in the patient, by direct questions about feelings of worrying, nervous tension, muscular tension, fatiguability, noise sensitivity, etc.

Section 4 - Panic, Anxiety and phobias

Section 4 measures the degree and physiological reactions associated with potential anxiety attacks and phobias, including behaviour in which situations are avoided due to phobias. Fear of dying and generalized anxiety disorder are also measured.

Section 5 - Obsessional symptoms

Section 5 explores, by direct questions, whether the respondent experiences behaviour characteristic of OCD.

Section 6 - Depressed mood and ideation

Section 6 measures, by direct questions, whether the respondent is depressed, by items relating to feeling low, uncontrolled crying, anhedonia, loss of feeling, suicidal tendencies, social withdrawal, insomnia or hypersomnia, dysthymia, etc.

Section 7 - Thinking, concentration, energy, interest

Section 7 measures cognitive functioning through direct questions about concentration, loss of interests or drive, and being overwhelmed by everyday tasks.

Section 8 - Bodily functions

Section 8 asks direct questions about weight and weight gain or loss, appetite, sleep patterns, and libido.

Section 9 - Eating disorders

Section 9 aims to diagnose eating disorders such as bulimia and anorexia nervosa.

Section 10 - Expansive mood and ideation

Section 10 measures whether the respondent experiences euphoria or abnormally elevated mood (mania), which can be used in diagnosing, for instance, bipolar disorders.

Section 11 - Use of alcohol

Section 11 measures, through direct questions, amounts of alcoholic beverages consumed and social, legal, physical, and other problems related to alcohol use.

Section 12 - Use of psychoactive substances other than alcohol

Section 12 measures, again through direct questions, the same as section 11, only relating to prescription drugs, illicit drugs, and nicotine.

Section 13 - Interference and attributions for part one

This section is rated by the interviewer based on the clinical picture of the interview and the patient in general, and is thus not completed by using direct questions.

Section 14 - Screen for items in part two

Just like section 1, section 14 is used for screening the existence of symptoms, in this case for part 2 of the SCAN interview which focuses on psychotic symptoms.

Section 15 - Language problems at examination

In this section, the interviewer rates the existence of any language problems that makes conducting the interview impossible. Many of the other sections provide options for rating that assessment of individual items is impossible because of the presence of language problems recorded in section 15.

Section 16 - Perceptual disorders other than hallucinations

Section 16 measures, through direct questions, whether non-hallucinatory perceptual disorders are present. These may present themselves by the respondents stating to have experiences of their surroundings being distorted, or unreal (derealization), or that they themselves are not real, but more like characters in a play (depersonalization). Experiences such as believing that one's reflection is unrecognizable, or that one's appearance has been changed, are also rated here.

Section 17 - Hallucinations

In this section, the respondent is asked about the experience of hallucinations, be they visual, auditory (verbal or non-verbal), olfactory, tactile, or sexual.

Section 18 - Experiences of thought interference and replacement of will

Section 18 measures the existence and type of thought interference. These include the respondents' thoughts being read, loud (i.e. having voice-like sound), echoing, being broadcast, or even stolen. Experiences of thought being inserted into the respondents' minds are also rated here, as is the experience of thought stopping, involuntarily, as suddenly as a TV becoming unplugged. Alternate lines of thought, that don't belong to the respondent but that comment on the respondents thoughts, are rated as well. So is the experience of external forces (e.g. other people) controlling the respondents' will, voice, handwriting, actions, or affect.

Section 19 - Delusions

Delusions of being spied upon, and other paranoid delusions, are rated by direct questions in this section. Other types of delusions covered in this section include others not being who they claim to be, that people close to the respondent have been replaced with lookalikes, and delusions of conspiracy. Furthermore, hypochondrial delusions, and grandiose delusions, etc., are rated by the interviewer.

Section 20 - Further information for classification of Part 2 symptoms

This section is fully rated by the interviewer after the interview, and deals with aspects of duration and course of schizophrenia and psychosis and other symptoms rated in part 2 of the SCAN interview.

Section 21 - Cognitive impairment and decline

This section consists of a series of tests to be conducted by the respondent to establish the presence of cognitive impairment such as dementia. The majority of the section consists of a Mini-Mental State Examination (MMSE). This includes testing the respondents' ability to know where they are, what the date and year is, to remember words, to follow instructions, attention, and concentration.

Section 22 - Motor and behavioral items

This section is rated by the interviewer based on observing the respondents, or consulting their medical charts. A variety of items are assessed, including underactivity, stupor, distractibility, agitation, ambitendence, echopraxia, embarrassing or bizarre behavior, histrionic behavior, self injury, hoarding of objects, and a variety of negative symptoms.

See also

Related Research Articles

Mania, also known as manic syndrome, is a mental and behavioral disorder defined as a state of abnormally elevated arousal, affect, and energy level, or "a state of heightened overall activation with enhanced affective expression together with lability of affect." During a manic episode, an individual will experience rapidly changing emotions and moods, highly influenced by surrounding stimuli. Although mania is often conceived as a "mirror image" to depression, the heightened mood can be either euphoric or dysphoric. As the mania intensifies, irritability can be more pronounced and result in anxiety or anger.

Specific phobia is an anxiety disorder, characterized by an extreme, unreasonable, and irrational fear associated with a specific object, situation, or concept which poses little or no actual danger. Specific phobia can lead to avoidance of the object or situation, persistence of the fear, and significant distress or problems functioning associated with the fear. A phobia can be the fear of anything.

A delusion is a false fixed belief that is not amenable to change in light of conflicting evidence. As a pathology, it is distinct from a belief based on false or incomplete information, confabulation, dogma, illusion, hallucination, or some other misleading effects of perception, as individuals with those beliefs are able to change or readjust their beliefs upon reviewing the evidence. However:

<span class="mw-page-title-main">Delusional disorder</span> Mental illness featuring beliefs with inadequate grounding

Delusional disorder is a mental illness in which a person has delusions, but with no accompanying prominent hallucinations, thought disorder, mood disorder, or significant flattening of affect. Delusions are a specific symptom of psychosis. Delusions can be bizarre or non-bizarre in content; non-bizarre delusions are fixed false beliefs that involve situations that could occur in real life, such as being harmed or poisoned. Apart from their delusion or delusions, people with delusional disorder may continue to socialize and function in a normal manner and their behavior does not necessarily generally seem odd. However, the preoccupation with delusional ideas can be disruptive to their overall lives.

<span class="mw-page-title-main">Thought disorder</span> Disorder of thought form, content or stream

A thought disorder (TD) is a disturbance in cognition which affects language, thought and communication. Psychiatric and psychological glossaries in 2015 and 2017 identified thought disorders as encompassing poverty of ideas, neologisms, paralogia, word salad, and delusions - all disturbances of thought content and form. Two specific terms have been suggested — content thought disorder (CTD) and formal thought disorder (FTD). CTD has been defined as a thought disturbance characterized by multiple fragmented delusions, and the term thought disorder is often used to refer to an FTD: a disruption of the form of thought. Also known as disorganized thinking, FTD results in disorganized speech and is recognized as a major feature of schizophrenia and other psychoses. Disorganized speech leads to an inference of disorganized thought. Thought disorders include derailment, pressured speech, poverty of speech, tangentiality, verbigeration, and thought blocking. One of the first known cases of thought disorders, or specifically OCD as we know it today, was in 1691. John Moore, who was a bishop, had a speech in front of Queen Mary II, about "religious melancholy."

<span class="mw-page-title-main">Claustrophobia</span> Medical condition

Claustrophobia is the fear of confined spaces. It can be triggered by many situations or stimuli, including elevators, especially when crowded to capacity, windowless rooms, and hotel rooms with closed doors and sealed windows. Even bedrooms with a lock on the outside, small cars, and tight-necked clothing can induce a response in those with claustrophobia. It is typically classified as an anxiety disorder, which often results in panic attacks. The onset of claustrophobia has been attributed to many factors, including a reduction in the size of the amygdala, classical conditioning, or a genetic predisposition to fear small spaces.

Ganser syndrome is a rare dissociative disorder characterized by nonsensical or wrong answers to questions and other dissociative symptoms such as fugue, amnesia or conversion disorder, often with visual pseudohallucinations and a decreased state of consciousness. The syndrome has also been called nonsense syndrome, balderdash syndrome, syndrome of approximate answers, hysterical pseudodementia or prison psychosis.

The mental status examination (MSE) is an important part of the clinical assessment process in neurological and psychiatric practice. It is a structured way of observing and describing a patient's psychological functioning at a given point in time, under the domains of appearance, attitude, behavior, mood and affect, speech, thought process, thought content, perception, cognition, insight, and judgment. There are some minor variations in the subdivision of the MSE and the sequence and names of MSE domains.

Depersonalization-derealization disorder is a mental disorder in which the person has persistent or recurrent feelings of depersonalization and/or derealization. Depersonalization is described as feeling disconnected or detached from one's self. Individuals may report feeling as if they are an outside observer of their own thoughts or body, and often report feeling a loss of control over their thoughts or actions. Derealization is described as detachment from one's surroundings. Individuals experiencing derealization may report perceiving the world around them as foggy, dreamlike/surreal, or visually distorted.

Personality Assessment Inventory (PAI), developed by Leslie Morey, is a self-report 344-item personality test that assesses a respondent's personality and psychopathology. Each item is a statement about the respondent that the respondent rates with a 4-point scale. It is used in various contexts, including psychotherapy, crisis/evaluation, forensic, personnel selection, pain/medical, and child custody assessment. The test construction strategy for the PAI was primarily deductive and rational. It shows good convergent validity with other personality tests, such as the Minnesota Multiphasic Personality Inventory and the Revised NEO Personality Inventory.

The Positive and Negative Syndrome Scale (PANSS) is a medical scale used for measuring symptom severity of patients with schizophrenia. It was published in 1987 by Stanley Kay, Lewis Opler, and Abraham Fiszbein. It is widely used in the study of antipsychotic therapy. The scale is known as the "gold standard" that all assessments of psychotic behavioral disorders should follow.

An auditory hallucination, or paracusia, is a form of hallucination that involves perceiving sounds without auditory stimulus. While experiencing an auditory hallucination, the affected person would hear a sound or sounds which did not come from the natural environment.

Bipolar II disorder (BP-II) is a mood disorder on the bipolar spectrum, characterized by at least one episode of hypomania and at least one episode of major depression. Diagnosis for BP-II requires that the individual must never have experienced a full manic episode. Otherwise, one manic episode meets the criteria for bipolar I disorder (BP-I).

Childhood schizophrenia is similar in characteristics of schizophrenia that develops at a later age, but has an onset before the age of 13 years, and is more difficult to diagnose. Schizophrenia is characterized by positive symptoms that can include hallucinations, delusions, and disorganized speech; negative symptoms, such as blunted affect and avolition and apathy, and a number of cognitive impairments. Differential diagnosis is problematic since several other neurodevelopmental disorders, including autism spectrum disorder, language disorder, and attention deficit hyperactivity disorder, also have signs and symptoms similar to childhood-onset schizophrenia.

<span class="mw-page-title-main">Cotard's syndrome</span> Delusion that one is dead or non-existent

Cotard's syndrome, also known as Cotard's delusion or walking corpse syndrome, is a rare mental disorder in which the affected person holds the delusional belief that they are dead, do not exist, are putrefying, or have lost their blood or internal organs. Statistical analysis of a hundred-patient cohort indicated that denial of self-existence is present in 45% of the cases of Cotard's syndrome; the other 55% of the patients presented with delusions of immortality.

Driving phobia, driving anxiety, vehophobia, amaxophobia or driving-related fear (DRF) is a pathological fear of driving. It is an intense, persistent fear of participating in car traffic that affects a person's lifestyle, including aspects such as an inability to participate in certain jobs due to the pathological avoidance of driving. The fear of driving may be triggered by specific driving situations, such as expressway driving or dense traffic. Driving anxiety can range from a mild cautious concern to a phobia.

The relationship between religion and schizophrenia is of particular interest to psychiatrists because of the similarities between religious experiences and psychotic episodes; religious experiences often involve auditory and/or visual phenomena, and those with schizophrenia commonly report hallucinations and delusions that may resemble the events found within a religious experience. In general, religion has been found to have "both a protective and a risk increasing effect" for schizophrenia.

The Hamilton Anxiety Rating Scale (HAM-A) is a psychological questionnaire used by clinicians to rate the severity of a patient's anxiety. Anxiety can refer to things such as "a mental state...a drive...a response to a particular situation…a personality trait...and a psychiatric disorder." Though it was one of the first anxiety rating scales to be published, the HAM-A remains widely used by clinicians. It was originally published by Max Hamilton in 1959. For clinical purposes, and the purpose of this scale, only severe or improper anxiety is attended to. This scale is considered a "clinical rating" of the extensiveness of anxiety, and is intended for individuals that are "already diagnosed with anxiety neurosis."

The delayed-maturation theory of obsessive–compulsive disorder suggests that obsessive–compulsive disorder (OCD) can be caused by delayed maturation of the frontal striatal circuitry or parts of the brain that make up the frontal cortex, striatum, or integrating circuits. Some researchers suspect that variations in the volume of specific brain structures can be observed in children that have OCD. It has not been determined if delayed-maturation of this frontal circuitry contributes to the development of OCD or if OCD is the ailment that inhibits normal growth of structures in the frontal striatal, frontal cortex, or striatum. However, the use of neuroimaging has equipped researchers with evidence of some brain structures that are consistently less adequate and less matured in patients diagnosed with OCD in comparison to brains without OCD. More specifically, structures such as the caudate nucleus, volumes of gray matter, white matter, and the cingulate have been identified as being less developed in people with OCD in comparison to individuals that do not have OCD. However, the cortex volume of the operculum (brain) is larger and OCD patients are also reported to have larger temporal lobe volumes; which has been identified in some women patients with OCD. Further research is needed to determine the effect of these structural size differences on the onset and degree of OCD and the maturation of specific brain structures.

<span class="mw-page-title-main">Kiddie Schedule for Affective Disorders and Schizophrenia</span>

The Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) is a semi-structured interview aimed at early diagnosis of affective disorders such as depression, bipolar disorder, and anxiety disorder. There are different versions of the test that have use different versions of diagnostic criteria, cover somewhat different diagnoses and use different rating scales for the items. All versions are structured to include interviews with both the child and the parents or guardians, and all use a combination of screening questions and more comprehensive modules to balance interview length and thoroughness.

References