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A microcomputer version of the Geriatric Mental State Schedule
Journal of Microcomputer Applications (1984) 7, 385-387
COMMUNICATION
A microcomputer State Schedule
version
of the Geriatric
Mental
J. R. Jones
Greaves Hall Hospital, Banks, nr Southport, PR9 8BP, UK* A version of the Geriatric Mental State Schedule, which is a standardized questionnaire to assess the mental state of the elderly, has been adapted to be administered by microcomputer. The system is described and advantages of the technique are discussed, comparing it with the former pencil-and-paper version of the schedule. The hardware used and software developed are described, and a pilot study, assessing it in use on a small group of patients, is outlined. Further developments of the system are considered.
1.
Introduction
The Geriatric Mental State Schedule (GMS) is a standard psychiatric interview schedule which has been developed for assessing the mental state of the elderly. It was developed by Copeland, Kelleher, Kellet, Gourlay, Gurland, Fleiss & Sharpe (1976), and has been widely used. It consists of 541 items which are rated, and allows classification of patients on the basis of symptom profile. It has been shown to have the advantage of good reliability, both inter-rater and test-retest, and the reliability is improved by using raters who have been trained in its administration. These raters need not necessarily be psychiatrists, but could for instance be social workers. Variations of the original full schedule have been developed which are shorter, take less time to administer, but contain a number of the most essential questions of the full GMS (Copeland, Dewey & Griffiths-Jones, submitted). The present study uses Version A of the GMS, which is a shortened version consisting of 240 items to be rated. This was chosen as it was easier to adapt for small microcomputer than the full GMS, and as it contains the core questions and can be used in screening a population. It is usually administered by a rater who interviews a patient with the aid of a questionnaire, the interviewer asking the standard questions on the questionnaire. The rater then rates the subjects by marking on the form the appropriate response or observation, the ratings being integers less than 10. Absence of a symptom is scored as 0, and the presence of a symptom is scored as 1 or 2, depending on the severity. A score of 8 indicates that there was no appropriate response, and a score of 9 indicates that a question was not asked as it was inappropriate. The interview may be terminated at any stage if the subject is not responding to most questions and it seems pointless to continue. *Present address: Royal Liverpool Hospital, Prescot Street, Liverpool L7 8XP, UK.
0745-7138/84/030385 + 03 $03.00/O
385 0 1984 Academic Press Inc. (London) Limited
386
J. R. Jones
The usual pencil-and-paper version of the GMS (Version A) was adapted for administration by microcomputer, with minor alterations to the original schedule which were needed for ease of administration by microcomputer. Administration by this latter technique has a number of advantages over the previous method. These include ease of administration, automation of certain procedures such as decisions about which groups of questions to include, error checking, improvement in presentation, and finally the results may be sorted on floppy discs. This direct encoding of results eliminates a stage of transcription used with the previous method, i.e. the transfer of results from paper questionnaire to computer, and thus as well as saving time eliminates a stage at which further errors may occur. The direct encoding of results on discs also saves the substantial expense involved in transcription. The results are stored as a file on discs, which is in a form readily accessible for further processing, e.g. by another program on the same computer or transfer to another computer.
2.
Hardware
and software
The program developed for administering the GMS version A by microcomputer is written in Microsoft BASIC and is about 200 program lines long. A separate program is used to prepare and edit the text questions, which are held in a separate text file, and loaded in as variables by the main program. A third program is used to carry out a simple analysis of the results. The microcomputer used is a Tandy TRS-80 Model III, with 48 k of memory, two disc drives and an RS232 interface. The questions are presented individually on the computer’s monitor and the person rating the patient asks the patient the standard questions printed on the screen and types in the patient’s response coded as an integer. Like the paper version, the program allows the rater to stop the interview at any stage and to change the responses recorded by entering the questionnaire at any point. The questionnaire has a branching structure, and certain groups of questions are only asked depending on the response to previous questions. The computer is programmed to carry out this branching automatically, and scores all those questions not answered as 9. On the paper questionnaire the interviewer is told which questions not to ask in a particular case. However, the computer does this branching automatically by calculating the scores of previous questions and deciding whether or not to ask a specific group of questions. For instance if the initial questions in the depression section are scored positively, then a number of other questions on depression are asked. Thus the questionnaire reflects the practice of a clinician, who in interviewing a patient, concentrates on those areas likely to be of relevance.
3.
Studies
The program has been tested on a number of psychogeriatric patients who are attending a Psychogeriatric Day Unit, at Greaves Hall Hospital, Southport. A number of patients with various diagnoses have been interviewed using the prototype microcomputer schedule, to examine its feasibility, and to elimiante any initial design flaws. A reliability
The Geriatric Mental State Schedule
387
study is being carried out to compare the microcomputer version with the pencil-andpaper version. The whole interview takes about 15 to 45 minutes, depending on the type of subject. The interview seems to be facilitated by using a microcomputer, e.g. by not having to be constantly looking down on a piece of paper, but using the video screen as a sort of teleprompter. Also the time taken to interview individual patients could be shortened by using the microcomputer. The results are then stored on floppy discs when the interview has been completed.
4.
Further
developments
The patients’ ratings stored on discs may later be transferred by RS232 interface to a separate minicomputer for further processing by a diagnostic system for the GMS called AGECAT, which is currently being developed by Copeland, Dewey & Griffiths-Jones. AGECAT is a method of arriving at standardized diagnostic categories from the results of the GMS. Alternatively the results could be analysed by a diagnostic program running on the same microcomputer. Further studies are planned in the community as part of an ongoing study of a sample of the geriatric population of Liverpool. This is facilitated by the advent of small portable microcomputers of sufficient power, which can be used to administer the computer version of the GMS in the community. The GMS program will thus aid the rapid screening of a geriatric population for mental illness.
References Copeland, J. R. M., Dewey, M. E. & Griffith+Jones, H. G. The Geriatric Mental State Schedule: Further development and the development of a computerised diagnostic system. Submitted to Psychological Medicine.
Copeland, J. R. M., Kelleher, M. J., Kellet, J. M., Gourlay, A. J., Gurland, B. J., Fleiss, J. L. & Sharpe, L. 1976. A semi-structured clinical interview for the assessment of diagnosis and mental state in the elderly: the Geriatric Mental State Schedule. Psychological Medicine, 6, 43949. Jefiey Jones was born in North Wales in 195 1. He studied art at the Camberwell School of Art & Crafts, London, from 1969 to 1973. He trained in medicine at the Welsh National School of Medicine, Cardiff, and qualified in 1978. Following one year of houseposts in Wales, he specialized in psychiatry, and has worked in North Wales and London. He has been a senior registrar in psychiatry in the Mersey Region since 1983.
COMMUNICATION
A microcomputer State Schedule
version
of the Geriatric
Mental
J. R. Jones
Greaves Hall Hospital, Banks, nr Southport, PR9 8BP, UK* A version of the Geriatric Mental State Schedule, which is a standardized questionnaire to assess the mental state of the elderly, has been adapted to be administered by microcomputer. The system is described and advantages of the technique are discussed, comparing it with the former pencil-and-paper version of the schedule. The hardware used and software developed are described, and a pilot study, assessing it in use on a small group of patients, is outlined. Further developments of the system are considered.
1.
Introduction
The Geriatric Mental State Schedule (GMS) is a standard psychiatric interview schedule which has been developed for assessing the mental state of the elderly. It was developed by Copeland, Kelleher, Kellet, Gourlay, Gurland, Fleiss & Sharpe (1976), and has been widely used. It consists of 541 items which are rated, and allows classification of patients on the basis of symptom profile. It has been shown to have the advantage of good reliability, both inter-rater and test-retest, and the reliability is improved by using raters who have been trained in its administration. These raters need not necessarily be psychiatrists, but could for instance be social workers. Variations of the original full schedule have been developed which are shorter, take less time to administer, but contain a number of the most essential questions of the full GMS (Copeland, Dewey & Griffiths-Jones, submitted). The present study uses Version A of the GMS, which is a shortened version consisting of 240 items to be rated. This was chosen as it was easier to adapt for small microcomputer than the full GMS, and as it contains the core questions and can be used in screening a population. It is usually administered by a rater who interviews a patient with the aid of a questionnaire, the interviewer asking the standard questions on the questionnaire. The rater then rates the subjects by marking on the form the appropriate response or observation, the ratings being integers less than 10. Absence of a symptom is scored as 0, and the presence of a symptom is scored as 1 or 2, depending on the severity. A score of 8 indicates that there was no appropriate response, and a score of 9 indicates that a question was not asked as it was inappropriate. The interview may be terminated at any stage if the subject is not responding to most questions and it seems pointless to continue. *Present address: Royal Liverpool Hospital, Prescot Street, Liverpool L7 8XP, UK.
0745-7138/84/030385 + 03 $03.00/O
385 0 1984 Academic Press Inc. (London) Limited
386
J. R. Jones
The usual pencil-and-paper version of the GMS (Version A) was adapted for administration by microcomputer, with minor alterations to the original schedule which were needed for ease of administration by microcomputer. Administration by this latter technique has a number of advantages over the previous method. These include ease of administration, automation of certain procedures such as decisions about which groups of questions to include, error checking, improvement in presentation, and finally the results may be sorted on floppy discs. This direct encoding of results eliminates a stage of transcription used with the previous method, i.e. the transfer of results from paper questionnaire to computer, and thus as well as saving time eliminates a stage at which further errors may occur. The direct encoding of results on discs also saves the substantial expense involved in transcription. The results are stored as a file on discs, which is in a form readily accessible for further processing, e.g. by another program on the same computer or transfer to another computer.
2.
Hardware
and software
The program developed for administering the GMS version A by microcomputer is written in Microsoft BASIC and is about 200 program lines long. A separate program is used to prepare and edit the text questions, which are held in a separate text file, and loaded in as variables by the main program. A third program is used to carry out a simple analysis of the results. The microcomputer used is a Tandy TRS-80 Model III, with 48 k of memory, two disc drives and an RS232 interface. The questions are presented individually on the computer’s monitor and the person rating the patient asks the patient the standard questions printed on the screen and types in the patient’s response coded as an integer. Like the paper version, the program allows the rater to stop the interview at any stage and to change the responses recorded by entering the questionnaire at any point. The questionnaire has a branching structure, and certain groups of questions are only asked depending on the response to previous questions. The computer is programmed to carry out this branching automatically, and scores all those questions not answered as 9. On the paper questionnaire the interviewer is told which questions not to ask in a particular case. However, the computer does this branching automatically by calculating the scores of previous questions and deciding whether or not to ask a specific group of questions. For instance if the initial questions in the depression section are scored positively, then a number of other questions on depression are asked. Thus the questionnaire reflects the practice of a clinician, who in interviewing a patient, concentrates on those areas likely to be of relevance.
3.
Studies
The program has been tested on a number of psychogeriatric patients who are attending a Psychogeriatric Day Unit, at Greaves Hall Hospital, Southport. A number of patients with various diagnoses have been interviewed using the prototype microcomputer schedule, to examine its feasibility, and to elimiante any initial design flaws. A reliability
The Geriatric Mental State Schedule
387
study is being carried out to compare the microcomputer version with the pencil-andpaper version. The whole interview takes about 15 to 45 minutes, depending on the type of subject. The interview seems to be facilitated by using a microcomputer, e.g. by not having to be constantly looking down on a piece of paper, but using the video screen as a sort of teleprompter. Also the time taken to interview individual patients could be shortened by using the microcomputer. The results are then stored on floppy discs when the interview has been completed.
4.
Further
developments
The patients’ ratings stored on discs may later be transferred by RS232 interface to a separate minicomputer for further processing by a diagnostic system for the GMS called AGECAT, which is currently being developed by Copeland, Dewey & Griffiths-Jones. AGECAT is a method of arriving at standardized diagnostic categories from the results of the GMS. Alternatively the results could be analysed by a diagnostic program running on the same microcomputer. Further studies are planned in the community as part of an ongoing study of a sample of the geriatric population of Liverpool. This is facilitated by the advent of small portable microcomputers of sufficient power, which can be used to administer the computer version of the GMS in the community. The GMS program will thus aid the rapid screening of a geriatric population for mental illness.
References Copeland, J. R. M., Dewey, M. E. & Griffith+Jones, H. G. The Geriatric Mental State Schedule: Further development and the development of a computerised diagnostic system. Submitted to Psychological Medicine.
Copeland, J. R. M., Kelleher, M. J., Kellet, J. M., Gourlay, A. J., Gurland, B. J., Fleiss, J. L. & Sharpe, L. 1976. A semi-structured clinical interview for the assessment of diagnosis and mental state in the elderly: the Geriatric Mental State Schedule. Psychological Medicine, 6, 43949. Jefiey Jones was born in North Wales in 195 1. He studied art at the Camberwell School of Art & Crafts, London, from 1969 to 1973. He trained in medicine at the Welsh National School of Medicine, Cardiff, and qualified in 1978. Following one year of houseposts in Wales, he specialized in psychiatry, and has worked in North Wales and London. He has been a senior registrar in psychiatry in the Mersey Region since 1983.