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Piersma, Harry L.; Boes, Janna L.

doi:10.1023/a:1022413110345

Cited by 79 publications

(14 citation statements)

References 4 publications

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“…The Global Assessment of Functioning (GAF) is known worldwide, has been translated into many languages, and used in many outcome studies [1-3]. In the US, GAF is used for all patients receiving mental health care in the Veterans Health Administration system [4-8].…”

Section: Introductionmentioning

confidence: 99%

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Global Assessment of Functioning (GAF): properties and frontier of current knowledge

2010

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BackgroundGlobal Assessment of Functioning (GAF) is well known internationally and widely used for scoring the severity of illness in psychiatry. Problems with GAF show a need for its further development (for example validity and reliability problems). The aim of the present study was to identify gaps in current knowledge about properties of GAF that are of interest for further development. Properties of GAF are defined as characteristic traits or attributes that serve to define GAF (or may have a role to define a future updated GAF).MethodsA thorough literature search was conducted.ResultsA number of gaps in knowledge about the properties of GAF were identified: for example, the current GAF has a continuous scale, but is a continuous or categorical scale better? Scoring is not performed by setting a mark directly on a visual scale, but could this improve scoring? Would new anchor points, including key words and examples, improve GAF (anchor points for symptoms, functioning, positive mental health, prognosis, improvement of generic properties, exclusion criteria for scoring in 10-point intervals, and anchor points at the endpoints of the scale)? Is a change in the number of anchor points and their distribution over the total scale important? Could better instructions for scoring within 10-point intervals improve scoring? Internationally, both single and dual scales for GAF are used, but what is the advantage of having separate symptom and functioning scales? Symptom (GAF-S) and functioning (GAF-F) scales should score different dimensions and still be correlated, but what is the best combination of definitions for GAF-S and GAF-F? For GAF with more than two scales there is limited empirical testing, but what is gained or lost by using more than two scales?ConclusionsIn the history of GAF, its basic properties have undergone limited changes. Problems with GAF may, in part, be due to lack of a research programme testing the effects of different changes in basic properties. Given the widespread use, research-based development of GAF has not been especially strong. Further research could improve GAF.

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Section: Introductionmentioning

confidence: 99%

“…Overall reliability can be good, but is lower in the routine clinical setting [3,13,15,25-27]. Concurrent validity [1,2,4,8,10,17,25,26,28-34] and predictive validity [8,9,15,17,29,35,36] are more problematic. There are few empirical results for GAF sensitivity [37].…”

Section: Introductionmentioning

confidence: 99%

Global Assessment of Functioning (GAF): properties and frontier of current knowledge

2010

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“…It is assumed that the GAF-S and GAF-F are comparable scales [16,27], so recording only the most severe of the GAF-S and GAF-F scores is in accordance with the general principle of using the most severe condition as the overall score [16]; however, the difference between the two scales is disregarded so it is not clear which factor of symptoms and functioning is being measured [52]. An alternative could be to record the average of symptoms and functioning levels [72], but this raises the question of whether or not symptoms and functioning have equal weight, and the importance of any weighting effect [73]. Although the values on each scale may be close [29], symptoms and functioning are different aspects of patient condition and they do not necessarily vary together [23], so in some countries a dual-scale GAF is used where both GAF-S and GAF-F are recorded [13].…”

Section: Resultsmentioning

confidence: 99%

“…For GAF to have such a broad range of applications, it must be good enough for the purpose. It is important not to simply dismiss GAF because of problems concerning either the instrument itself [13] or guidelines; existing scales can be dismissed too lightly [72]. …”

Section: Discussionmentioning

confidence: 99%

Guidelines for rating Global Assessment of Functioning (GAF)

2011

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BackgroundGlobal Assessment of Functioning (GAF) is a scoring system for the severity of illness in psychiatry. It is used clinically in many countries, as well as in research, but studies have shown several problems with GAF, for example concerning its validity and reliability. Guidelines for rating are important. The present study aimed to identify the current status of guidelines for rating GAF, and relevant factors and gaps in knowledge for the development of improved guidelines.MethodsA thorough literature search was conducted.ResultsFew studies of existing guidelines have been conducted; existing guidelines are short; and rating has a subjective element. Seven main categories were identified as being important in relation to further development of guidelines: (1) general points about guidelines for rating GAF; (2) introduction to guidelines, with ground rules; (3) starting scoring at the top, middle or bottom level of the scale; (4) scoring for different time periods and of different values (highest, lowest or average); (5) the finer grading of the scale; (6) different guidelines for different conditions; and (7) different languages and cultures. Little information is available about how rules for rating are understood by different raters: the final score may be affected by whether the rater starts at the top, middle or bottom of the scale; there is little data on which value/combination of GAF values to record; guidelines for scoring within 10-point intervals are limited; there is little empirical information concerning the suitability of existing guidelines for different conditions and patient characteristics; and little is known about the effects of translation into different languages or of different cultural understanding.ConclusionsFew studies have dealt specifically with guidelines for rating GAF. Current guidelines for rating GAF are not comprehensive, and relevant points for new guidelines are presented. Theoretical and empirical studies, and international expert panels would be valuable, as well as production of a manual with more information about scoring. Computerised assessment may well be the future.

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“…The GAF is a method for representing a clinician’s judgment of a patient’s overall level of psychosocial functioning [15]. The GAF requires a clinician to make an overall judgment about a patient’s current psychological, social, and occupational functioning.…”

Section: Methodsmentioning

confidence: 99%

Efficacy and tolerability of quetiapine versus haloperidol in first-episode schizophrenia: a randomized clinical trial

Amr¹,

Lakhan²,

Sanhan³

et al. 2013

Int Arch Med

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BackgroundSchizophrenia is a chronic disease of global importance. The second-generation antipsychotic quetiapine has a favorable side-effect profile, however, its clinical effectiveness has been called into question when compared with first-generation antipsychotics such as haloperidol. This study evaluates the efficacy and tolerability of quetiapine versus haloperidol for first-episode schizophrenia in the outpatient setting.Methods156 adult patients with first-episode schizophrenia participated in an outpatient clinical trial and were randomized to quetiapine (200 mg/d; n = 78) or haloperidol (5 mg/d; n = 78). The study medications were titrated to a mean daily dose of 705 mg for quetiapeine and 14 mg for haloperidol. The patients were assessed at baseline, six weeks, and twelve weeks. The primary outcome measures were positive and negative scores of the Positive and Negative Syndrome Scale (PANSS). Secondary measures were Global Assessment of Functioning (GAF) scale for overall psychosocial functioning, and Simpson-Angus Scale (SAS) for extra-pyramidal symptoms.ResultsAt twelve weeks, the quetiapine group had a greater decrease in PANSS positive (18.9 vs. 15.3, p = 0.013) and negative scores (15.5 vs. 11.6, p = 0.012), however, haloperidol showed a greater decrease in general psychopathology score (23.8 vs. 27.7, p = 0.012). No significant difference between groups were found for total PANSS (58.3 vs. 54.8, p = 0.24) and GAF (45.7 vs. 46.2, p = 0.79).ANOVA identified significant group interactions on PANSS positive (F = 18.72, df = 1.6,52.4, p < 0.0001), negative (F = 5.20, df = 1.1,35.7, p < 0.0001), depression/anxiety (F = 106.49, df = 1.14,37.8, p < 0.0001), and total scores (F = 7.51, df = 1.4,45.6, p = 0.001).SAS (8.62 vs. 0.26, p < 0.0001) and adverse events of akathisia (78% vs. 0%, p = 0.000), parkinsonism (66.6% vs. 0%, p < 0.0001), and fatigue (84.6% vs. 66.6%, p = 0.009) were greater in haloperidol compared to quetiapine, whereas headache was more common in quetiapine treated patients (11.5% vs. 35.9%, p < 0.0001).ConclusionsQuetiapine has greater efficacy for positive and negative symptoms with less extra-pyramidal symptoms than haloperidol when used for first-episode schizophrenia in the outpatient setting.

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Cited by 79 publications

References 4 publications

Global Assessment of Functioning (GAF): properties and frontier of current knowledge

Global Assessment of Functioning (GAF): properties and frontier of current knowledge

Guidelines for rating Global Assessment of Functioning (GAF)

Efficacy and tolerability of quetiapine versus haloperidol in first-episode schizophrenia: a randomized clinical trial

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