Global Assessment of Functioning (GAF)

1 32 Multia-KialAssessmentGlobal Assessment of Functioning (GAF) ScaleConsider psychological, social, and occupational Functioning on a hyporhetical conrinuumof mental healtl-r-illness. Do not include impairment in Functioning due ro physical (orenvironmenral) (Nore: Use imennediate codes when appropciate, , 45, @, 12)100Io190 III8l80I7lSuperior funcdonlng kr a widc raoge of act{vities, life's problcms never seem ro get outof hand is sought out by others bccatsc of hls or her many posltive qualitles. mlnlmalsyrnptorns( , mild anxiety before an exam), good fuoctioning in all areas,intcrested and involved In a wldc range of actlvlties, socially effectlve. geaerally satlsfiedwith [ife' no more than cvery&y problerns or concerns (e-g., an occasi6nal argument withfamily rnembers),If sympto{Ds pr setrt, ttrey are traflsient and cxpectatrle re-actlons to psychosoclalstr ssors ( ditfic'ulty conceorrating alter family ); no more than slighiirnpat mentin soc{al occupational, or school fuoctioning ( , tempocarily falling Lrehind in schoolwork).]}}}

2 Somc mil{ s1'mptoms ( , depressed mood and mild insomnia) OR some difficulty ln sociat,occupatiooat or sclrool fuactlontng ( , occasional t uancy, or the{l within the househotd), butgenerally Functioning pretty wcll, somc meaningful interpersonal relatiooships-l!{oderate symptod< ( , flat affect aod circumsuntial speech, occasional panic arucks) ORmod ratc dlfficulry i-rr soclel, occupatiooat or schoot functiooing (e g., few friends, coofli . ,wi*t peers or co-rorkers).Serior'rs symptoos ( , suicidal ideation, severe obsessional rituals, frequent shoplifiing) OR anyserious impaircacat in soclat occupational or school furrctioning ( , no fiiends, unable tokeep a iob).Some impairmentinr alltyt stingorcommunicatioa( .g., speech is attimes illogical, obscure,or irrelerant) OR m-ior impalrmcnt in scveralare-as, such as work orschoo! family relations,'iudgment, q{gLin& or mood( , depressed man avoids friends, neglects family, and is unableto work; child frequendy beas up younger children, is defiant ar home,-and is failing at school).}}}}

3 Behavior is coosidcrabty tnfluenccd by delusions or hallucinations oR seriou5 impairmentin coru-rnunicadoo or iudgneot ( , sometimes incoherent, acts grossly inappropriately, suicidalpreoccuparion) oR inablltty to functioo lo almost all areas ( stays in-bed alt day; no iob,home, or danger of hurting sclf or othcrs ( , suicide anempc without clear expectarion of dearh;frequently' violcnt: manic excitement) OR occasionalty f"it" to rorintal11 "iirrlrrrl personalhygienc ( ,. snrsars fece;) OR gross impairment ln communication ( , largely incoherento( mule).Persist at of scverety hurting sclf or otlrers ( , recurrent violeoce) OR pcrsistcntinability to rnaiatztn mtntmal persooal hygiene oR scrious suicidal act wirh clcarexpecta-tion of dcatLInadequate infomr:rti, of ovecall pq'chological funcrioning on a scale of O-l@ was operationalized by Luborsky in theHealth-Sickness Rating St--rlc (Luborsky L 'Clinicians'Judgments of Menral Heahh.)))

4 " Arcbitns of GmeralPsycbiatryT:4O7-4f 7, lgal)_ Spitzer and colleagues developed a revisioo of the Heatth-sickness RatingScale catled the Clobal .\ Scale (GA5) (tndicon J, Spirzer RL, Fleiss JL, Cohen J: 'The GlobaiAssessmenl Scale: A Prot-edure for Overall Severiry of Psychiatric Disrurbance." Archites ofCeneral :7f<.--ll. 1976). A modified version of the GAS was included in DSM_llt-R as rheClobal Assessmenr of Frrnrriooing (GAF) TEST CJ{ARACTEzuSTICS OF THEExAMTNAnoN AM'NG TSRE; E;;-cirro*o,MINI-MENTAL STATESTRATAE ducationai attuill.,tMiddIeSchoolHiChSchoolCoilege/ CraduateSchoolNumber Demented:ROC Curve Area:MMSE )A252627)A23/40 (sB%).95 +-65/ / .7 | 1 (sT% '58/.gz'58/ 'gz'70/ ' /.. tso%).96 / ' Mittimum normal score." St nsi t io i ty/ S pecificity-TABLE 2.^ACCURACY OF TI{E {g ExAMrNArroN FoRDETECTING DEMENTIA'An increasinr and, we believe, justifiable placed-in reeent years on the use of staadard-rzed screening instuments for the aetecion of cogni_tive dys f unction and de men fi " ;6 "-d.}}}

5 ;:; e"i;the prevalence and significa nce,i ;";;;", howeve r,the diagnostic accuracy of such i*t u*"nS has con_siderable personal and pubric h;J,h"; positive result:sary emo do n"r di, .,l:',"" T"** ::Tijff ":T T:;as experuive and potentiilly complica,ua and rearmer,t. r"b" ;"g;d;,rll *uy u" u,consequential if reversible or rJmediaUte cu,rses of de_ _mentia are not recognized ana teaiJ. Thus, suchinskuments should be carefully."d;;; to the pop-ulations in which they are studies have noted. associations betweeneducation and MMSFi,y or the MM$;;'#;;#i.:[:T#$ :T 9Tt"n analytii t".r,r,iq"* io-";-tiio" MMSE nonns and evaluate its a-ccuracy in various educatiorialEroups- These results indicate,i" MG;; ar, accuratesceening test for Alzheimer,s d"m"r,ti-u*umong both:T:]t_""dhighlyeducared"H";;l;;i?t,, ."tio,,_speatlc nonns are applied. These results also suggestl:1"* of MMSE,p". "; ;;;;;& in poorlvflt1-iid not to reflect an inherenr,qL ur accuracy rn the MMSE in such it appeal to be ,i;;;;;; tf subyectingpoorly educated individuals ,o.

6 O""" MMSE norrns. When lower norrns are applied, the MMSEDTSCUSSIONE ducational AftainsrentMiddle HishSchool >/. atq .as1um lhe preoatcnce ,f ii*r"it" "'iiii" Minimum norma! MMSE .90-88 .89-92 ..81-48 .7s-39 .62-34 . OF YEARSwrrH YMSE SUBSECIONOFSCORESr'Orientation flime)Orientation (place) #.19"'Aft ention and calcula tionKecall$ng-uaget otal score' Pea'on conelaiton coefficient. positiac o",ruliiriiTfi,i:::: ::r:,' :,,:::.o c i a t e d w' i t h h i s h e r MM s E * o,,,,.' o,l i' o i,, o < rsa I o rappears to be hiehlv acorate in persons with middleschool educariori. Ho*"rr".. the accuracv of lowerl:T: i,., Tol". poortv educated p"oon, ,utu need toDe determined in subsequent studies_" P < '.. P < P < \ ,.\, \' (FOLSTEIN) Examinerss#Check box if correcl response given. Record the incorrect ORIF\T{TIO\. Ask the foilowing questions. (Maximum score is l0)IJA T T:Incorrect Respoase:t'!'hat is ioday"s date?What rs thc y-car?}

7 What rs the month!What day is roda;'?C-an you also teil me whatseason it rs?C-a-n you also teLl me tie namcof thrs hospruJ (clrruc)?Mrat floor are we on?Wha[ town or city are we in?What county are we in?What sgte are we in?BabyGardenLeaderDaughterRiverTableDar c (c g. Jan. 2l)YcrrMonthDay ( Monday)SeasonHospinl(Clinic)FloorTown or CityCountySrateSubscoreCircle list used. (Maximum score is 3)Village Ball ApPleHeaven Flag PennYFinger Tree TableSubscore(F{aximum score is f)Qf patient refusesto subract)SubscoreSubscoretruntrDtrnUnnItr . ATTFN]TION ANT} CAI CIII RECALL: (of above list used)(Maximum score is 3)LANGUAGE:NAMING:(lv{aximum score is 9)WatchPcnREPETITION: "No ifs, ands or buts".ISTAGE COMMAND: Givc &c srb!:ct a picccof plain blank papcr and say, "Takc thc papcr inyour right han4 fold it in half with bothhands and placc it in your lap""'READING: Scorc correctly only if he/shc 4trrally closcs eyes.\I/RITING: Have thc subject writc a completc sentenccCOPYING: Ask the subject to copy tlrc intersccting penugonsTOTAL SCORE: (Maximum score is 30.}

8 Tatcs wittr right tundFolds ppcr in halfRrs papcr on laptrtrntrtrtrntrnSubscorcTOTALCLOsr YOUREYESMini-Mental Status Examination (MMSE), Montreal Cognitive Assessment (MoCA), and the Saint Louis Mental Status Examination (SLUMS) The MMSE was the widely used default test for years, but has been removed from the public domain. Can you still use it legally? Here is from the PAR website: Q: Does the administration of the MMSE in a clinical setting constitute copyright infringement? A: No. As long as the MMSE is not copied or reproduced, the administration of the test does not constitute copyright infringement. Hence, if a person has an authorized (legal) version of the MMSE (a copy that was not illegally obtained or produced) or has it memorized and administers the test, there has been no copyright infringement. Answers and scores may be recorded. Please note two important caveats: 1. we should not copy (infringe on the copyright of) the official answer sheet being distributed by PAR; 2.

9 Administering any standardized Assessment instrument from memory may impact the quality of the administration, and therefore the results. Thus, caution should be taken before embarking upon administration strictly from memory. From Stewart et al. (2012), Clinical Gerontologist, 35:57 75 SCORING HIGH SCHOOL EDUCATIONLESS THAN HIGH SCHOOL EDUCATION 27-30 Normal 25-30 21-26 MNCD* 20-24 1-20 Dementia 1-19 * Mild Neurocognitive DisorderVAMCSLUMS Examination__/1__/1__/1__/3__/3__/5__/2_ _/4__/2__/8 Name AgeIs patient alert? Level of education1111201011221122221. What day of the week is it?2. What is the year?3. What state are we in?4. Please remember these five objects. I will ask you what they are You have $100 and you go to the store and buy a dozen apples for $3 and a tricycle for $ much did you spend?How much do you have left?6. Please name as many animals as you can in one animals 5-9 animals 10-14 animals15+ animals7.

10 What were the five objects I asked you to remember? 1 point for each one I am going to give you a series of numbers and I would like you to give them to me example, if I say 42, you would say This is a clock face. Please put in the hour markers and the time atten minutes to eleven o markers okayTime correct10. Please place an X in the of the above figures is largest?11. I am going to tell you a story. Please listen carefully because afterwards, I m going to ask yousome questions about was a very successful stockbroker. She made a lot of money on the stock market. She then metJack, a devastatingly handsome man. She married him and had three children. They lived in then stopped work and stayed at home to bring up her children. When they were teenagers, shewent back to work. She and Jack lived happily ever was the female s name?What work did she do?When did she go back to work?What state did she live in?TOTAL SCORESH Tariq, N Tumosa, JT Chibnall, HM Perry III, and JE Morley.