Clinical-Global-Impression

RatingClinician-ratedAdministrationtimeVarieswithfamiliaritywithpatientMainpurposeToprovideaglobalratingofillnessseverity,improvementandresponsetotreatmentPopulationAdultsCommentaryAmongstthemostwidelyusedofextantbriefassessmenttoolsinpsychiatry,theCGIisa3-itemobserver-ratedscalethatmeasuresillnessseverity(CGIS),globalimprovementorchange(CGIC)andtherapeuticresponse.Theillnessseverityandimprovementsectionsoftheinstrumentareusedmorefrequentlythanthetherapeuticresponsesectioninbothclinicalandresearchsettings.TheEarlyClinicalDrugEvaluationProgram(ECDEU)ver-sionoftheCGI(reproducedhere)isthemostwidelyusedformat,andasksthattheclinicianratethepatientrelativetotheirpastexperiencewithotherpatientswiththesamediagnosis,withorwithoutcollateralinformation.SeveralalternativeversionsoftheCGIhavebeendeveloped,how-ever,suchastheFDAClinicians’Interview-BasedImpressionofChange(CIBIC),whichusesonlyinforma-tioncollectedduringtheinterview,notcollateral.TheCGIhasprovedtobearobustmeasureofefficacyinmanyclinicaldrugtrials,andiseasyandquicktoadmin-ister,providedthattheclinicianknowsthepatientwell.ScoringTheCGIisratedona7-pointscale,withtheseverityofillnessscaleusingarangeofresponsesfrom1(normal)throughto7(amongstthemostseverelyillpatients).CGI-Cscoresrangefrom1(verymuchimproved)throughto7(verymuchworse).Treatmentresponseratingsshouldtakeaccountofboththerapeuticefficacyandtreatment-relatedadverseeventsandrangefrom0(markedimprovementandnoside-effects)and4(unchangedorworseandside-effectsoutweighthethera-peuticeffects).EachcomponentoftheCGIisratedsepa-rately;theinstrumentdoesnotyieldaglobalscore.VersionsCGIforbipolardisorder(CGI-BD),FDAClinicians’Interview-BasedImpressionofChange(CIBIC),Clinicians’Interview-BasedImpressionofChange-Plus(CIBIC+),NYUCIBIC+,Parke-DavisPharmaceuticalsClinicalInterview-BasedImpression(CIBI);theCGIhasbeentranslatedintomostlanguages.AdditionalreferencesLeonAC,ShearMK,KlermanGL,PorteraL,RosenbaumJF,GoldenbergI.Acomparisonofsymptomdeterminantsofpatientandclinicianglobalratingsinpatientswithpanicdisorderanddepression.JClinPsychopharmacol1993;13(5):327–31.SpearingMK,PostRM,LeverichGS,BrandtD,NolenW.ModificationoftheClinicalGlobalImpressions(CGI)Scaleforuseinbipolarillness(BP):theCGI-BP.PsychiatryRes1997;73(3):159–71.ZaiderTI,HeimbergRG,FrescoDM,SchneierFR,LiebowitzMR.Evaluationoftheclinicalglobalimpressionscaleamongindividualswithsocialanxietydisorder.PsycholMed2003;33(4):611–22.AddressforcorrespondenceNotapplicable–theCGIisinthepublicdomain.125ClinicalGlobalImpression(CGI)Reference:GuyW,editor.ECDEUAssessmentManualforPsychopharmacology.1976.Rockville,MD,U.S.DepartmentofHealth,Education,andWelfare1261.SeverityofillnessConsideringyourtotalclinicalexperiencewiththisparticularpopulation,howmentallyillisthepatientatthistime?0=Notassessed4=Moderatelyill1=Normal,notatallill5=Markedlyill2=Borderlinementallyill6=Severelyill3=Mildlyill7=Amongthemostextremelyillpatients2.Globalimprovement:Ratetotalimprovementwhetherornot,inyourjudgement,itisdueentirelytodrugtreatment.Comparedtohisconditionatadmissiontotheproject,howmuchhashechanged?0=Notassessed4=Nochange1=Verymuchimproved5=Minimallyworse2=Muchimproved6=Muchworse3=Minimallyimproved7=Verymuchworse3.Efficacyindex:Ratethisitemonthebasisofdrugeffectonly.Selectthetermswhichbestdescribethedegreesoftherapeuticeffectandsideeffectsandrecordthenumberintheboxwherethetwoitemsintersect.EXAMPLE:Therapeuticeffectisratedas‘Moderate’andsideeffectsarejudged‘Donotsignificantlyinterferewithpatient’sfunctioning’.TherapeuticeffectSideeffectsNoneDonotsignificantlySignificantlyinterferesOutweighsinterferewithwithpatient’stherapeuticpatient’sfunctioningfunctioningeffectMarkedVastimprovement.Completeornearlycomplete01020304remissionofallsymptomsModerateDecidedimprovement.Partialremissionof05060708symptomsMinimalSlightimprovementwhichdoesn’talterstatus09101112ofcareofpatientUnchangedorworse13141516Notassessed=00ReproducedfromGuyW,editor.ECDEUAssessmentManualforPsychopharmacology.1976.Rockville,MD,U.S.DepartmentofHealth,Education,andWelfareClinicalGlobalImpression(CGI)