SCAN
Encyclopedia
SCAN or Schedules for Clinical Assessment in Neuropsychiatry is a set of tools created by WHO
Who
Who may refer to:* Who , an English-language pronoun* who , a Unix command* Who?, one of the Five Ws in journalism- Art and entertainment :* Who? , a 1958 novel by Algis Budrys...
aimed at diagnosing and measuring mental illness
Mental illness
A mental disorder or mental illness is a psychological or behavioral pattern generally associated with subjective distress or disability that occurs in an individual, and which is not a part of normal development or culture. Such a disorder may consist of a combination of affective, behavioural,...
that may occur in adult life. It is not constructed explicitly for use with either ICD-10
ICD-10
The International Statistical Classification of Diseases and Related Health Problems, 10th Revision is a medical classification list for the coding of diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases, as maintained by the...
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.
Interview items
The entire SCAN interview consists of 1,872 itemItem
- Organizations :* ITeM, refers to the Uruguay-based Third World Institute , going by its Spanish acronym Instituto del Tercer Mundo* ITEM club, an economic forecasting group based in the United Kingdom- Newspapers :...
s, 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 patientPatient
A patient is any recipient of healthcare services. The patient is most often ill or injured and in need of treatment by a physician, advanced practice registered nurse, veterinarian, or other health care provider....
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 around somatoformSomatoform disorder
In psychology, a somatoform disorder is a mental disorder characterized by physical symptoms that suggest physical illness or injury - symptoms that cannot be explained fully by a general medical condition, direct effect of a substance, or attributable to another mental disorder . The symptoms that...
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 anxietyAnxiety
Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...
attacks and phobia
Phobia
A phobia is a type of anxiety disorder, usually defined as a persistent fear of an object or situation in which the sufferer commits to great lengths in avoiding, typically disproportional to the actual danger posed, often being recognized as irrational...
s, 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, anhedoniaAnhedonia
In psychology and psychiatry, anhedonia is defined as the inability to experience pleasure from activities usually found enjoyable, e.g. hobbies, exercise, social interaction or sexual activity....
, loss of feeling, suicidal tendencies
Suicide
Suicide is the act of intentionally causing one's own death. Suicide is often committed out of despair or attributed to some underlying mental disorder, such as depression, bipolar disorder, schizophrenia, alcoholism, or drug abuse...
, social withdrawal, insomnia
Insomnia
Insomnia is most often defined by an individual's report of sleeping difficulties. While the term is sometimes used in sleep literature to describe a disorder demonstrated by polysomnographic evidence of disturbed sleep, insomnia is often defined as a positive response to either of two questions:...
or hypersomnia
Hypersomnia
Hypersomnia is a disorder characterized by excessive amounts of sleepiness.There are two main categories of hypersomnia: primary hypersomnia and recurrent hypersomnia...
, dysthymia, etc.
Section 7 - Thinking, concentration, energy, interest
Section 7 measures cognitive functioningCognition
In science, cognition refers to mental processes. These processes include attention, remembering, producing and understanding language, solving problems, and making decisions. Cognition is studied in various disciplines such as psychology, philosophy, linguistics, and computer science...
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 libidoLibido
Libido refers to a person's sex drive or desire for sexual activity. The desire for sex is an aspect of a person's sexuality, but varies enormously from one person to another, and it also varies depending on circumstances at a particular time. A person who has extremely frequent or a suddenly...
.
Section 9 - Eating disorders
Section 9 aims to diagnose eating disorderEating disorder
Eating disorders refer to a group of conditions defined by abnormal eating habits that may involve either insufficient or excessive food intake to the detriment of an individual's physical and mental health. Bulimia nervosa, anorexia nervosa, and binge eating disorder are the most common specific...
s such as bulimia and anorexia nervosa
Anorexia nervosa
Anorexia nervosa is an eating disorder characterized by refusal to maintain a healthy body weight and an obsessive fear of gaining weight. Although commonly called "anorexia", that term on its own denotes any symptomatic loss of appetite and is not strictly accurate...
.
Section 10 - Expansive mood and ideation
Section 10 measures whether the respondent experiences euphoriaEuphoria (emotion)
Euphoria is medically recognized as a mental and emotional condition in which a person experiences intense feelings of well-being, elation, happiness, ecstasy, excitement and joy...
or abnormally elevated mood (mania
Mania
Mania, the presence of which is a criterion for certain psychiatric diagnoses, is a state of abnormally elevated or irritable mood, arousal, and/ or energy levels. In a sense, it is the opposite of depression...
), which can be used in diagnosing, for instance, bipolar disorder
Bipolar disorder
Bipolar disorder or bipolar affective disorder, historically known as manic–depressive disorder, is a psychiatric diagnosis that describes a category of mood disorders defined by the presence of one or more episodes of abnormally elevated energy levels, cognition, and mood with or without one or...
s.
Section 11 - Use of alcohol
Section 11 measures, through direct questions, amounts of alcoholic beverageAlcoholic beverage
An alcoholic beverage is a drink containing ethanol, commonly known as alcohol. Alcoholic beverages are divided into three general classes: beers, wines, and spirits. They are legally consumed in most countries, and over 100 countries have laws regulating their production, sale, and consumption...
s consumed and social, legal, physical, and other problems related to alcohol use.
Section 12 - Use of psyhoactive substances other than alcohol
Section 12 measures, again through direct questions, the same as section 11, only relating to prescription drugPrescription drug
A prescription medication is a licensed medicine that is regulated by legislation to require a medical prescription before it can be obtained. The term is used to distinguish it from over-the-counter drugs which can be obtained without a prescription...
s, illicit drugs, and nicotine
Nicotine
Nicotine is an alkaloid found in the nightshade family of plants that constitutes approximately 0.6–3.0% of the dry weight of tobacco, with biosynthesis taking place in the roots and accumulation occurring in the leaves...
.
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 symptomsPsychosis
Psychosis means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality"...
.
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-hallucinatoryHallucination
A hallucination, in the broadest sense of the word, is a perception in the absence of a stimulus. In a stricter sense, hallucinations are defined as perceptions in a conscious and awake state in the absence of external stimuli which have qualities of real perception, in that they are vivid,...
perceptual disorders are present. These may present themselves by the respondents stating to have experiences of their surroundings being distorted, or unreal (derealization
Derealization
Derealization is an alteration in the perception or experience of the external world so that it seems unreal. Other symptoms include feeling as though one's environment is lacking in spontaneity, emotional coloring and depth. It is a dissociative symptom of many conditions, such as psychiatric and...
), or that they themselves are not real, but more like characters in a play (depersonalization
Depersonalization
Depersonalization is an anomaly of the mechanism by which an individual has self-awareness. It is a feeling of watching oneself act, while having no control over a situation. Sufferers feel they have changed, and the world has become less real, vague, dreamlike, or lacking in significance...
). 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, auditoryAuditory system
The auditory system is the sensory system for the sense of hearing.- Outer ear :The folds of cartilage surrounding the ear canal are called the pinna...
(verbal or non-verbal), olfactory, tactile
Somatosensory system
The somatosensory system is a diverse sensory system composed of the receptors and processing centres to produce the sensory modalities such as touch, temperature, proprioception , and nociception . The sensory receptors cover the skin and epithelia, skeletal muscles, bones and joints, internal...
, 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 respondentss 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
DelusionDelusion
A delusion is a false belief held with absolute conviction despite superior evidence. Unlike hallucinations, delusions are always pathological...
s of being spied upon, and other paranoid
Paranoia
Paranoia [] is a thought process believed to be heavily influenced by anxiety or fear, often to the point of irrationality and delusion. Paranoid thinking typically includes persecutory beliefs, or beliefs of conspiracy concerning a perceived threat towards oneself...
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
Collusion
Collusion is an agreement between two or more persons, sometimes illegal and therefore secretive, to limit open competition by deceiving, misleading, or defrauding others of their legal rights, or to obtain an objective forbidden by law typically by defrauding or gaining an unfair advantage...
. Furthermore, hypochondria
Hypochondria
Hypochondriasis or hypochondria refers to excessive preoccupation or worry about having a serious illness. This debilitating condition is the result of an inaccurate perception of the body’s condition despite the absence of an actual medication condition...
l 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 schizophreniaSchizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...
and psychosis
Psychosis
Psychosis means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality"...
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 dementiaDementia
Dementia is a serious loss of cognitive ability in a previously unimpaired person, beyond what might be expected from normal aging...
. 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, stuporStupor
Stupor is the lack of critical cognitive function and level of consciousness wherein a sufferer is almost entirely unresponsive and only responds to base stimuli such as pain. This is often mistaken for delirium and treated with Haldol and or other anti-psychotic drugs...
, distractibility, agitation, ambitendence, echopraxia
Echopraxia
Echopraxia is the involuntary repetition or imitation of the observed movements of another. It is closely related to echolalia, the involuntary repetition of another's speech. The etymology of the term is from Ancient Greek: "ἠχώ from ἠχή " and "πρᾶξις "...
, embarrassing or bizarre behavior, histrionic behavior, self injury, hoarding of objects, and a variety of negative symptoms.