Department of Psychiatry, University of British Columbia, Vancouver, Canada.
Psychiatr Serv. 2011 Apr;62(4):411-7. doi: 10.1176/ps.62.4.pss6204_0411.
The Global Assessment of Functioning scale (GAF) is included as axis V in the DSM-IV multiaxial diagnostic system. The GAF is simple to administer and routinely used in treatment planning and as a measure of program performance. The GAF assesses both symptom severity and functional impairment, but the resultant rating provides no information about the contribution of each of these domains. This study aimed to improve the clinical utility of the GAF by creating subscales.
The authors divided the scale into its two principal domains: descriptors of social and occupational functioning (SOFAS) and descriptors of symptoms (GAF minus SOFAS descriptors). These and other measures of symptoms and functioning were used to assess 407 patients while acutely psychotic and again after treatment.
Symptom scores were of greater severity than functional impairment scores in most cases. Because of this, the GAF score tended to reflect symptom severity rather than functional impairment. The symptom rating was more strongly correlated with measures of positive symptoms, and the functional rating had higher associations with negative symptoms and functional impairment. Both scales were good indicators of clinical change.
Findings indicate that GAF ratings for patients with psychosis tend to reflect symptom severity rather than functional impairment. Splitting the GAF into two parts resulted in greater discrimination for this patient group yet retained ease of administration.
功能全面评估量表（GAF）被纳入 DSM-IV 多轴诊断系统的第五轴。GAF 易于管理，常用于治疗计划和作为项目绩效的衡量标准。GAF 评估症状严重程度和功能障碍，但得出的评分没有提供关于这两个领域各自贡献的信息。本研究旨在通过创建子量表来提高 GAF 的临床实用性。
作者将量表分为两个主要领域：社会和职业功能描述符（SOFAS）和症状描述符（GAF 减去 SOFAS 描述符）。这些和其他症状和功能的衡量标准用于评估 407 名急性精神病患者，然后在治疗后再次进行评估。
在大多数情况下，症状评分比功能障碍评分更为严重。因此，GAF 评分往往反映的是症状严重程度而不是功能障碍。症状评分与阳性症状的衡量标准相关性更强，而功能评分与阴性症状和功能障碍的相关性更高。这两个量表都是临床变化的良好指标。
研究结果表明，精神病患者的 GAF 评分往往反映的是症状严重程度，而不是功能障碍。将 GAF 量表分为两部分，虽然对这一患者群体的区分度更高，但仍保留了易于管理的特点。
