Sheehan – Clinician Global Improvement Scale (S-CGI-21) & Sheehan – Patient Global Improvement Scale (S-PGI-21)

About the Standard S-CGI-21 & S-PGI-21

The S-PGI-21 and S-CGI-21 are designed to provide an overall assessment of how much a patient’s symptoms have improved or worsened since the start of treatment.

About the S-PGI-21 and S-CGI-21: The Sheehan – Global Improvement Scales exist in a clinician rated format (S-CGI-21) and in a patient rated format (S-PGI-21).  These 21-point global improvement scales were designed as more sensitive outcome measures in detecting efficacy signals than the old standard 7-point CGI-I Scale (Clinician Global Impressions – Improvement) and the related 7 point PGI-I (Patient Global Impressions – Improvement), which were developed during the early PRB Collaborative Schizophrenia treatment studies. (ECDEU Assessment Manual. US Dept. of Health Education and Welfare. W. Guy. Editor. NIMH Psychopharmacology Research Branch 1976 Washington DC).  Since the original design of the 7-point CGI-I, research needs and treatment outcome expectations require greater sensitivity. Each new generation of treatments brings incremental improvements over earlier treatments.  It is necessary to be able to detect such differences globally. The 21-point S-CGI-21 and S-PGI-21 have 10 points of improvement and 10 points of deterioration compared to baseline, while the original CGI-I has only 3 points of improvement and 3 points of deterioration compared to baseline.  This spread in the original CGI-I is not sufficiently sensitive to detect either small increments of improvement or small differences between treatments.  Such differences can be clinically meaningful.  For example, both a 40% and a 60% improvement are rated as “moderate” or a score of 2 on the old CGI-I whereas the S-CGI-21 and S-PGI-21 detect these as quite different.  Clinicians, researchers and pharmaceutical companies are increasingly interested in differences in efficacy among the many treatments available and between efficacy at different doses. Scales designed using a discretized visual-analog format (like the S-CGI-21 and S-PGI-21) appear to be more sensitive than scales that adhere to categorical response options like the old CGI-I.  Discretized visual-analog scales use numerical, verbal and visual-spatial modes simultaneously in capturing a response, thereby anchoring the response more precisely and gaining sensitivity. For more information about the design and logic behind Discan Metrics in rating scales such as the SDS, the SIS, the S-STS CMCM, the SIAS, the S-HTS CMCM, and the HIAS see citation 1 in How to Cite The SDS (click here).

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