A Short Clinical Diagnostic Self-rating Scale for Psychoneurotic Patients: The Middlesex Hospital Questionnaire (M.H.Q.)

Abstract

In the practice of our department at the Middlesex Hospital, the need has been felt for a means of rapid quantification of common symptoms and traits relevant to the conventional diagnostic categories of psychoneurotic illness. Until now, none of the available British scales have fulfilled this requirement. The most widely used is the Maudsley Personality Inventory (Eysenck, 1959) with its subsequent modifications. This, however, although scientifically based, is limited to the assessment of broad categories such as “neuroticism” and “extraversion” which appear to go only a small way towards describing the wide variability of psychoneurotic disturbances. Foulds and his co-workers (Foulds, 1965) have for a number of years developed personality scales in which clinical sophistication and a rigorous methodology are combined. Their Symptom-Sign Inventory, however, consists of eighty questions which have to be presented orally. Furthermore, although the inventory covers psychotic disturbances, it is necessary to use an additional questionnaire, the Hysteroid-Obsessoid Questionnaire (Caine & Hawkins, 1963) to complete the spectrum of psychoneurotic illness. Moreover, the concept of psychiatric illness developed by these workers is individual rather than conventional in a number of respects. The Tavistock Self-Assessment Inventory (Sandler, 1954) is too long for the present purposes (876 items in six booklets). The Taylor Manifest Anxiety Scale (Taylor, 1953) is short and convenient, but it measures one dimension only. As many doctors, including psychiatrists, find it useful to think in terms of orthodox clinical categories for diagnostic, therapeutic, prognostic and research purposes, it was decided to design and attempt to validate a self-rating scale adapted to these categories, taking the patient 5–10 minutes to complete and capable of being rapidly scored by the doctor or an assistant.