The 18-item Brief Psychiatric Rating Scale (BPRS-18) was used to assess symptomatology across a comprehensive set of common symptom characteristics in psychiatric patients [31]. It covers five domains of clinical symptoms: affect, positive symptoms, negative symptoms, resistance, and activation as proposed by Shafer [32]. Items are rated on an 8-point scale from 0- “not assessed”, 1- “not at all” to 7- “extremely severe” by a clinician to assess symptom severity. The total score ranges from 0 to 126, with higher score representing greater severity of symptoms. The BPRS-18 has been frequently used in schizophrenia with well-established psychometric properties [31, 32]. In the current study, the BPRS-18 showed good internal consistency, with a Cronbach’s alpha of 0.85.
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