[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"assessment-cgi":3,"all-assessments-nav":393,"related-assessments-query":1073},{"id":4,"title":5,"body":6,"category":353,"categoryTitle":354,"clinicalCitations":355,"copyright":353,"description":367,"disclaimer":353,"downloadLink":353,"extension":368,"faqs":369,"featured":382,"i18nReady":382,"icon":353,"interpreter":353,"lastReviewed":383,"meta":384,"navigation":385,"path":386,"permissionsNote":353,"published":382,"recommendedFrequency":353,"relatedCodes":353,"relatedConditions":353,"reviewedBy":353,"seo":387,"slug":388,"stem":389,"summary":390,"takeaways":353,"timeline":353,"type":391,"usedToDiagnose":353,"__hash__":392},"assessments\u002Fassessments\u002Fcgi.md","CGI: Clinical Global Impression",{"type":7,"value":8,"toc":330},"minimark",[9,14,18,21,25,28,45,48,52,57,102,107,144,150,154,180,184,204,208,216,221,229,233,236,239,242,245,249,252,256,259,262,265,269,272,286,290,293,297,300,303,307,310,313,317,320,323,327],[10,11,13],"h3",{"id":12},"foundational-context","Foundational Context",[15,16,17],"p",{},"The Clinical Global Impression (CGI) scale was developed by William Guy in 1976 as part of the ECDEU Assessment Manual for Psychopharmacology (NIMH). It was designed to provide a brief, standardized global measure of illness that could be used across all psychiatric conditions.",[15,19,20],{},"It is now used in virtually every psychiatric clinical trial worldwide as a face-valid, clinician-rated anchor for treatment outcomes.",[10,22,24],{"id":23},"what-the-assessment-measures","What the Assessment Measures",[15,26,27],{},"The CGI consists of two primary independent ratings:",[29,30,31,39],"ol",{},[32,33,34,38],"li",{},[35,36,37],"strong",{},"CGI-S (Severity of Illness)",": A 1–7 rating of the patient's current condition relative to the clinician's total experience with that population.",[32,40,41,44],{},[35,42,43],{},"CGI-I (Global Improvement)",": A 1–7 rating of the patient's change from baseline condition.",[15,46,47],{},"Ratings are based on the clinician's overall judgment, integrating symptom severity, functional impact, and clinical presentation.",[10,49,51],{"id":50},"interpretation-guidelines","Interpretation Guidelines",[15,53,54],{},[35,55,56],{},"CGI-S (Severity):",[58,59,60,66,72,78,84,90,96],"ul",{},[32,61,62,65],{},[35,63,64],{},"1",": Normal, not at all ill",[32,67,68,71],{},[35,69,70],{},"2",": Borderline mentally ill",[32,73,74,77],{},[35,75,76],{},"3",": Mildly ill",[32,79,80,83],{},[35,81,82],{},"4",": Moderately ill",[32,85,86,89],{},[35,87,88],{},"5",": Markedly ill",[32,91,92,95],{},[35,93,94],{},"6",": Severely ill",[32,97,98,101],{},[35,99,100],{},"7",": Among the most extremely ill",[15,103,104],{},[35,105,106],{},"CGI-I (Improvement):",[58,108,109,114,119,124,129,134,139],{},[32,110,111,113],{},[35,112,64],{},": Very much improved",[32,115,116,118],{},[35,117,70],{},": Much improved",[32,120,121,123],{},[35,122,76],{},": Minimally improved",[32,125,126,128],{},[35,127,82],{},": No change",[32,130,131,133],{},[35,132,88],{},": Minimally worse",[32,135,136,138],{},[35,137,94],{},": Much worse",[32,140,141,143],{},[35,142,100],{},": Very much worse",[15,145,146,149],{},[35,147,148],{},"Clinical Benchmarks",": A CGI-I score of 1 or 2 is the standard definition of \"responder\" in clinical trials. A CGI-S of 1 or 2 generally indicates remission.",[10,151,153],{"id":152},"administration-considerations","Administration Considerations",[58,155,156,162,168,174],{},[32,157,158,161],{},[35,159,160],{},"Rater",": Must be completed by a clinician; not for patient self-report.",[32,163,164,167],{},[35,165,166],{},"Time",": Less than 2 minutes.",[32,169,170,173],{},[35,171,172],{},"Baseline",": CGI-I requires a prior CGI-S baseline rating to be validly completed.",[32,175,176,179],{},[35,177,178],{},"Global Judgment",": Scores are based on overall clinical impression, not a sum of symptoms.",[10,181,183],{"id":182},"psychometric-properties","Psychometric Properties",[58,185,186,192,198],{},[32,187,188,191],{},[35,189,190],{},"Reliability",": Excellent when used by experienced clinicians.",[32,193,194,197],{},[35,195,196],{},"Validity",": Strong correlation with disorder-specific rating scales (e.g., PHQ-9, PANSS).",[32,199,200,203],{},[35,201,202],{},"Sensitivity",": Highly sensitive to treatment-related change across all psychiatric categories.",[10,205,207],{"id":206},"limitations","Limitations",[58,209,210,213],{},[32,211,212],{},"Reliant on the clinician's subjective experience and \"internal norms\" for that population.",[32,214,215],{},"Not a substitute for detailed, disorder-specific symptom assessment.",[217,218,220],"h2",{"id":219},"references","References",[15,222,223,224,228],{},"Guy, W. (1976). ",[225,226,227],"em",{},"ECDEU Assessment Manual for Psychopharmacology",". US Department of Health, Education, and Welfare.",[217,230,232],{"id":231},"what-is-the-clinical-global-impression-scale","What is the Clinical Global Impression Scale?",[15,234,235],{},"The Clinical Global Impression (CGI) scale was developed by William Guy in\n1976 as part of the ECDEU Assessment Manual for Psychopharmacology, commissioned by the\nNational Institute of Mental Health (NIMH). Designed for rapid clinician-rated assessment,\nthe CGI was built to provide a standardized global measure that could be used across\ndifferent clinical categories and treatment settings, making it the most practical and\nwidely adopted outcome measure in psychiatric clinical trials.",[15,237,238],{},"Unlike patient self-report measures such as the PHQ-9 or GAD-7, the CGI asks the\nclinician to make a global judgment based on their overall clinical\nexperience with patients presenting with similar conditions. Two subscales capture different dimensions\nof outcome: the CGI-S (Severity of Illness) assesses current illness\nseverity on a 1–7 scale, and the CGI-I (Global Improvement) rates total\nchange from baseline, also on a 1–7 scale, requiring a prior CGI-S rating for\nmeaningful comparison.",[15,240,241],{},"The CGI is in the public domain and free for clinical and research use.\nIts brevity, simplicity, and its independence from any single condition have kept it a fixture in clinical\ntrials for nearly five decades, from antipsychotic studies in schizophrenia to SSRI\ntrials in depression and anxiolytic research in generalized anxiety disorder. Regulators\nand sponsors frequently require or strongly recommend the CGI as an anchor measure\nalongside disorder-specific rating scales.",[15,243,244],{},"Clinician-rated tool. Rate current illness severity (CGI-S) and, if a baseline is\navailable, global improvement (CGI-I).",[10,246,248],{"id":247},"severity-of-illness","Severity of Illness",[15,250,251],{},"Considering your total clinical experience with this particular population, how mentally ill is the patient at this time?",[10,253,255],{"id":254},"global-improvement","Global Improvement",[15,257,258],{},"Compared to the patient's condition at baseline, how much has the patient changed?",[15,260,261],{},"Requires a baseline CGI-S rating for valid interpretation.",[15,263,264],{},"Clinician reference tool only. Cannot replace individualized clinical judgment.",[217,266,268],{"id":267},"cgi-score-interpretation","CGI Score Interpretation",[15,270,271],{},"Guy (1976) \u002F NIMH ECDEU Assessment Manual definitions. CGI-S and CGI-I are independent ratings.",[58,273,274,280],{},[32,275,276,279],{},[35,277,278],{},"CGI-S"," — Severity of Illness",[32,281,282,285],{},[35,283,284],{},"CGI-I"," — Global Improvement",[217,287,289],{"id":288},"how-the-cgi-works-in-practice","How the CGI Works in Practice",[15,291,292],{},"Two subscales, one global judgment. The CGI-S can stand alone; the CGI-I always requires a prior CGI-S baseline.",[10,294,296],{"id":295},"cgi-s-severity-of-illness","CGI-S: Severity of Illness",[15,298,299],{},"The clinician rates the patient's current illness severity relative to their total\nexperience with patients who have the same clinical condition. The rating is a single global\njudgment on the 1–7 scale, not a sum of symptoms.",[15,301,302],{},"Can be completed at intake or any visit without a prior score. Scores of 1–2 indicate\nminimal or no illness; 3–4 mild to moderate; 5–7 mark clinically significant impairment\nrequiring active treatment.",[10,304,306],{"id":305},"cgi-i-global-improvement","CGI-I: Global Improvement",[15,308,309],{},"The clinician rates total improvement since the baseline assessment, regardless\nof whether it is due to drug treatment. A score of 1 (\"Very much improved\") or 2 (\"Much\nimproved\") is typically considered a positive clinical trial response. Scores of 4 indicate\nno meaningful change; 5–7 indicate deterioration.",[15,311,312],{},"Always requires a prior CGI-S baseline rating to be interpretable. In clinical trials,\nCGI-I is often co-primary or key secondary endpoint alongside disorder-specific scales.",[10,314,316],{"id":315},"efficacy-index-optional-third-component","Efficacy Index (Optional Third Component)",[15,318,319],{},"The original CGI also included an optional Efficacy Index, a ratio of\ntherapeutic effect to side-effect burden, scored on a 4x4 grid. This component is rarely\nused today because it conflates efficacy and tolerability, which most modern trial designs\ntreat as separate endpoints. The CGI-S and CGI-I remain the standard.",[15,321,322],{},"When clinicians or protocols refer to \"the CGI,\" they almost always mean CGI-S and CGI-I\nonly. The Efficacy Index is largely a historical artifact.",[217,324,326],{"id":325},"track-cgi-alongside-your-full-assessment-stack-in-hiboop","Track CGI Alongside Your Full Assessment Stack in HiBoop",[15,328,329],{},"CGI-S and CGI-I alongside PHQ-9, GAD-7, PCL-5, and 100+ more, automated scoring and longitudinal tracking for every patient.",{"title":331,"searchDepth":332,"depth":332,"links":333},"",3,[334,335,336,337,338,339,340,342,346,347,352],{"id":12,"depth":332,"text":13},{"id":23,"depth":332,"text":24},{"id":50,"depth":332,"text":51},{"id":152,"depth":332,"text":153},{"id":182,"depth":332,"text":183},{"id":206,"depth":332,"text":207},{"id":219,"depth":341,"text":220},2,{"id":231,"depth":341,"text":232,"children":343},[344,345],{"id":247,"depth":332,"text":248},{"id":254,"depth":332,"text":255},{"id":267,"depth":341,"text":268},{"id":288,"depth":341,"text":289,"children":348},[349,350,351],{"id":295,"depth":332,"text":296},{"id":305,"depth":332,"text":306},{"id":315,"depth":332,"text":316},{"id":325,"depth":341,"text":326},null,"Clinician-Rated",[356,358,361,364],{"text":357},"Guy W. ECDEU Assessment Manual for Psychopharmacology. US Dept of Health, Education, and Welfare. 1976.",{"text":359,"link":360},"Busner J, Targum SD. The clinical global impressions scale: applying a research tool in clinical practice. Psychiatry (Edgmont). 2007;4(7):28-37.","https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F20526405\u002F",{"text":362,"link":363},"Kadouri A, Corruble E, Falissard B. The improved Clinical Global Impression Scale (iCGI): development and validation in depression. BMC Psychiatry. 2007;7:7.","https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F17284321\u002F",{"text":365,"link":366},"Dunlop BW, Gray J, Rapaport MH. Transdiagnostic Clinical Global Impression Scoring for Routine Clinical Settings. Behav Sci (Basel). 2017;7(3):40.","https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F28653978\u002F","CGI scoring — clinician-rated illness severity (CGI-S 1–7) and treatment response (CGI-I 1–7). Used in virtually every psychiatric clinical trial.","md",[370,373,376,379],{"question":371,"answer":372},"Is the CGI self-report or clinician-administered?","The CGI is a clinician-administered scale. Both the CGI-S and CGI-I must be completed by a qualified clinician based on their overall clinical impression of the patient. It is not suitable for patient self-report because it relies on the clinician's comparative experience with similar patient populations.",{"question":374,"answer":375},"What is the difference between CGI-S and CGI-I?","The CGI-S (Severity of Illness) rates the patient's current illness severity on a 1–7 scale from 'not at all ill' to 'among the most extremely ill.' The CGI-I (Global Improvement) rates total change from a prior baseline on a separate 1–7 scale, ranging from 'very much improved' to 'very much worse.' CGI-S can be completed at any visit; CGI-I requires a prior CGI-S baseline to be interpretable.",{"question":377,"answer":378},"What does a CGI-I score of 1 or 2 indicate?","A CGI-I score of 1 ('very much improved') or 2 ('much improved') is the standard definition of a treatment responder in psychiatric clinical trials. A score of 4 indicates no meaningful change from baseline, and scores of 5–7 reflect varying degrees of worsening. These thresholds are widely used by regulators and researchers as anchor points for treatment response.",{"question":380,"answer":381},"Can the CGI provide a diagnosis?","No. The CGI measures illness severity and treatment response — it does not provide a diagnosis or identify specific symptoms. It is a global impression scale intended to complement, not replace, disorder-specific assessments. A thorough clinical evaluation using validated diagnostic criteria is required for diagnosis.",false,"2026-06-03",{},true,"\u002Fassessments\u002Fcgi",{"title":5,"description":367},"cgi","assessments\u002Fcgi","Standardized clinician-rated measure of psychiatric illness severity and treatment response. 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