Abstract
Purpose The Clinical Assessment Interview for Negative Symptoms (CAINS) was developed in order to advance the assessment of negative symptoms. The aim of this study was to validate the Swedish version of the CAINS. Materials and methods Thirty-four out-patients with a schizophrenia spectrum disorder were recruited. All patients were videotaped while interviewed with the CAINS and the Brief Psychiatric Rating Scale (BPRS). Another rater watched the video recordings in the reverse order, enabling a blinded design. The patients also filled in self-reported measures of depression, quality of life, and social and vocational functioning. We calculated inter-rater agreement and internal consistency for the CAINS. We also calculated validity measures by correlating the subscales Motivation and Pleasure (CAINS-MAP) and Expression (CAINS-EXP) to subscales of the BPRS. Results The blinded inter-rater agreement for the CAINS total score was high (ICC = 0.92) but slightly lower for the expression subscale (ICC = 0.76). Cronbach’s alpha was 0.84 for the total score. Convergent validity with the negative symptoms subscale of BPRS was different for the blinded and the unblinded data, with a CAINS-MAP correlation of 0.10 (p = 0.580) and a CAINS-EXP correlation of 0.48 (p = 0.004) in the blinded data. The unblinded data had a CAINS-MAP correlation of 0.38 (p = 0.026) and a CAINS-EXP correlation of 0.87 (p < 0.001). Self-rated measures of anhedonia correlated to CAINS-MAP with a coefficient of 0.68 (p < 0.001), while the CAINS-EXP only had a correlation of 0.16 (p = 0.366) to these measures. Conclusion The Swedish version of the CAINS displays adequate psychometric properties in line with earlier validation studies.
Highlights
Negative symptoms comprise motivational deficits such as anhedonia, avolition and apathy, as well as expressional deficits such as alogia and blunted affect [1]
The Scale for the Assessment of Negative Symptoms (SANS) was deemed more suitable than the Positive and Negative Syndrome Scale (PANSS) for assessing negative symptoms, but it was criticized for the inclusion of certain items that were not considered necessary for the negative symptom concept
The Clinical Assessment Interview for Negative Symptoms (CAINS)-EXP did, which is notable since the Brief Psychiatric Rating Scale (BPRS) negative symptoms subscale consists of three items that are all observational in character
Summary
Negative symptoms comprise motivational deficits such as anhedonia, avolition and apathy, as well as expressional deficits such as alogia and blunted affect [1]. The consensus statement stressed the need of a new instrument for assessing negative symptoms and a group of researchers were put together to construct such an instrument [12] This led to the development of the Clinical Assessment Interview for Negative Symptoms (CAINS) [13,14,15]. The CAINS was developed in several steps, and the final validation study concluded that the CAINS is reliable and valid, shows high intra- and interrater agreement, good internal consistency, strong convergent and discriminant validity and that it is linked to functional outcome [15] These results have been replicated when the CAINS was compared to another newly developed rating scale for negative symptoms called the Brief Negative Symptom Scale [16]. The aim of this study was to assess the reliability and validity of the Swedish version of the CAINS in a blinded study design
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