Cross-cultural adaptation of the Arabic Positive and Negative Syndrome Scale in schizophrenia: Qualitative analysis of a focus group.

Iman Amro,Ziyad Mahfoud,Mark Opler,Arij Yehya,Anzalee Khan,Samer Hammoudeh,Suhaila Ghuloum,Hassen Al-Amin,Yahya Hani

doi:10.1177/1363461519850345

Abstract

As part of a project to translate and validate scales used in the diagnosis and treatment of Arab patients with schizophrenia, this study aimed to explore the experience of clinical research coordinators (CRCs) while administering the Arabic version of the Positive and Negative Syndrome Scale (PANSS) on Arab schizophrenia patients. We previously reported that the Arabic version of PANSS is a valid and reliable tool to assess Arab patients with schizophrenia. Five CRCs and the principal investigator attended focus group discussions on cultural issues in administering the PANSS. A thematic analysis approach was utilized for data coding and analysis. The results identified issues related to the translation of the instrument, the structure of the interview, the cultural sensitivity of some questions, and the procedures for rating items of the PANSS. Qualitative analysis also identified four main themes relevant to clinical assessment of patients from Middle Eastern cultures: religion, beliefs and values, gender, and semantic expressions. In conclusion, researchers or clinicians administering the PANSS scale interview in Arabic should be trained to consider the roles of local dialects, familiarity with abstract thinking, religion, and social constructs when assessing psychosis.

Highlights

Schizophrenia is a chronic mental illness characterized by positive symptoms, negative symptoms, and cognitive deficits in working memory, verbal skills, and attention
Schizophrenia is usually diagnosed after a clinical interview and based on the International Statistical Classification of Disease and related health problems (ICD-10; WHO, 2010) or the Diagnostic and Statistical Manual (DSM) of mental disorders (American Psychiatric Association, 2000), which are based on field studies and expert opinions
The results section is divided into two parts: 1) general observations and findings of the SCI-Positive and Negative Syndrome Scale (PANSS) and the rating criteria; and 2) cultural themes that emerged from the focus group discussions on the assessment processes

Summary

Introduction

Schizophrenia is a chronic mental illness characterized by positive symptoms (such as hallucinations, delusions, and disorganized thinking), negative symptoms (like avolition, alogia, affect flattening, and lack of motivation), and cognitive deficits in working memory, verbal skills, and attention. Schizophrenia is usually diagnosed after a clinical interview and based on the International Statistical Classification of Disease and related health problems (ICD-10; WHO, 2010) or the Diagnostic and Statistical Manual (DSM) of mental disorders (American Psychiatric Association, 2000), which are based on field studies and expert opinions. These studies were conducted mainly in Western countries like the USA and Europe. The MINI has been translated and tested within the Arabic context (Ghanem, Gadallah, Meky, Mourad, & El Kholy, 2009; Kadri et al, 2005) and it follows the DSM, fourth edition, text revision (DSM-IV-TR) criteria (American Psychiatric Association, 2000) to confirm the diagnosis through a semi-structured interview

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