Positive And Negative Syndrome Scale Items Research Articles

Validity of the depressive dimension extracted from principal component analysis of the PANSS in drug-free patients with schizophrenia

Depressive symptoms frequently occur during the course of schizophrenia. This study explored the relationships between the schizophrenia symptomatology and three measures of depression. Eighty-one drug-free inpatients with acute schizophrenia were assessed with the positive and negative syndrome scale (PANSS), the Calgary depression scale for schizophrenia (CDSS), and the Hamilton rating scale for depression (HAM-D). The depressive subscale of PANSS (PANSS-D) was also considered as a third scale for measuring depression. A principal component analysis (PCA) of PANSS items identified five clinical dimensions of schizophrenia called ‘negative’, ‘positive’, ‘anxio-depressive’, ‘excitement’, and ‘disorganisation and others’. Our anxio-depressive dimension (PANSS-ad) was strictly identical with the PANSS-D. Scores on CDSS and HAM-D were highly inter-correlated and highly correlated with the PANSS-ad. Furthermore, while scores on CDSS were correlated only with this dimension, scores at HAM-D were also positively correlated with the negative dimension and negatively correlated with the excitement dimension. In conclusion, our results suggest that PANSS evaluation itself may be sufficient to give a correct approximation of the depression in patients with schizophrenia. However, depression scales are of course needed to assess specifically depressive symptoms in patients with schizophrenia; hence, the CDSS could be a more specific instrument than HAM-D.

Multiple dimensions of recovery in early psychosis

Recovery is a complex individual process that unfolds over time and involves multiple dimensions. We propose operational criteria for defining recovery in five symptom dimensions and two functional dimensions including an overall functional dimension that we characterize as 'return to the life line'. The multi-dimensional model was used to organize the results gathered from 103 clients, not previously treated with antipsychotic medications, who enrolled in the Nova Scotia Early Psychosis Program and completed one year of treatment for schizophrenia or a related psychotic disorder.The subjects were assessed with the Positive and Negative Syndrome Scale (PANSS), the Global Assessment of Function scale (GAF) and the Social and Occupational Functional Assessment scale (SOFA) prior to starting antipsychotic medication and again at six and 12 months of treatment. After one year of treatment, 67% of subjects met our criterion for symptomatic recovery (no relevant PANSS item greater than 'mild') for both positive and negative symptoms. Forty-two percent met the recovery criteria for all five symptom dimensions. Most of the symptom improvement occurred during the first six months of treatment. At one year, 50% of subjects met our criterion (SOFA greater than 60) for overall functional recovery ('return to the life line'). Operational criteria can be applied to ratings from commonly used standardized scales to determine the percentages of clients achieving recovery in multiple symptom and functional dimensions. For clients completing the first year of treatment in an early psychosis program, approximately half achieve recovery in all dimensions.

Validation of the behavioural activity rating scale (BARS)™: a novel measure of activity in agitated patients

We report psychometric results of the Behavioural Activity Rating Scale (BARS™) using data from three Phase III clinical trials of intramuscular ziprasidone in acutely agitated patients with psychosis (Studies 1 and 2) or in stable psychotic patients (Study 3). Convergent validity and divergent validity were assessed with baseline data from Studies 1 and 2 in subjects with acute agitation. To investigate convergent validity, we sought Pearson and Spearman correlation of BARS™ scores with scores on the Clinical Global Impression of Severity (CGI-S) Scale and a predefined cluster of agitation-related items from the Positive and Negative Syndrome Scale (PANSS). For divergent validity, we sought Pearson and Spearman correlation between BARS™ scores and a predefined cluster of PANSS items measuring negative symptoms. Discriminant validity was investigated with the help of subjects with moderate psychopathology (Study 3). Wilcoxon rank-sum and two-sample t tests determined whether mean (or median) BARS™ scores differed between subjects with acute agitation (Studies 1 and 2) and moderate psychopathology (Study 3). Responsiveness to treatment effect and rater reliability were also evaluated. In Study 2, Pearson correlation coefficients of BARS™ scores with PANSS agitation items and CGI-S were moderate ( convergent validity) and statistically significant ( P<0.005). The correlation between BARS™ scores and PANSS negative component scores was low ( divergent validity). Treatment effect size was larger for BARS™ than for PANSS agitation items and CGI-S ( responsive to treatment differences). Virtually perfect inter- and intra-rater reliability was achieved. Study 1 produced similar results. BARS™ showed psychometrically valid properties for measurement of behavioral activity in acutely agitated patients with psychosis.

Safety of the novel antipsychotic olanzapine in the treatment of bipolar I disorder

Background: We sought to develop and validate an excitement subscale from the Positive and Negative Syndrome Scale (PANSS) to allow the investigation of mania-like excitement symptoms in clinical trials of patients with schizophrenia using the PANSS and to provide clinicians with a short assessment tool for these states. Methods: Baseline PANSS data from six double-blind, randomized registration trials of olanzapine, three in schizophrenia and three in acute bipolar mania, were used in these post-hoc analyses. Schizophrenia study data were pooled and randomly split in half. Exploratory principal component factor analysis was performed on half of the data. Factors were extracted based on minimum eigenvalue criteria (eigenvalue≥1); loadings were determined using an equamax rotation. Confirmatory principal component factor analysis was performed on the other half of the data, retaining the original number of factors. Principal component factor analysis was also done for the pooled bipolar studies. Change in the new mania-like factor scores was then correlated with Young Mania Rating Scale (Y-MRS) scores in each bipolar study. Results: Exploratory principal components analysis on the pooled schizophrenia data extracted five factors: negative, positive, excitement, cognitive, and depressive factors. The mania-like excitement factor was represented by four items (uncooperativeness, poor impulse control, excitement, and hostility), with only moderate loadings by tension and suspiciousness/persecution. Results were similar in the confirmatory analysis and the pooled bipolar studies. Change from baseline to endpoint for the mania-like factor correlated reasonably well (0.64–0.78) with change in Y-MRS scores in the bipolar studies. At baseline, bipolar patients scored higher than patients with schizophrenia on three of four PANSS mania-like factor items: poor impulse control, excitement, and hostility; the converse was true for most other PANSS items. Conclusion: Factor analyses of the PANSS consistently uncovered an excitement factor including uncooperativeness, poor impulse control, excitement, and hostility items. This factor may be useful in examining manic symptoms in studies where the addition of a scale specific to mania would be burdensome and where symptoms of excitement are part of the clinical presentation.

Validation of the behavioural activity rating scale (BARS): A novel measure of activity in agitated patients

We report psychometric results of the Behavioural Activity Rating Scale (BARS) using data from three Phase III clinical trials of intramuscular ziprasidone in acutely agitated patients with psychosis (Studies 1 and 2) or in stable psychotic patients (Study 3). Convergent validity and divergent validity were assessed with baseline data from Studies 1 and 2 in subjects with acute agitation. To investigate convergent validity, we sought Pearson and Spearman correlation of BARS scores with scores on the Clinical Global Impression of Severity (CGI-S) Scale and a predefined cluster of agitation-related items from the Positive and Negative Syndrome Scale (PANSS). For divergent validity, we sought Pearson and Spearman correlation between BARS scores and a predefined cluster of PANSS items measuring negative symptoms. Discriminant validity was investigated with the help of subjects with moderate psychopathology (Study 3). Wilcoxon rank-sum and two-sample t tests determined whether mean (or median) BARS scores differed between subjects with acute agitation (Studies 1 and 2) and moderate psychopathology (Study 3). Responsiveness to treatment effect and rater reliability were also evaluated. In Study 2, Pearson correlation coefficients of BARS scores with PANSS agitation items and CGI-S were moderate (convergent validity) and statistically significant (P<0.005). The correlation between BARS scores and PANSS negative component scores was low (divergent validity). Treatment effect size was larger for BARS than for PANSS agitation items and CGI-S (responsive to treatment differences). Virtually perfect inter- and intra-rater reliability was achieved. Study 1 produced similar results. BARS showed psychometrically valid properties for measurement of behavioral activity in acutely agitated patients with psychosis.

Improvement of inter-rater reliability of PANSS items and subscales by a standardized rater training.

The present evaluation focused on the inter-rater reliability of single items and subscales of the Positive and Negative Syndrome Scale (PANSS) before and after a standardized rater training. The results of two independent studies comprising n=23 (study I) and n=12 (study II) psychiatrists and videotaped interviews with schizophrenic patients were analysed. Chance-corrected coefficients of rating agreement with expert standards (weighted kappa) were computed for single items and subscales of the PANSS. The results clearly demonstrate the importance of rater trainings. After three training sessions, 90% of the PANSS items reached an acceptable level of reliability (kappa(w)>0.40) in both evaluated studies, and for 80% of the PANSS items values of kappa(w)>0.60 were achieved.

P300 and the thought disorder factor extracted by factor-analytic procedures in schizophrenia

Background: In order to clarify the clinical significance of P300 as a biologic marker that can reflect schizophrenic symptomatology, many previous studies have evaluated the relationship of P300 with the symptoms on the basis of a positive/negative dichotomy, but yielded inconsistent conclusions. Such a dichotomy has been criticized as being too reductionistic. Recently, most studies with factor–analytic procedures have extracted some symptom factors outside this dichotomy. Therefore, it is important to examine associations of P300 with the symptom factors extracted by these statistical analyses. Methods: In the present study, the amplitudes of P300 were measured by using an auditory oddball paradigm for 73 schizophrenics whose psychopathology was assessed with the Positive and Negative Syndrome Scale (PANSS). Results: The principal component analysis of the PANSS items revealed five factors labeled the thought disorder, negative, hostile/excitable, delusional/hallucinatory, and depressive factors. The score for the thought disorder factor correlated negatively with the amplitude of P300 recorded at Pz, T5, and T6, but that for the other factors did not. Conclusions: These findings suggest that the reduction of P300 amplitudes recorded at the midline parietal and bilateral temporoparietal regions may be one of the electrophysiologic indices representing the thought disorder clinically observed in schizophrenia.

Validity of assessment of schizophrenic basic symptoms

A study on the concept and measurement of the basic disorders of schizophrenia is presented. A total of 151 male adult psychiatric inpatients (51 with a dual diagnosis of schizophrenia and alcoholism, 50 schizophrenics and 50 alcoholics) were included. The aims of this study were: (1) the replication of the previous finding that the Frankfurt Complaint Questionnaire (FBF) contains items that discriminate between schizophrenia and alcoholism; (2) an empirical comparison between FBF and the Bonn Scale for the Assessment of Basic Symptoms (BSABS); (3) testing the relationship between basic and negative versus positive symptoms, as measured by the Positive and Negative Syndrome Scale (PANSS). Regarding (1), the former result was replicated. Regarding (2), FBF subscales and BSABS categories were shown to be significantly but weakly related, even if identical symptoms were included in the inquiry. Regarding (3), FBF and BSABS were found to be more closely related to negative than to positive PANSS items. Theoretical implications and consequences for further research are discussed.