Positive And Negative Syndrome Scale Ratings Research Articles

Testing a Motor Score Based on PANSS Ratings: A Proxy for Comprehensive Motor Assessment.

Abnormal psychomotor behavior is a core schizophrenia symptom. However, assessment of motor abnormalities with expert rating scales is challenging. The Positive and Negative Syndrome Scale (PANSS) includes 3 items broadly related to hypokinetic motor behavior. Here, we tested whether a sum score of the PANSS items mannerisms and posturing (G5), motor retardation (G7), and disturbance of volition (G13) corresponds to expert ratings, potentially qualifying as a proxy-marker of motor abnormalities. Combining baseline datasets (n = 196) of 2 clinical trials (OCoPS-P, BrAGG-SoS), we correlated PANSS motor score (PANSSmot) and 5 motor rating scales. In addition, we tested whether the cutoff set at ≥3 on each PANSS motor item, ie, "mild" on G05, G07, and G13 (in total ≥9 on PANSSmot) would differentiate the patients into groups with high vs low scores in motor scales. We further sought for replication in an independent trial (RESIS, n = 102), tested the longitudinal stability using week 3 data of OCoPS-P (n = 75), and evaluated the validity of PANSSmot with instrumental measures of physical activity (n = 113). PANSSmot correlated with all motor scales (Spearman-Rho-range 0.19-0.52, all P ≤ .007). Furthermore, the cutoff set at ≥3 on each PANSS motor item was able to distinguish patients with high vs low motor scores in all motor scales except using Abnormal Involuntary Movement Scale (Mann-Whitney-U-Tests: all U ≥ 580, P ≤ .017). Our findings suggest that PANSSmot could be a proxy measure for hypokinetic motor abnormalities. This might help to combine large datasets from clinical trials to explore whether some interventions may hold promise to alleviate hypokinetic motor abnormalities in psychosis.

Ecological momentary assessment (EMA) combined with unsupervised machine learning shows sensitivity to identify individuals in potential need for psychiatric assessment

Ecological momentary assessment (EMA), a structured diary assessment technique, has shown feasibility to capture psychotic(-like) symptoms across different study groups. We investigated whether EMA combined with unsupervised machine learning can distinguish groups on the continuum of genetic risk toward psychotic illness and identify individuals with need for extended healthcare. Individuals with psychotic disorder (PD, N = 55), healthy individuals (HC, N = 25) and HC with first-degree relatives with psychosis (RE, N = 20) were assessed at two sites over 7 days using EMA. Cluster analysis determined subgroups based on similarities in longitudinal trajectories of psychotic symptom ratings in EMA, agnostic of study group assignment. Psychotic symptom ratings were calculated as average of items related to hallucinations and paranoid ideas. Prior to EMA we assessed symptoms using the Positive and Negative Syndrome Scale (PANSS) and the Community Assessment of Psychic Experience (CAPE) to characterize the EMA subgroups. We identified two clusters with distinct longitudinal EMA characteristics. Cluster 1 (NPD = 12, NRE = 1, NHC = 2) showed higher mean EMA symptom ratings as compared to cluster 2 (NPD = 43, NRE = 19, NHC = 23) (p < 0.001). Cluster 1 showed a higher burden on negative (p < 0.05) and positive (p < 0.05) psychotic symptoms in cross-sectional PANSS and CAPE ratings than cluster 2. Findings indicate a separation of PD with high symptom burden (cluster 1) from PD with healthy-like rating patterns grouping together with HC and RE (cluster 2). Individuals in cluster 1 might particularly profit from exchange with a clinician underlining the idea of EMA as clinical monitoring tool.

Are informants required to obtain valid ratings on the Positive and Negative Syndrome Scale (PANSS)?

Ratings on the Positive and Negative Syndrome Scale (PANSS) are ideally based on both a patient interview and an informant questionnaire. In research and clinical settings, however, the informant questionnaire is often omitted. This study investigated the consequences of omitting informant information by comparing PANSS ratings of patients with schizophrenia (n = 49 patients, 77 ratings) conducted with and without informant information, respectively. Additionally, changes in symptom severity over time based on ratings with and without informant information were also compared for the full PANSS and the six-item version of the PANSS (PANSS-6). PANSS ratings including informant information were higher than those without, both at the total score and individual item level. Additionally, the full PANSS appeared less “responsive” to baseline-to-endpoint changes for ratings without informant information compared to ratings including informant information, while no differences were found for the PANSS-6.

Site-independent confirmation of primary site-based PANSS ratings in a schizophrenia trial

Blinded, site-independent (remote) ratings from audio-digital recordings of site-based Positive and Negative Syndrome Scale (PANSS) interviews were obtained in a 5-week, randomized, double-blinded study assessing the safety, tolerability, and efficacy of KarXT (a fixed combination of xanomeline and trospium chloride) in hospitalized adults with schizophrenia experiencing an acute exacerbation of psychosis (EMERGENT-1; ClinicalTrials.gov identifier: NCT3697252). The blinded site-independent raters had no knowledge of site location, study visit, drug vs. placebo assignment, or any treatment emergent adverse events (TEAEs). Concordance analyses of 561 paired site-based and site-independent PANSS ratings across all visits revealed a high correlation (ICC = 0.775). Paired scoring differences were positively correlated with the PANSS total score (Spearman's rho = 0.37, p < 0.0001). Paired PANSS scores were available from 148 subjects at both the baseline and end of study visits (KarXT = 72, Placebo = 76). Site-based PANSS total scores (primary aim) revealed a significantly greater improvement from baseline in the KarXT group compared to the placebo group (p < 0.0001). The blinded site-independent PANSS total scores derived from listening to and scoring the recorded site-based PANSS interviews replicated this finding (p < 0.001) and yielded an overall predictive value of 85.1% for matching the site-based response/non-response outcomes. TEAE's have the potential to “unblind” site-based ratings. In this study, the site-independent raters were blinded to TEAEs, affirmed the site-based PANSS ratings, and mitigated concerns about possible functional unblinding of site-based raters. This method of blinded assessment via audio-digital recordings may have utility for other studies concerned with ratings precision and/or functional unblinding.

Longitudinal invariance of the positive and negative syndrome scale negative dimension in antipsychotic naïve first-episode schizophrenia.

Construct stability over time is required for reliable inference, but evidence regarding the longitudinal invariance of negative symptoms is still limited. Thus, we examined the longitudinal invariance of the negative dimension using the positive and negative syndrome scale (PANSS) in an antipsychotic-naïve first-episode schizophrenia sample at baseline and after 10 weeks. Our study was conducted at a specialized early intervention service. PANSS ratings were analysed for 138 patients, and two different models were specified and tested: a unidimensional and a two-correlated factor solution. The unidimensional model fulfilled criteria for longitudinal invariance, whilst the two-correlated did not. Our study provides support for the PANSS negative unidimensional model use to evaluate negative symptoms' longitudinal change following first-episode schizophrenia.

Exploring the Factorial Structure of the Clinician-Rated Dimension of Psychosis Symptom Severity (CRDPSS-DSM-5) in Patients with Schizophrenia

The present study aimes to explore the factorial structure and the internal consistency of the Clinician-Rated Dimension of Psychosis Symptom Severity (CRDPSS) on a sample of Saudi schizophrenic patients. The sample consisted of 160 participants: 80 schizophrenic patients their ages ranged between 18 and 60 years old (M= 33.82 &amp; SD= 9.70), and 80 participants as a matched group their ages ranged between 18 and 63 years old (M= 33.94 &amp; SD= 9.12). The following measurements were utilized: 1- Positive and Negative Syndrome Rating Scale (PANSS), 2- Brief Psychiatric Rating Scale (BPRS), and 3- the CRDPSS. The results indicated that the CRDPSS comprised three factors (positive symptoms, negative/cognitive symptoms, and affective symptoms. Furthermore, the results revealed that the CRDPSS has significantly discriminate between disordered and normal participants. Moreover, the results showed that the convergent validity of the CRDPSS with PANSS and BPRS. Finally, the CRDPSS has showed significant high internal consistency.

Reduced synchronized brain activity in schizophrenia during viewing of comedy movies

Previous evaluation of brain function in schizophrenia has focused on standard experimental tasks, with cerebral response to natural stimuli less clear. This study employed inter-subject correlation (ISC) analysis to investigate the neural basis of humor processing during free viewing of comedy movies in patients with schizophrenia. We recruited 29 patients diagnosed with schizophrenia and 29 healthy, age- and sex-matched controls. Each participant underwent fMRI scanning during two viewings of three comedy movie clips. The ISC map from each participant pair within each population group and each movie viewing was separately derived. The significance of ISC within a group and between two groups were assessed by bootstrapping. The ISC map from each patient pair were also correlated with the product of Positive and Negative Syndrome Scale (PANSS) rating between the same participant pair in schizophrenia patients. Schizophrenia patients showed significant ISC in bilateral lateraloccipital, bilateral superior frontal, left supramarginal, and right lateralorbiofrontal cortices. Compared with the controls, the schizophrenia group exhibited significantly lower ISC in the left superior temporal sulcus, bilateral supramarginal, and bilateral inferiorparietal cortices. Higher clinical severity (higher total PANSS rating) was associated with lower ISC in the middle frontal and middle temporal regions, and also higher ISC in the visual cortex, inferior temporal gyrus, and anterior cingulate. The findings indicated that patients with schizophrenia are characterized by lower ISC in a frontal parietal network while viewing comedy film clips, which implicated a deficit in the cognitive component of humor processing. The lower synchronization in parts of the frontal parietal network also correlated with symptom severity.

SA26. Increase in Set-Shifting Abilities After Illness Onset in Patients With Schizophrenia (a 7- to 16-Year Follow-Up Study)

Abstract Background: Deficits in set shifting have been identified in schizophrenia, reflecting rigidity in problem solving, for example, not using feedback to change behavior. The aim of this study was to examine potential long-term development of set-shifting abilities for schizophrenia patients and their associations with psychopathology, both at baseline (BL) and at follow-up (FU). Methods: In a longitudinal follow-up study, we reexamined 33 initially antipsychotic-naive patients with schizophrenia and 43 healthy controls 7–16 years after illness onset, on their set-shifting abilities using the Intra-Extra Dimensional Set Shifting Task from Cambridge Neuropsychological Test Automated Battery. Positive, negative, and general symptoms in the patient group were assessed with the Positive and Negative Syndrome Rating Scale (PANSS) at BL and FU. We used a univariate analysis of covariance in a preliminary analysis of change scores on both extra-dimensional shift (EDS) errors and total errors (adjusted for stages not completed) with the following covariates: age, sex, baseline level performance, and the time interval between BL and FU examinations (7–16 years). Difference between PANSS subscores (positive, negative, and general) at BL and FU scores was assessed with repeated measures test. We used Spearman’s correlation analysis between PANSS composite scores and EDS errors, and total errors adjusted at BL and FU. Results: We found a significant group difference in change scores of EDS errors (P = .025) and total errors adjusted (P = .049). Patients showed increased performances (less errors) when compared to controls who remained relatively stable (mean EDS error change for patients = −3.2 (SD = 10.8) and controls = −0.7 (SD = 4.2) and mean total errors adjusted change for patients = −5.1 (SD = 23.3), controls = −1.5 (SD = 8.3)).There was a significant decline in PANSS positive scores (BL = 19.7 (SD = 4.3), FU = 14.4 (SD = 5.5), t(31) = 4.9, P < .001), negative scores (BL = 21.6 (SD = 4.6), FU= 17.5 (SD = 6.2), t(31) = 3.3, P = .002), and total scores (BL = 77.6 (SD = 12.2), FU = 65.2 (SD = 1.6), t(31) = 3.6; P = .001) and a nonsignificant decrease in PANSS general scores (BL = 36.3 (SD = 7.9), FU = 33.4 (SD = 7.9), t(31) = 1.48 (P = 0.15)). We did not find significant correlation between symptom dimension and EDS errors or total errors adjusted, neither at BL nor at FU. Conclusion: The preliminary results show a longitudinal increase in set-shifting abilities in the years following onset of schizophrenia compared to a relative stability of set-shifting abilities in the healthy control group. Set-shifting deficits could not be linked to psychopathology. Support of work: The study was supported a by grant (R25-A2701) from the Lundbeck Foundation. The funding bodies had no role in the design or conduct of the study.

Social anxiety disorder co-morbid with schizophrenia: a cross-sectional study from India

Introduction: The co-morbidity of various psychiatric disorders with schizophrenia (SZ) is increasingly being recognized, with anxiety disorders (ADs) being no exception. Among the various ADs, the co morbidity of social anxiety disorder (SAD) and SZ is not well studied. We hypothesized that the prevalence of SAD in SZ is high. Objective: We aimed to study the prevalence of SAD in patients with SZ, and to determine the associated socio-demographic and clinical correlates. Materials and methods: This was an outpatient study on consecutively sampled 64 International Diagnostic Criteria (ICD-10) diagnosed treatment-naive SZ patients, who were rated on the Positive and Negative Syndrome Scale (PANSS), the Social Interaction Anxiety Scale (SIAS), the WHO-5 Well-Being Index (WHO-5) and the Global Assessment of Functioning Scale (GAF). Results: The prevalence of SAD in or sample of SZ patients was 26.56%. Compared to the SZ without SAD group, the SZ with SAD group had a lower quality of life (QoL) and GAF scores, but, no significant difference in the PANSS ratings. Conclusions: The SAD is highly co morbid with SZ, and appears to be independent of psychosis, and is associated with lower QoL and psychosocial functioning. Future follow-up studies should evaluate whether this SAD co-morbidity has any impact on the treatment outcome of SZ.

Initiative for capacity building in academic psychiatry in India: The E-Journal Club of the Indian Psychiatric Society.

Byline: T. Sathyanarayana Rao, Chittaranjan. Andrade The previous issue of the Indian Journal of Psychiatry carried an editorial [sup][1] which observed that India does not have adequate psychiatric manpower, that there are few psychiatric centers in the country that are strongly oriented toward academics and research, and that, in consequence, many psychiatric centers with an interest in research may not have the necessary skills to demonstrate or create excellence in research. The editorial [sup][1] further observed that sustained exposure to good quality research in high ranking journals, combined with the development of the ability to critically evaluate a study and its place in the field, are together necessary to drive the desired improvements. The editorial [sup][1] referred to an initiative that was in the pipeline at the time of writing. This initiative sought to develop an e-platform for discussing and imparting training in research-related issues in the field of mental health and the allied neurosciences, linking postgraduate and academic psychiatry departments across the country. We are delighted to announce that, during the second week of March, 2015, the E-Journal Club (eJCIndia) initiative was successfully launched by the Task Force of the Indian Psychiatric Society on Psychopharmacology, along with the Task Force of the Indian Psychiatric Society on Workshops and Training, and with the support of the Department of Psychopharmacology at the National Institute of Mental Health and Neurosciences, Bengaluru. As of the first week of April, 2015, the e-group already has nearly 200 members, comprising postgraduate students, postgraduate teachers, and psychiatrists who are interested in academia even though their practice is not part of an academic environment. The eJCIndia group has completed several activities. The first activity presented an extract from the results of a meta-analysis [sup][2] and invited the membership to comment on whether they would alter their clinical practice based on a highlighted statistically significant finding. After discussion, an answer was provided that explained concepts in meta-analysis, aspects related to schizophrenia rating using the Positive and Negative Syndrome Scale (PANSS), and the clinical significance (as distinct from statistical significance) of a difference in PANSS ratings. Another activity sought to stimulate critical thought by examining paradoxes in the pillars of homeopathy, a school of treatment that enjoys popularity in India and elsewhere. Homeopathy considers that the administration of a diluted dose of a substance that produces a symptom will treat that symptom when that symptom occurs as part of an illness; the greater the dilution, the greater the efficacy of the treatment. It was discussed that the water that we drink has, in the past, come in contact with thousands of chemicals. This water, to use a concept in homeopathy, will therefore contain of those chemicals. Hence, water should be therapeutic for every disease! Alternately, how do we know that the memories in the water that we drink won't cancel out the memories of the homeopathic medicines? Then, what about the solvent that was used for the dilution of the homeopathic treatment; that would also have previously come in contact with plenty of substances with therapeutic or adverse effect potential, resulting with the potential to interact with the homeopathic substance(s). …

Equipercentile linking of scales measuring functioning and symptoms: Examining the GAF, SOFAS, CGI-S, and PANSS

The Global Assessment of Functioning (GAF) and the Social and Occupational Functioning Assessment Scale (SOFAS) are rating scales commonly used to assess the level of functioning in patients with schizophrenia. To understand the correspondence of scores between GAF and SOFAS, and what they mean from a clinical point of view, we examined the linkage of (a) GAF with SOFAS total scores, (b) GAF with Clinical Global Impressions Scale (CGI) and Positive and Negative Syndrome Scale (PANSS), and (c) SOFAS with CGI and PANSS. We used the equipercentile linking method to identify corresponding scores of simultaneous GAF, SOFAS, PANSS and CGI ratings in 1208 patients from a naturalistic European cohort study. Data were collected at baseline and at months 6, 12, 18 and 24. GAF and SOFAS total scores were found to be practically exchangeable. Both scales had strong negative correlations with CGI and PANSS; the linkage also suggested the presence of slight impairment in functioning even when patients are free from symptoms. These findings are important for the comparison of scores when different rating scales are used. We present a detailed conversion table in an online supplement.

Is the PANSS cognitive scale measuring cognition?

Objective: To investigate the association between the Positive and Negative Syndrome Scale (PANSS) cognitive factors and cognition assessed by neuropsychological tests. Method: Ninety patients with a psychotic illness, the majority having a schizophrenia diagnosis, were assessed with PANSS ratings and tested by a comprehensive computerized neuropsychological test battery, EuCog. Results: Test performance was in the normal range for some of the cognitive indices, but substantially reduced for others, compared with norms, particularly speed-based indices. PANSS ratings were non-specifically associated with cognitive indices representing performance (speed and accuracy) and problem solving strategies (executive functions). There was no discriminant validity for the cognitive factor. A regression analysis suggested that the PANSS cognitive factors reflected verbal IQ but no other cognitive domain like memory, attention or speed. Conclusion: Cognitive test performance is associated with psychopathology as assessed by PANSS items but in a non-specific way. The PANSS cognitive subscale seems to reflect over-learned verbal skills rather than the cognitive domains, which are known to be specifically affected in schizophrenia and relevant for the prognosis. Consequently, PANSS ratings cannot replace the information inherent in neuropsychological test data. The extensive speed problem of patients with schizophrenia should be studied in more detail using test batteries that focus on that problem.

Symptom structure and severity: A comparison of responses to the positive and negative syndrome scale (PANSS) between patients with PTSD or schizophrenia

ObjectivesTo describe and compare the structure and relative severity of symptoms in clinical trial patients diagnosed with Post Traumatic Stress Disorder (PTSD) or schizophrenia using the Positive and Negative Syndrome Scale (PANSS), developed originally to evaluate symptoms of schizophrenia. MethodThis secondary data analysis used baseline PANSS symptom ratings (n=267) from a six-month multicenter randomized placebo-controlled trial of adjunctive risperidone in patients with chronic military-related PTSD. First, using a split-half design, Exploratory Factor Analysis (EFA) was employed to identify independent factors which were then compared to published factor structures for schizophrenia. Next, Confirmatory Factor Analysis (CFA) was applied to the second half of the sample to compare the results of the EFA and published factor structures. Finally, T-tests were used to compare the severity of factor scores between the PTSD sample and the baseline PANSS ratings from the Clinical Antipsychotic Trial for Intervention Effectiveness (CATIE) schizophrenia sample (n=1460). ResultsEFA suggested five factors similar to those identified in a summary of 29 schizophrenia studies by Wallwork (Schizophrenia Research, 137:246–250). CFA showed that the five factor Wallwork model fit the data better than the EFA, although both had relatively high goodness of fit. T-tests showed that the PTSD sample had more severe symptoms on the Depressive factor, and the schizophrenia sample on the Positive, Negative, and Disorganized factors, with no significant difference on the Excited factor. ConclusionVeterans with PTSD had similar symptom structure to patients with schizophrenia on the PANSS, but were less symptomatic on psychosis-related factors and more symptomatic on depression. Dimensional symptom factors can be virtually the same across diagnoses.

Distinct Molecular Phenotypes in Male and Female Schizophrenia Patients

BackgroundIn schizophrenia, sex specific dimorphisms related to age of onset, course of illness and response to antipsychotic treatment may be mirrored by sex-related differences in the underlying molecular pathways.Methodology/Principal FindingsHere, we have carried out multiplex immunoassay profiling of sera from 4 independent cohorts of first episode antipsychotic naive schizophrenia patients (n = 133) and controls (n = 133) to identify such sex-specific illness processes in the periphery. The concentrations of 16 molecules associated with hormonal, inflammation and growth factor pathways showed significant sex differences in schizophrenia patients compared with controls. In female patients, the inflammation-related analytes alpha-1-antitrypsin, B lymphocyte chemoattractant BLC and interleukin-15 showed negative associations with positive and negative syndrome scale (PANSS) scores. In male patients, the hormones prolactin and testosterone were negatively associated with PANSS ratings. In addition, we investigated molecular changes in a subset of 33 patients before and after 6 weeks of treatment with antipsychotics and found that treatment induced sex-specific changes in the levels of testosterone, serum glutamic oxaloacetic transaminase, follicle stimulating hormone, interleukin-13 and macrophage-derived chemokine. Finally, we evaluated overlapping and distinct biomarkers in the sex-specific molecular signatures in schizophrenia, major depressive disorder and bipolar disorder.Conclusions/SignificanceWe propose that future studies should investigate the common and sex-specific aetiologies of schizophrenia, as the current findings suggest that different therapeutic strategies may be required for male and female patients.

Equipercentile linking of the BPRS and the PANSS

The Positive and Negative Syndrome Scale (PANSS) and the Brief Psychiatric Rating Scale (BPRS) are the most frequently used scales to rate the symptoms of schizophrenia. There are many situations in which it is important to know what a given total score or a percent reduction from baseline score of one scale means in terms of the other scale. We used the equipercentile linking method to identify corresponding scores of simultaneous BPRS and PANSS ratings in 3767 patients from antipsychotic drug trials. Data were collected at baseline and at weeks 1, 2, 4 and 6. BPRS total scores of 18, 30, 40 and 50 roughly corresponded to PANSS total scores of 31, 55, 73 and 90, respectively. An absolute BPRS improvement of 10, 20, 30, 40 points corresponded to a PANSS improvement of 15, 32, 50, and 67. A percentage improvement of the BPRS total score from baseline of 19%, 30%, 40% and 50% roughly corresponded to percentage PANSS improvement of 16%, 25%, 35%, and 44%. Thus a given PANSS percent improvement was always lower than the corresponding BPRS percent improvement, on the average by 4–5%. A reason may be the higher number of items used in the PANSS. These results are important for the comparison of trials that used these rating scales. We present a detailed conversion table in an online supplement.

Evaluation of the factor structure of symptoms in patients with schizophrenia

Considering the widespread use of the Positive and Negative Syndrome Scale (PANSS) and its factors around the world in clinical trials, it is clearly necessary to perform a transcultural validation of the factor structure of the PANSS. The purpose of the present study was to examine the PANSS factor structure in a Korean sample of subjects with schizophrenia. A total of 150 outpatients were assessed using the PANSS and other clinical rating scales. Principal component analyses revealed five factors, i.e., negative, cognitive/disorganization, positive, excitement, and depression/anxiety dimensions, which accounted for 64.1% of the total variance. All five factors showed good internal consistency, suggesting that the reliability of the factors extracted was adequate. Significant correlations were found between the five components of the PANSS and the corresponding clinical rating scales. The results of the present study indicate that the five-factor model best fit the data from our patients and that it was validated transculturally. The factor structures should be further validated using various neurobiological methods to ultimately help in clarifying the heterogeneity and pathogenesis of symptomatology in schizophrenia.

Does Clinical Judgment of Baseline Severity and Changes in Psychopathology Depend on the Patient Population?

Linking of the Clinical Global Impression (CGI) Scale and the Positive and Negative Syndrome Scale (PANSS) was performed within a naturalistic sample. Furthermore, these linking results were compared with those derived from randomized controlled trials to examine if the baseline severity might influence the linking results. Biweekly PANSS and CGI ratings were performed from admission to discharge in 398 schizophrenia patients treated within a naturalistic study. Equipercentile linking was performed using the statistical program, R 2.8.1. To evaluate how the naturalistic study design would influence linkage results, a so-called study sample was computed with patients of the naturalistic study fulfilling common inclusion criteria of randomized controlled trials (n = 199). Patients not fulfilling these criteria (less ill sample) and those fulfilling the criteria (study sample) were compared using confidence intervals. We found a considerable difference between the linking of the CGI severity score and the PANSS total score comparing the less ill sample and the study sample. Being considered "mildly ill" at admission in the less ill sample corresponded to a PANSS total score of 47 points and to a PANSS total score of 67 points in the study sample. Considering the linking of the CGI improvement score and PANSS changes, similar results were found for CGI improvement ratings ranging from "very much improved" to "minimally improved". Despite considerable differences, a 50% PANSS reduction was found to correspond to a clinical rating of much improved, which seems to be a suitable definition for response in clinical drug trials.

Prise en charge médicamenteuse de l’anxiété chez le patient souffrant de schizophrénie

Anxiety is a major and frequent symptom of schizophrenia, which is associated with an increased risk of relapse, impaired functioning, lower quality of life and increased incidence of suicide attempts. Despite its clinical relevance, anxiety in schizophrenia remains poorly understood. In the prodromic phase, anxiety indicates a progression towards psychotic decompensation. After a first episode, it is an indicator of relapse. Two approaches have been used to investigate anxiety in schizophrenia: (i) categorical approach (comorbidity of schizophrenia and anxiety disorders) and (ii) dimensional approach (anxiety as a major symptom of the "dysphoric" dimension). Clinical categorical studies reported an increased frequency of comorbidity between schizophrenia and obsessive-compulsive disorder, panic disorder, social phobia, post-traumatic stress disorder, generalized anxiety disorder, agoraphobia, and specific phobia. The dimensional approach proposes that five different factors contribute to the structure of the Positive and Negative Syndrome Scale (PANSS), with anxiety as a major symptom of the "dysphoria" dimension. Concerning diagnosis, it is unclear whether psychotic and neurotic anxiety differs in nature or intensity. Nevertheless, both are frequently opposed. Psychotic anxiety is intense, profound and hermetic. In contrast to neurotic anxiety, it is associated with psychomotor disturbances, such as agitation and sideration. There is no specific tool to evaluate anxiety in schizophrenia. The dimensional approach usually runs an evaluation using items or factors extracted from the most widely-used scales, i.e. PANSS or Brief Psychiatric Rating Scale (BPRS) or from anxiety scales developed in non-schizophrenic populations, such as the Hamilton Anxiety Scale (HAMA). Recently, we developed a specific scale for hetero-evaluation (Échelle Anxiété Schizophrénie [EAS scale]). The EAS scale was recently validated and the study of its sensitivity is ongoing. THERAPEUTICAL ISSUES: Several studies have examined the effects of antipsychotics on the anxious/depressive cluster extracted from the PANSS, and some other studies have specifically evaluated the effect of antipsychotics on depressive symptoms using the Montgomery and Asberg Depression Rating Scale (MADRS) and Calgary Depression Scale for Schizophrenia (CDSS), but to our knowledge, no study has reported the effect of antipsychotics or other treatment on anxiety when using a schizophrenia-specific scale. There are no specific guideline treatments for anxiety in schizophrenia. Among phenothiazines, cyamemazine is frequently prescribed in France, because of its potent anxiolytic activity and good neurological tolerance. Some authors have suggested a specific treatment with benzodiazepines. However, benzodiazepines should be used with caution, due to undesirable actions such as dependence, rebound and potentiation of certain lateral effects.

Revisiting the 5 Dimensions of the Positive and Negative Syndrome Scale

The Positive and Negative Syndrome Scale (PANSS) is a widely used instrument to measure severe psychopathology in schizophrenia. Recently, its widely accepted 5-factor solution is questioned using confirmatory factor analysis (CFA). This article examines the appropriateness of applying CFA to PANSS data and the dimensionality of the PANSS in a large sample of persons with chronic schizophrenia, schizophreniform disorder, and schizoaffective disorder. Data reduction was conducted on PANSS baseline assessments from 2 multicenter clinical trials consisting of 1284 persons' available PANSS data at baseline and Week 8. Supplementary analyses were conducted for separate trials and for noncompleters at baseline (n = 1872). Examination of the data indicated that the statistical requirements of CFA (eg, multivariate normality) were not met by the data. Multidimensional scaling and a scree plot of principal components superimposed on simulated random data converged to indicate that 5 dimensions are generally a parsimonious fit to the PANSS at baseline, whereas 4 dimensions emerged after 8 weeks of treatment. The components included negative symptoms, positive symptoms, disorganized (baseline only), anxiety/depression, and excited. The results demonstrate realistic alternatives to CFA when studying the PANSS, support a 5-component model of PANSS ratings at baseline, and indicate that the structure of symptoms change after 8 weeks of treatment. These results seem to be robust because they generally replicate within trials for completers and at baseline for the entire sample.

Aggression and Quantitative MRI Measures of Caudate in Patients With Chronic Schizophrenia or Schizoaffective Disorder

Caudate dysfunction is implicated in schizophrenia. However, little is known about the relationship between aggression and caudate volumes. Forty-nine patients received magnetic resonance imaging scanning in a double-blind treatment study in which aggression was measured. Caudate volumes were computed using a semiautomated method. The authors measured aggression with the Overt Aggression Scale and the Positive and Negative Syndrome Scale. Larger caudate volumes were associated with greater levels of aggression. The relationship between aggression and caudate volumes may be related to the iatrogenic effects of long-term treatment with typical antipsychotic agents or to a direct effect of schizophrenic processes on the caudate.