Innovations In Clinical Neuroscience

NOV-DEC 2017

A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience

Issue link: http://innovationscns.epubxp.com/i/924986

Contents of this Issue

Navigation

Page 67 of 83

68 ICNS INNOVATIONS IN CLINICAL NEUROSCIENCE November-December 2017 • Volume 14 • Number 11–12 C O M M E N T A R Y T The most widely used measure of the symptom severity of schizophrenia in clinical studies is the Positive and Negative Syndrome Scale (PANSS), 1 which was published in 1987. PANSS was created by merging 12 items from the Psychopathology Rating Schedule 2 with the 18-item Brief Psychiatric Rating Scale (BPRS). 3 Due to the large number of items (30 in total), the structured clinical interview for PANSS (SCI-PANSS) often takes an hour or more to administer—and is occasionally impossible to complete in the case of patients in very severe states of illness. For these reasons, the 30-item PANSS is not ideal for routine use in most clinical practice settings and has remained a research tool, despite evidence that supports its use to help characterize, predict, and manage the course of illness. 4,5 To help bring the power of rating scales to clinical practice, an abbreviated set of instruments and an accompanying assessment schedule are required that will allow for a quick and valid measurement of symptom severity of core dimensions of schizophrenia across research and clinical practice settings. 6 In this commentary, we will make the argument that valid measurements of schizophrenia symptom severity can likely be obtained by rating the six-item subscale of PANSS (PANSS-6) 7–10 and other clinician-rated outcomes using the recently developed, stand-alone Simplified Negative and Positive Symptoms Interview (SNAPSI). FROM PANSS TO PANSS-6 In a first study based on data from two large randomized controlled trials in schizophrenia, 11,12 we identified PANSS-6 by means of item response theory analysis. 7 A B S T R A C T ABSTRACT: There is currently a "measurement gap" between research and clinical care in schizophrenia. The main reason behind this gap is that the most widely used rating scale in schizophrenia research, the 30-item Positive and Negative Syndrome Scale (PANSS), takes so long to administer that it is rarely used in clinical practice. This compromises the translation of research findings into clinical care and vice versa. The aim of this paper is to discuss how this measurement gap can be closed. Specifically, the main points of discussion are 1) the practical problems associated with using the full 30-item PANSS in clinical practice; 2) how the brief, six-item version of the Positive and Negative Syndrome Scale (PANSS-6) was derived empirically from the full 30-item PANSS and what the initial results obtained with PANSS-6 entail; and 3) how PANSS-6 ratings, guided by the newly developed, 15–25-minute, stand-alone Simplified Negative and Positive Symptoms Interview (SNAPSI), might help bridge the measurement gap between research and clinical care in schizophrenia. The full 30-item PANSS is often used in research studies, but is too time consuming to allow for routine clinical use. Recent studies suggest that the much briefer PANSS-6 is a psychometrically valid measure of core positive and negative symptoms of schizophrenia and that the scale is sensitive to symptom improvement following pharmacological treatment. SNAPSI is a brief interview that yields the information needed to rate PANSS-6 (and other brief rating scales). We believe that PANSS-6 ratings guided by SNAPSI will help bridge the measurement gap between research and clinical care in schizophrenia. KEYWORDS: Schizophrenia, psychometrics, rating scale, measurement-based care Bridging the Measurement Gap Between Research and Clinical Care in Schizophrenia: Positive and Negative Syndrome Scale-6 (PANSS-6) and Other Assessments Based on the Simplified Negative and Positive Symptoms Interview (SNAPSI) by SØREN D. ØSTERGAARD, MD, PhD; MARK G. A. OPLER, PhD, MPh; and CHRISTOPH U. CORRELL, MD Dr. Østergaard is Associate Professor at Aarhus University in Denmark. Dr. Opler is Adjunct Assistant Professor at NYU School of Medicine and Chief Research Officer at MedAvante-ProPhase, Inc. Dr. Correll is Medical Director of the Recognition and Prevention program at the Zucker Hillside Hospital in Glenn Oaks, New York, and Professor at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell in Hempstead, New York, and the Charité Universitätsmedizin, Department of Child and Adolescent Psychiatry, Berlin, Germany. Innov Clin Neurosci. 2017;14(11–12):68–72 FUNDING: No funding was provided for this article. DISCLOSURES: The home institution of SD Østergaard (Aarhus University) holds one-third of the copyright for the Simplified Negative and Positive Symptoms Interview (SNAPSI). Dr. Correll has been a consultant and/or advisor to or has received honoraria from: Alkermes, Allergan, Bristol-Myers Squibb, Gerson Lehrman Group, IntraCellular Therapies, Janssen/J&J, LB Pharma, Lundbeck, Medavante, Medscape, Neurocrine, Otsuka, Pfizer, Sunovion, Takeda, and Teva. He has provided expert testimony for Bristol-Myers Squibb, Janssen, and Otsuka. He served on a Data Safety Monitoring Board for Lundbeck and Pfizer. He received grant support from Takeda. The home institution of Dr. Correll (The Feinstein Institute for Medical Research, Manhasset, New York, USA) holds one-third of the copyright for the SNAPSI. The home institution of Dr. Opler (MedAvante-ProPhase Inc.) holds one-third of the copyright for the SNAPSI. Dr. Opler also has received grant funding from US NIMH, the Brain and Behavior Foundation (formerly NARSAD), the Stanley Research Foundation, and the Qatar National Research Fund. CORRESPONDENCE: Søren D. Østergaard MD, PhD; Email: soeoes@rm.dk

Articles in this issue

Links on this page

Archives of this issue

view archives of Innovations In Clinical Neuroscience - NOV-DEC 2017