Innovations In Clinical Neuroscience

NOV-DEC 2017

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

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73 ICNS INNOVATIONS IN CLINICAL NEUROSCIENCE November-December 2017 • Volume 14 • Number 11–12 R E V I E W T The Positive and Negative Syndrome Scale (PANSS), a well-established scale for measuring symptom severity in schizophrenia, 1 evaluates 30 separate items grouped in positive, negative, and general psychopathology subscales. The PANSS has been translated and validated in numerous languages 2,3 and is considered the world- wide "gold standard" for the measurement of symptoms of schizophrenia. The PANSS is predominantly used as an outcome measure for the evaluation of psychopharmacological and nonpsychopharmacologial treatment interventions in schizophrenia. The scale was created by merging the 18-item Brief Psychiatric Rating Scale 4 with 12 items from the Psychopathology Rating Schedule. 5 These items were essentially added in order to capture negative symptoms and general psychopathology symptoms. Advantages of a shorter PANSS. Generally, the administration and scoring of the PANSS, which includes the use of a semi- structured clinical interview (SCI-PANSS 6 ), can take up to 50 minutes, placing a burden on both patient and rater/clinician. Thus, researchers and clinicians have long been interested in the development of a shorter version of the PANSS that can measure the severity of symptoms in schizophrenia and take less time to administer. In addition, a shorter version of the PANSS offers the possibility of using the same tool in clinical care as is used in research. Another, more fundamental reason for developing a brief version of the PANSS is based on the failure to replicate a common factor structure underlying the current 30 PANSS items across different patient samples. Since the original five-factor model was published, 9 many more factor analyses have been published with varying numbers of factors, varying numbers of items assigned to factors, and varying levels of goodness- of-fit data. Even the widely used Marder model, 10 which contains all 30 PANSS items, performed poorly as measured by the goodness-of-fit statistics (root mean square error of approximation [RMSEA] and the confirmatory fit index [CFI]). In contrast, the pentagonal model 11 performed well using only 25 PANSS items in the confirmatory factor analysis (CFA). However, more recently, a study examined 25 published five-factor models on a new dataset containing nearly 6,000 patients from clinical trials, finding unsatisfactory fit indices. 12 Wallwork et al 13 examined 29 published models with a new patient sample; again, none fit the data well. Interestingly, Hayashi et al 14 reported that using fewer than half of the PANSS items produced the most resilient models. These findings suggest that a shorter PANSS containing fewer items (but not necessarily A B S T R A C T ABSTRACT: The Positive and Negative Syndrome Scale (PANSS) is a well-established assessment tool for measuring symptom severity in schizophrenia. Researchers and clinicians have been interested in the development of a short version of the PANSS that could reduce the burden of its administration for patients and raters. The author presents a comprehensive overview of existing brief PANSS measures, including their strengths and limitations, and discusses some possible next steps. There are two available scales that offer a reduced number of original PANSS items: PANSS-14 and PANSS-19; and two shorter versions that include six items: Brief PANSS and PANSS-6 . The PANSS-6 has been tested quite extensively in established trials and appears to demonstrate high sensitivity to change and an established cut off definition for remission. Prospective testing in new antipsychotic treatment trials is still required for these shorter versions of PANSS. In addition, they need to be supplemented with interview guides, as well as provide conversion formulas to translate total scores from the short PANSS versions to the PANSS-30. Both short versions of the PANSS are essentially designed to evaluate response to antipsychotic treatment. Future PANSS scale development needs to address specific measurement of treatment-responsive positive symptoms by including treatment-sensitive items, as well as illness- phase specific PANSS tools. KEYWORDS: Positive and Negative Syndrome Scale, PANSS, Brief PANSS, PANSS-6, schizophrenia, patient assessment Are Shorter Versions of the Positive and Negative Syndrome Scale (PANSS) Doable? A Critical Review by JEAN-PIERRE LINDENMAYER, MD Dr. Lindenmayer is Clinical Professor of the Department of Psychiatry at the NYU School of Medicine in New York, New York. Innov Clin Neurosci. 2017;14(11–12):73–76 FUNDING: No funding was provided for this article. DISCLOSURES: The author has no financial conflicts relevant to the content of this article. CORRESPONDENCE: Jean-Pierre Lindenmayer, MD; Email: Jean-Pierre.Lindenmayer@NKI.rfmh.org

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