Innovations In Clinical Neuroscience

NOV-DEC 2017

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

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10 ICNS INNOVATIONS IN CLINICAL NEUROSCIENCE November-December 2017 • Volume 14 • Number 11–12 R E V I E W T These are the generations of Shem: Shem was an hundred years old, and begat Arphaxad two years after the flood: And Shem lived after he begat Arphaxad five hundred years, and begat sons and daughters: And Arphaxad lived five and thirty years, and begat Salah: And Arphaxad lived after he begat Salah four hundred and three years, and begat sons and daughters. And Salah lived thirty years, and begat Eber. —Genesis, Chapter 11, King James Version (1611 copyright expired) This issue of Innovations in Clinical Neuroscience reviews the Positive and Negative Syndrome Scale (PANSS) on the occasion of the 30-year anniversary of the first publication of the PANSS. 1 Included articles look both at the remarkable utility of the scale in the development of new antipsychotic medications and other treatments in schizophrenia and psychotic disorders as well as to consider its future. The goal of this contribution is to consider some of the origins of the PANSS. UNIFORM LIKERT SCALING Sixteen of the 30 items in the PANSS come from the original Brief Psychiatric Rating Scale (BPRS). 2 The BPRS itself was derived from longer and earlier scales developed by Maurice Lorr and his colleagues—the Inpatient Multi- dimensional Psychiatric Scale (IMPS) and the Multidimensioal Scale for Psychopathology (MSPP). 3–5 The IMPS, which was used in some of the earliest studies of antipsychotic (then neuroleptic) medications in schizophrenia, included 75 items. As was common in rating scales in those days, the scaling was not uniform among items; some were scaled along a severity dimension and some offered simple "yes" or "no" options. The BPRS introduced the uniform 7-point Likert scaling for all items and the naming of the rated scale points that continues in the PANSS. Although the severity anchors in the BPRS are uniform, ranging from 1 (not at all) to 7 (extremely severe), the anchor points themselves were not defined. ASSESSMENT SPECIFICIT Y The "items" in the BPRS are actually factor names that were conferred by the researchers on the factors that they extracted from the IMPS and MSPR. The resulting factor analyses yielded 14 factors that were augmented by two additional items deemed critical by a panel of experts assembled to rate the new scale that John Overall (an experimental psychologist) and Don Gorham (a clinical psychologist) were developing. The two added items were Unusual Thought Content (Item G9 in the PANSS) and Blunted Affect (Item N1 in the PANSS). The 1962 Overall and Gorham article divided the items into two broad groups: those to be evaluated by observation and those that required direct questioning. They also included some relatively extended descriptions of what to look for and what to ask about. Tension. It should be noted that the construct "tension" is restricted in the Brief Scale to physical and motor signs commonly associated with anxiety. Tension does not involve the subjective experience or mental A B S T R A C T The systematic assessment of signs and symptoms of psychopathology has roots that date back to rating scale development that began in the 1950s. This article reviews some of those rating scales. The focus is on the Brief Psychiatric Rating Scale, which is the most important precursor of the Positive and Negative Symptom Rating Scale. KEYWORDS: The Positive and Negative Syndrome Scale, PANSS, the Brief Psychiatric Rating Scale, BPRS, 7-point Likert scale, factor analysis of data, psychometrics, schizophrenia, symptom assessment Precursors to the PANSS: The BPRS and its progenitors by NINA R. SCHOOLER, PhD Dr. Schooler is Professor of Psychiatry at SUNY Downstate Medical Center in Brooklyn, New York. Innov Clin Neurosci. 2017;14(11–12):10–11 FUNDING: No funding was provided for this article. DISCLOSURES: The author has no financial conflicts relevant to the content of this article. CORRESPONDENCE: Nina R. Schooler, PhD; Email: nina.schooler@gmail.com

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