Innovations In Clinical Neuroscience

NOV-DEC 2017

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

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Page 11 of 83

12 ICNS INNOVATIONS IN CLINICAL NEUROSCIENCE November-December 2017 • Volume 14 • Number 11–12 R E V I E W O Our rating scales, diagnostic instruments, and psychometric tools are not created in a vacuum; rather, they are products of their time, with input from culture, biases, and what is considered to be state of the art in psychopathology and psychopharmacology at the time of their development in. The Positive and Negative Syndrome Scale (PANSS) is no exception. It was developed during a time in which negative symptoms were gaining broad acceptance as separate constructs of schizophrenia, and the scale was utilized in the first wave of studies for the earliest second- generation antipsychotics. The PANSS and other instruments like it affect and are affected by how we conceptualize mental illness. The purpose of this review is twofold: first, to provide a historical narrative of the events that led to the creation of the PANSS, and second, to identify some of the implicit and overt cultural assumptions and statements that have played a role in the development of this psychometric instrument. THE RISE OF MENTAL DISORDER AWARENESS IN THE UNITED STATES By the mid-1940s, there was growing awareness in the United States of the extent and severity of mental disorders. By 1944, nearly half of the individuals dismissed from the armed services were discharged for reasons of mental health, a far greater loss of manpower than that seen due to influenza, battle wounds, malaria, or any other single illness. 1 Data from the selective service records echoe this at-the-time profound revelation: mental illness was listed as the sixth most common "defect" among service members, with a prevalence rate of 55.8 per 1,000 men. 2 This discovery, for the United States government, was more than simply a health crisis but also a crisis of training and education, economics, and, most importantly, a crisis that posed a threat to national security. If the incidence of mental illness, particularly psychosis, appeared so abundantly among a subgroup of the country's population, how prevalent might it be across the nation as a whole? Congress signed the National Mental Health Act in 1946, and, on April 15, 1949, the National Institute for Mental Health was formally established. The year 1946 also saw the establishment of the Clinical Psychology Section and the Psychiatry and Neurology Sections in the Veterans Administration (VA) Central Office to oversee and respond specifically to treatment efforts and ongoing research in VA hospitals and regional offices across the country. A B S T R A C T ABSTRACT: Psychometric instruments are products of their time— Their designs and initial purposes are influenced and shaped by the contemporary treatment regimens, context, and cultural and conceptual biases of their developers. In this review article, the authors explore the history of the most influential schizophrenia research tools that have been created over the past several decades. The authors describe the scientific concepts, cultural influences, and challenges of past and present researchers as they strive to develop better assessment tools for schizophrenia. Starting with Moore's Scheme for the Quantitative Measurement of Abnormal Emotional Condition, developed in the early 1900s, and concluding with Kay, Fiszbein, and Opler's Positive and Negative Syndrome Scale, developed in the 80s, the authors describe several scales and illustrate how each scale led to and influenced the development of a later scale. The authors hope that a better understanding of schizophrenia assessment tool evolution and limitations will assist in the development of new instruments that better address the global needs for the evaluation, research, and treatment of psychosis. KEYWORDS: Positive and Negative Syndrome Scale (PANSS), Brief Psychiatric Rating Scale (BPRS), Inpatient Multidimensional Psychiatric Scale (IMPS), Multidimensional Scale for Rating Psychiatric Patients (MSRPP), psychometrics, symptoms, psychosis A Developmental History of the Positive and Negative Syndrome Scale (PANSS) by STAC Y LIECHTI, PhD; GIANNA CAPODILUPO, MA; DOUGLAS J. OPLER, MD; MARK OPLER, PhD, MPH; and LAWRENCE H. YANG, PhD Dr. Liechti is Lead Research Consultant at the PANSS Institute in New York, New York. Ms. Capodilupo is Research Assistant at MedAvante-ProPhase in New York, New York. Dr. D. Opler is Assistant Professor in the Department of Psychiatry at Rutgers New Jersey Medical School in Newark, New Jersey. Dr. Opler is Adjunct Assistant Professor at NYU School of Medicine and Chief Research Officer at MedAvante-ProPhase Inc. in New York, New York. Dr. Yang is Associate Prrofessor of Social and Behavioral Sciences at New York University in New York, New York. Innov Clin Neurosci. 2017;14(11–12):12–17 FUNDING: No funding was provided for this article. DISCLOSURES: The authors have no financial conflicts relevant to the content of this article. CORRESPONDENCE: Gianna Capodilupo, MA; Email:

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