Innovations In Clinical Neuroscience

NOV-DEC 2017

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

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70 ICNS INNOVATIONS IN CLINICAL NEUROSCIENCE November-December 2017 • Volume 14 • Number 11–12 C O M M E N T A R Y separate the effects of typical and atypical antipsychotics from each other and from that of placebos. 7,8 PANSS-6 therefore represents a promising alternative to the full PANSS. There is, however, a critical limitation to the studies on PANSS-6 that have been conducted so far, namely that PANSS-6 was extracted from the results of studies in which ratings on all 30 PANSS items were obtained. 11,12,14 Therefore, it remains an open question as to whether it is possible to obtain sufficient information for PANSS-6 rating via a brief and focused interview, which is a prerequisite for the advantage of PANSS-6 over more comprehensive rating scales, such as the BPRS 3 or the full 30-item PANSS. Until recently, no brief interview with the possibility of extracting the information needed for PANSS-6 rating was available. Additionally, most interview guides are specific to an underlying scale (i.e., built only to gather information necessary to rate a single instrument). There is a need for a highly efficient interview that works in clinical settings, allows clinicians to gather data to support several ratings simultaneously, and is useful across clinical disciplines (e.g., psychiatry, nursing, social work). To meet this need, we have developed the Simplified Negative and Positive Symptoms Interview (SNAPSI). The SNAPSI is an assessment guide that includes probes and structures modeled on both standard semi-structured tools, such as the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders 17 and the BPRS, as well as newer tools for the evaluation of negative symptoms, such as the Brief Negative Symptoms Scale (BNSS), 18 the Negative Symptoms Assessment (NSA), 19 and functional assessments such as the Personal and Social Performance Scale. 20 For example, in addition to standard probes for delusional ideas, and hallucinations, SNAPSI contains a section that asks the participant to describe emotional states directly and a section on task sequencing that allows for a direct and more efficient evaluation of thought disorder than passive observation. Additionally, a well-integrated assessment section for caregivers adds an important component, clearly delineating how to evaluate collateral information from third- party sources. In addition to enabling rating on PANSS-6, SNAPSI can be used to: (1) collect information to rate selected items from the BPRS 3 ; (2) to supplement evaluations of negative symptoms, including those considered in the BNSS 18 or the NSA 19 ; and (3) to facilitate standardized rating on global severity rating scales such as the Clinical Global Impression Severity and Improvement Scales. 21 In the "feasibility tests" that we have conducted, the final version of the SNAPSI (patient section) has taken approximately 15–25 minutes to administer (by raters who are unfamiliar with the interview and involving patients hearing the questions for the first time). The informal feasibility tests were conducted by seven clinical raters (three medical doctors, one psychologist, and three research assistants) at two hospitals in the United States and one hospital in Denmark, respectively. The raters simply interviewed the patients using the SNAPSI and tested whether they themselves and the patients with schizophrenia or schizoaffective disorder (n = 16 in total) understood the questions—and whether the targeted psychopathology was covered sufficiently to allow for quantitative rating after the interview. The feedback from the feasibility tests led to minor revisions of the SNAPSI. The final version of SNAPSI is freely available for non-commercial clinical and academic use (please email the following address for further information: snapsi@ medavante-prophase.com). Whether valid PANSS-6 ratings can be FIGURE 3. Correlation between Positive and Negative Syndrome Scale-6 (PANSS-6) and full PANSS (PANSS-30) total scores in the Clinical Antipsychotic Trials for Intervention Effectiveness (CATIE) study. The correlation between PANSS-6 total scores and PANSS-30 total scores from the entire CATIE study (ratings=5,081) was performed by means of Spearman correlation analysis. For PANSS-6 and PANSS-30, we also assessed the correlation between the 1) relative change in total score (current total score – baseline score)/baseline score); 2) total score ratio to baseline (current total score/baseline score); and 3) log (ratio to baseline) (i.e. log(current total score/ baseline total score), which corresponds to: log (current total score) - log (baseline total score). These three correlations were based on 3,929 ratings (i.e., 5,081 ratings minus the baseline ratings). This figure and the figure text is reproduced from Østergaard et al. (8) with permission from the publisher via RightsLink.

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