Innovations In Clinical Neuroscience

NOV-DEC 2017

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

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71 ICNS INNOVATIONS IN CLINICAL NEUROSCIENCE November-December 2017 • Volume 14 • Number 11–12 C O M M E N T A R Y obtained by means of SNAPSI is an empirical question that we will be addressing in a study to be launched in the fall of 2017. In this study, inpatients with schizophrenia will be interviewed by two independent raters (in a random order). One rater will conduct the SCI-PANSS and subsequently rate the patient on the full 30-item PANSS. The other rater will conduct SNAPSI and rate on PANSS-6. These "sets" of interviews and ratings will be performed two times—as close to admission and as close to discharge, respectively, as possible—to also allow testing of PANSS-6 for sensitivity to change in severity of illness. If the PANSS-6 scores obtained following SNAPSI correspond to the PANSS-6 extracted from the full PANSS, it is safe to assume that the very promising results of the PANSS-6 studies published so far 7,8,10 are valid—and that SNAPSI is a valid way of obtaining information on core schizophrenia symptom severity in relation to PANSS-6 rating. SNAPSI AND PANSS-6 MAY BRIDGE THE GAP BET WEEN RESEARCH AND CLINICAL CARE One issue that complicates the translation of research findings into clinical care is that in research studies, procedures and outcome measures are very different from those used in clinical care settings. 6,22 Because of this, it can be difficult for clinicians to apply research findings to their populations and integrate them into their management of patients. In this context, another potential application of the SNAPSI–PANSS-6 combination is in relation to measurement-based care in real- world settings (i.e., treatment approaches that are guided by quantitative measures of psychopathology). In a recent study, it was demonstrated that measurement-based care significantly improved the treatment of depression as compared to treatment as usual. 23 There is no reason to believe that this should be different for the treatment of schizophrenia. 6 However, a brief and valid rating scale to measure symptom levels— thereby allowing the treating psychiatrist to make measurement-based treatment choices in collaboration with the patient—has been lacking. As outlined above, we believe that PANSS-6 rating, guided by SNAPSI, is a prime candidate to fill this current void. REFERENCES 1. Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull. 1987;13(2):261– 276. 2. Singh MM, Kay SR. A comparative study of haloperidol and chlorpromazine in terms of clinical effects and therapeutic reversal with benztropine in schizophrenia. Theoretical implications for potency differences among neuroleptics. Psychopharmacologia. 1975;43(2):103–113. 3. Overall JE, Gorham DR. The Brief Psychiatric Rating Scale. Psychol Rep. 1962;10(3):799–812. 4. Best MW, Grossman M, Oyewumi LK, Bowie CR. Examination of the Positive and Negative Syndrome Scale factor structure and longitudinal relationships with functioning in early psychosis. Early Interv Psychiatry. 2016;10(2):165–170. 5. Samara MT, Leucht C, Leeflang MM, et al. Early improvement as a predictor of later response to antipsychotics in schizophrenia: a diagnostic test review. Am J Psychiatry. 2015;172(7):617–629. 6. Correll CU, Kishimoto T, Nielsen J, Kane JM. Quantifying clinical relevance in the treatment of schizophrenia. Clin Ther 2011;33(12):B16–B39. 7. Østergaard SD, Lemming OM, Mors O, et al. PANSS-6: a brief rating scale for the measurement of severity in schizophrenia. Acta FIGURE 4. Illustration of the similarity of the trajectories of Positive and Negative Syndrome Scale-6 (PANSS-6) and full PANSS (PANSS-30) scores during the Clinical Antipsychotic Trials for Intervention Effectiveness (CATIE) Phase I study, stratified by treatment. The figure shows estimated polynomials of order three describing trajectories of PANSS-30 and PANSS-6 scores with treatment (weeks from baseline) as measured by the log(ratio to baseline). The models included drug-specific coefficients—four parameters for each drug—and were adjusted for tardive dyskinesia (SET 2 and SET 3) and exacerbation (all four sets). The SETs refer to those used for pairwise drug-comparisons in the CATIE publication by Lieberman et al. 14 The comparison between pairs of drugs was carried out by the four degrees of freedom likelihood ratio test of the null hypothesis that all two times four coefficients in the polynomials shown above were equal. The results showed that PANSS-6 and PANSS-30 identified the exact same statistically significant (Bonferroni-adjusted level = 0.005) differences in antipsychotic efficacy, namely that olanzapine was superior to risperidone (p-value PANSS-6 = 0.0003 and p-value PANSS-30 = 0.0003) and ziprasidone (p-value PANSS-6 = 0.0018 and p-value PANSS-30 = 0.0046). This figure and the figure text is reproduced from Østergaard et al. 8 with permission from the publisher via RightsLink.

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