Antipsychotic-placebo separation on the PANSS-6 subscale as compared to the PANSS-30: a pooled participant-level analysis

AbstractIn order for measurement-based care to be implemented, there is a need for brief rating instruments that can be administered in a short amount of time, but that are still sufficiently informative. Here, we assessed the drug–placebo sensitivity of the six-item subscale (PANSS-6) of the 30-item Positive and Negative Syndrome Scale (PANSS-30) using a large collection of patient-level data (n = 6685) from randomized controlled trials of risperidone and paliperidone. When analyzing the data by study, we found no material difference in mean effect sizes (ES) between the two measures (PANSS-30 ES = 0.45, PANSS-6 ES = 0.44; p = 0.642). Stratifying the pooled population according to several putative effect moderators (e.g., age, formulation, dose, or diagnosis) generally yielded no meaningful ES differences between the two measures. Similarly, early improvement (≥20% improvement at week 1) on the PANSS-6 predicted subsequent response (≥40% improvement at endpoint) as well as the analog prediction using PANSS-30. Finally, cross-sectional symptom remission assessed via the PANSS-6 showed very good agreement (sensitivity = 100%, specificity = 98%) with cross-sectional symptom remission defined by the Remission in Schizophrenia Working Group.

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S244. RELIABILITY OF CORE SCHIZOPHRENIA SYMPTOMS RATINGS USING THE SIX-ITEM POSITIVE AND NEGATIVE SYNDROME SCALE (PANSS-6) PERFORMED BY MEDICAL STUDENTS

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa031.310 ◽

2020 ◽

Vol 46 (Supplement_1) ◽

pp. S131-S132

Author(s):

Johanna Hansen ◽

David Dines ◽

Mark Opler ◽

Ole Mors ◽

Søren D Østergaard ◽

...

Keyword(s):

Medical Students ◽

Training Program ◽

Clinical Experience ◽

Gold Standard ◽

Rating Scales ◽

Sufficient Information ◽

Percent Agreement ◽

Syndrome Scale ◽

Measurement Based Care ◽

Negative Syndrome

Abstract Background Assessing and monitoring the severity of illness is an essential component of the measurement-based treatment of schizophrenia. The six-item Positive And Negative Syndrome Scale (PANSS-6) is a psychometrically valid scale, which allows for a brief and valid assessment of the severity of core symptoms of schizophrenia via the Simplified positive And Negative Symptoms interview (SNAPSI). The use of the PANSS-6 in a clinical setting requires raters to obtain reliable and valid ratings. The aim of the study was to determine the amount of training needed for raters with no or very little clinical experience to perform reliable PANSS-6 ratings. Methods A total of 89 5th year medical students, divided in 4 groups, which were enrolled in a 4-week mandatory internship in the psychiatric unit of Aarhus University Hospital were invited to participate in the training program. Out of 89 students 58% (n=52) participated. The training program contained 9 hours of standardized training. All participants performed a baseline rating of a SNAPSI patient interview before the display of a theoretical introduction video to SNAPSI and the principles of PANSS-6 rating. Following the theoretical introduction, the students individually rated another 5 SNAPSI patient videos. After each SNAPSI video, an expert consensus-video was displayed. The order of the SNAPSI and corresponding consensus videos was randomized between the 4 different groups of students. The PANSS-6 ratings performed by the students were compared to gold standard ratings performed by a certified PANSS-rater and psychiatrist at different time-points during the training. Agreements were calculated by using percent agreement. Results The percent agreement between the students and the gold standard on the PANSS-6 total score improved from time 1 (baseline) to time 4 (after the theoretical introduction video and 3 SNAPSIs) from 88% to 100%. Discussion In conclusion, medical students with very limited clinical experience were able to perform reliable PANSS-6 ratings of SNAPSI patient interviews after participating in a brief standardized training program. Future studies should assess whether raters with very limited clinical experience are able to conduct the SNAPSI and extract sufficient information for PANSS-6 rating. This would render the possibility of using medical students as PANSS-6 raters in clinical practice to remedy the shortage of psychiatrists and to allow for measurement-based care, which requires systematic administration of symptom rating scales to drive clinical decision making.

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Nicotine dependence and illness severity in schizophrenia

The British Journal of Psychiatry ◽

10.1192/bjp.bp.111.107953 ◽

2012 ◽

Vol 201 (4) ◽

pp. 306-312 ◽

Cited By ~ 53

Author(s):

Rajeev Krishnadas ◽

Sameer Jauhar ◽

Susan Telfer ◽

Somashekara Shivashankar ◽

Robin G. McCreadie

Keyword(s):

Nicotine Dependence ◽

Social Adjustment ◽

Symptom Severity ◽

Clinical Symptoms ◽

Cross Sectional ◽

Syndrome Scale ◽

Never Smokers ◽

Negative Syndrome ◽

The Relationship ◽

Higher Doses

BackgroundReasons for the increased prevalence of cigarette smoking in schizophrenia are unclear. Studies assessing clinical symptoms have sampled heterogeneous populations, with discrepant findings.AimsTo examine the relationship between clinical features, social adjustment and nicotine dependence in a geographically defined population of people with schizophrenia.MethodCross-sectional clinical study of 131 people with schizophrenia in Nithsdale, Scotland.ResultsSmokers were younger, mostly males and three times more likely to be unemployed. Those with severe nicotine dependence had greater scores on the positive subscale of the Positive and Negative Syndrome Scale (PANSS), and were prescribed higher doses of antipsychotic. Those with mild–moderate dependence had greater scores on the PANSS negative subscale. Greater symptom severity was associated with poorer social adjustment. Psychopathology and social adjustment were similar in quitters and never-smokers.ConclusionsOur findings indicate an association between nicotine dependence, clinical symptoms and social adjustment in schizophrenia. Although causal links cannot be inferred, identifying the relationship between nicotine dependence and psychopathology may have some value in the management of smoking in schizophrenia. Further longitudinal studies are required to explore this relationship.

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Brain-Derived Neurotropic Factor Serum Level and Severity Symptom of Bataknese Male Patients with Schizophrenia in North Sumatera, Indonesia

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2019.550 ◽

2019 ◽

Vol 7 (12) ◽

pp. 1957-1961

Author(s):

Deasy Hendriati ◽

Elemeida Effendy ◽

Mustafa Mahfud Amin ◽

Vita Camellia ◽

Muhammad Surya Husada

Keyword(s):

Serum Level ◽

Negative Correlation ◽

Symptom Severity ◽

Negative Symptoms ◽

Chronic Schizophrenia ◽

Serum Levels ◽

Cross Sectional ◽

Syndrome Scale ◽

Male Patients ◽

Negative Syndrome

BACKGROUND: Schizophrenia is a severe mental disorder that is multi-causative and multi-factor, generally affecting about 1% of the population. The elevation level of brain-derived neurotrophic factor (BDNF) offers several protections from other neurodegenerative processes that occur in schizophrenia since this deficit of neurotrophic factors can contribute to changes in brain structure and function that underlie the schizophrenia psychopathology.AIM: To analyse the correlation between BDNF serum levels and symptom severity by using the Positive and Negative Syndrome Scale (PANSS) instrument in Bataknese male patients with schizophreniaMETHODS: This study was a correlative analytical study with a cross-sectional approach using the Positive and Negative Syndrome Scale (PANSS) instrument to assess symptom severity with 60 subjects of Bataknese male patients with chronic schizophrenia. Moreover, this research was conducted at the Psychiatric Hospital of Prof. Dr M. Ildrem Medan, Indonesia. BDNF serum was analysed with the Quantitative sandwich enzyme immunoassay technique by via Quantikine ELISA Human CXCL8/IL-8 HS. Also, the data analysis was performed through Spearman's correlative bivariate analytics using SPSS software.RESULTS: A negative correlation between the BDNF serum level and the negative scale PANSS score in men with schizophrenia (r = -0.820, p < 0.001) was found. Moreover, there is a negative correlation between BDNF serum levels and PANSS total scores in men with schizophrenia (r = -0.648, p < 0.001)CONCLUSION: BDNF serum level in Bataknese male patients with schizophrenia has a relationship that affects the severity of symptoms in schizophrenic patients, especially for negative symptoms.

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Prevalence and correlates of antipsychotic polypharmacy among outpatients with schizophrenia attending a tertiary psychiatric facility in Nigeria

Therapeutic Advances in Psychopharmacology ◽

10.1177/2045125316672134 ◽

2016 ◽

Vol 7 (1) ◽

pp. 3-10 ◽

Cited By ~ 4

Author(s):

Nosa Godwin Igbinomwanhia ◽

Sunday Osasu Olotu ◽

Bawo Onesirosan James

Keyword(s):

Psychosocial Functioning ◽

Side Effect ◽

Negative Symptoms ◽

Rating Scale ◽

Cross Sectional Study ◽

Global Assessment Of Functioning ◽

Psychiatric Facility ◽

Cross Sectional ◽

Syndrome Scale ◽

Negative Syndrome

Background: The study aimed to determine the prevalence, pattern and correlates of antipsychotic polypharmacy (APP) among outpatients with schizophrenia attending a tertiary psychiatric facility in Nigeria. Method: A cross-sectional study of 250 patients with schizophrenia attending the outpatient clinic of a regional tertiary psychiatric facility in Nigeria was undertaken. They were administered a sociodemographic questionnaire, the Positive and Negative Syndrome Scale (PANSS), the Global Assessment of Functioning (GAF) scale and the Liverpool University Side Effects Rating Scale (LUNSERS). Results: Of the 250 subjects interviewed, 176 (70.4%) were on APP. APP was significantly associated with higher prescribed chlorpromazine equivalent doses of antipsychotics ( p < 0.001), increased frequency of dosing ( p < 0.001), negative symptoms ( p < 0.01), poorer functioning ( p = 0.04) and greater side-effect burden ( p = 0.04). Conclusion: The APP rate reported from this study is high. Clinicians should be mindful of its impact on dosage and side-effect profiles as APP use is associated with negative symptoms and poor psychosocial functioning.

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An early improvement threshold to predict response and remission in first-episode schizophrenia

The British Journal of Psychiatry ◽

10.1192/bjp.bp.109.069328 ◽

2010 ◽

Vol 196 (6) ◽

pp. 460-466 ◽

Cited By ~ 30

Author(s):

R. Schennach-Wolff ◽

F. H. Seemüller ◽

A. Mayr ◽

W. Maier ◽

S. Klingberg ◽

...

Keyword(s):

Predictive Validity ◽

Area Under The Curve ◽

First Episode ◽

Early Improvement ◽

Score Improvement ◽

Syndrome Scale ◽

Definition Of ◽

First Episode Schizophrenia ◽

Negative Syndrome ◽

First Episode Of Schizophrenia

BackgroundEarly improvement with treatment is thought to be important in patients with first-episode schizophrenia, yet a valid definition is still outstanding.AimsTo develop a valid definition of early improvement and test its predictive validity regarding response and remission.MethodWe examined 188 in-patients with first-episode schizophrenia. Early improvement was defined as improvement in Positive and Negative Syndrome Scale (PANSS) total score at week 2, response as a 40% PANSS total score improvement at end-point, and remission according to consensus criteria.ResultsReasonable predictive validity of early improvement was found for a 46% PANSS total score improvement at week 2 and a 50% improvement for remission (area under the curve: response 0.707, remission 0.692). Estimated confidence intervals ranged from 26 to 62% PANSS reduction for response and remission.ConclusionsPatients with a first episode of schizophrenia should improve by at least 30% in PANSS total score at week 2 to achieve response and remission.

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Anxiety sensitivity depending on presence of positive symptoms in psychosis

European Psychiatry ◽

10.1016/s0924-9338(11)73088-7 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 1383-1383

Author(s):

E. Fernândez-Jiménez ◽

J. Pastor-Morales ◽

V. Sanz-Largo ◽

E. Castillo-Gordillo ◽

F. Rivas-Marîn

Keyword(s):

Anxiety Sensitivity ◽

Self Report ◽

Rehabilitation Service ◽

General Factor ◽

Positive Symptoms ◽

Cross Sectional ◽

Syndrome Scale ◽

Cross Sectional Design ◽

Mental Health Rehabilitation ◽

Negative Syndrome

IntroductionAn important corpus of scientist evidence is linking psychotic activity and anxiety-related processes (Freeman and Garety, 2003).ObjectivesWe intended to assess differences in Anxiety Sensitivity dimensions between patients diagnosed by psychosis with and without positive symptoms.MethodsParticipants: 49 patients with DSM psychosis diagnosis (42 men and 7 women; mean age: 40), who attended a Mental Health Rehabilitation Service in 2008, of whom 24 patients had positive symptomatology.Design, materials and procedure: A Cross-sectional design (one measurement) for a co-relational method of comparison between groups.We used the Spanish validated Anxiety Sensitivity lndex-3 -ASI 3- (Sandîn et al, 2007), a 18-item Likert self-report that assesses fears of anxious symptoms. It presents a hierarchical structure (a general factor and three subscales -Physical, Cognitive and Social Concerns-). It's also used the first and third items (delusions and hallucinatory behaviour) of The Positive and Negative Syndrome Scale -PANSS- (Kay, Opler and Lindenmayer, 1988) to detect positive symptoms.ResultsPatients with positive symptoms showed a higher sensitivity to cognitive (z = -3.22, p < 0.01) and social anxiety (z = -2.66, p < 0.01), as well as higher punctuations in ASI-total (z = -2.91, p < 0.01), than patients without positive symptoms.ConclusionsPatients with positive symptoms show significant fears of symptoms of different anxious domains (ASI-total) with regard to patients without this kind of symptomatology. Specially, they are worried about the possibility that concentration difficulties and restlessness lead to mental incapacitation (ASI-cognitive) and about social reactions before their own publicly observable anxiety manifestations (ASI-social).

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Effects of chewing betel nut (Areca catechu) on the symptoms of people with schizophrenia in Palau, Micronesia

The British Journal of Psychiatry ◽

10.1192/bjp.177.2.174 ◽

2000 ◽

Vol 177 (2) ◽

pp. 174-178 ◽

Cited By ~ 49

Author(s):

Roger J. Sullivan ◽

John S. Allen ◽

Caleb Otto ◽

Josepha Tiobech ◽

Karen Nero

Keyword(s):

Rating Scale ◽

Longitudinal Research ◽

Extrapyramidal Symptom ◽

Cross Sectional Study ◽

Betel Nut ◽

Cross Sectional ◽

Syndrome Scale ◽

Areca Catechu ◽

Symptom Ratings ◽

Negative Syndrome

BackgroundAlthough millions of people with schizophrenia live in betel chewing regions, the effects of betel chewing on their symptoms are unknown. Betel nut alkaloids include potent muscarinic cholinomimetics: recent research suggests that these agents may be therapeutic in schizophrenia.AimsTo compare the primary and extrapyramidal symptom profiles and substance-using habits of betel chewing v. non-chewing people with schizophrenia.MethodA cross-sectional study of 70 people with schizophrenia. Symptom ratings measured by the Positive and Negative Syndrome Scale (PANSS) and Extrapyramidal Symptom Rating Scale (ESRS), and demographic and substance-use data, were compared for 40 chewers and 30 non-chewers of betel nut.ResultsBetel chewers with schizophrenia scored significantly lower on the positive (P=0.001) and negative (P=0.002) sub-scales of the PANSS than did non-chewers. There were no significant differences in extrapyramidal symptoms or tardive dyskinesia.ConclusionsBetel chewing is associated with milder symptomatology and avoidance of more harmful recreational drugs. These initial results indicate that longitudinal research is merited.

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Early improvement as a predictor of remission and response in schizophrenia: Results from a naturalistic study

European Psychiatry ◽

10.1016/j.eurpsy.2009.02.005 ◽

2009 ◽

Vol 24 (8) ◽

pp. 501-506 ◽

Cited By ~ 30

Author(s):

M. Jäger ◽

M. Schmauß ◽

G. Laux ◽

H. Pfeiffer ◽

D. Naber ◽

...

Keyword(s):

Operating Characteristic ◽

Subsequent Treatment ◽

Early Improvement ◽

Syndrome Scale ◽

Icd 10 ◽

Clinical Drug Trials ◽

Discharge From Hospital ◽

Negative Syndrome ◽

Total Accuracy ◽

Clinical Drug

AbstractObjectiveTo examine the predictive validity of early improvement in a naturalistic sample of inpatients and to identify the criterion that best defines early improvement.MethodsTwo hundred and forty-seven inpatients who fulfilled ICD-10 criteria for schizophrenia were assessed with the Positive And Negative Syndrome Scale (PANSS) at admission and at biweekly intervals until discharge from hospital. Remission was defined according to the recently proposed consensus criteria, response as a reduction of at least 40% in the PANNS total score from admission to discharge.ResultsReceiver operating characteristic (ROC) analyses showed that early improvement (reduction of the PANSS total score within the first 2 weeks of treatment) predicts remission (AUC = 0.659) and response (AUC = 0.737) at discharge. A 20% reduction in the PANSS total score within the first 2 weeks was the most accurate cut-off for the prediction of remission (total accuracy: 65%; sensitivity: 53%; specificity: 76%), and a 30% reduction the most accurate cut-off for the prediction of response (total accuracy: 76%; sensitivity: 47%; specificity: 90%).ConclusionThe findings of clinical drug trials that early improvement is a predictor of subsequent treatment response were replicated in a naturalistic sample. Further studies should examine whether patients without early improvement benefit from an early change of antipsychotic medication.

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The impact of biomedical innovation on longevity and health

Nordic Journal of Health Economics ◽

10.5617/njhe.1290 ◽

2015 ◽

Vol 5 (1) ◽

pp. 45-57 ◽

Cited By ~ 12

Author(s):

Frank R Lichtenberg

Keyword(s):

Biomedical Research ◽

Medical Innovation ◽

Substantial Portion ◽

Cross Sectional ◽

Biomedical Innovation ◽

Research And Innovation ◽

Level Data ◽

Medical Good ◽

Two Measures ◽

The Impact

Many authors have expressed the view that a substantial portion of recent gains in longevity and health is due to biomedical research and innovation. This article describes the methodologies and findings of a number of studies based on observational data that have sought to measure the impact of biomedical innovation on the longevity and health of Americans and other populations during recent decades. Most of these studies have examined the impact of innovation in pharmaceuticals, the most research-intensive medical good or service. Two measures of medical innovation that have been used are the mean vintage of the medical goods or procedures used by an individual or population, and the number of distinct products (e.g. drugs) available for treating a condition. Longevity (e.g. time till death) is the health outcome that has been analyzed the most, but several studies have studied the impact of medical (i.e. pharmaceutical) innovation on the ability of people to work or engage in activities of daily living. Some studies have been based on cross-sectional patient-level data. Others have been based on longitudinal, region-level data; they have investigated whether regions (e.g. states) undergoing more rapid medical innovation have exhibited larger improvements in health. And some studies have been based on longitudinal, disease-level data; they have investigated whether the medical conditions undergoing more rapid innovation have exhibited larger gains in health outcomes. Innovation related to some specific major diseases (e.g. cardiovascular disease and cancer) has been investigated, but the overall impact of innovation related to other major diseases (e.g. diabetes) has not.These studies provide considerable support for the hypothesis that a substantial portion of recent gains in longevity and health is due to biomedical research and innovation. It would be desirable to apply these methods to data from developing countries.

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Clinical validation of ratings on the six-item Positive and Negative Syndrome Scale obtained via the Simplified Negative and Positive Symptoms Interview

Journal of Psychopharmacology ◽

10.1177/0269881121996890 ◽

2021 ◽

pp. 026988112199689

Author(s):

Pernille Kølbæk ◽

David Dines ◽

Tine Holm ◽

Anne B Blicher ◽

Rune D Sørensen ◽

...

Keyword(s):

Correlation Coefficient ◽

Clinical Decision Making ◽

Paranoid Schizophrenia ◽

Intraclass Correlation ◽

Rank Correlation ◽

Positive Symptoms ◽

Syndrome Scale ◽

Measurement Based Care ◽

Core Symptoms ◽

Negative Syndrome

Background: The six-item version of the Positive and Negative Syndrome Scale (PANSS-6) has shown promise as a brief measure of the severity of core symptoms of schizophrenia. However, since all prior analyses of the PANSS-6 were based on data extracted from studies using the full 30-item PANSS (PANSS-30), it remains unknown whether it is possible to obtain valid information for the PANSS-6 ratings via a brief interview, such as the Simplified Negative and Positive Symptoms Interview (SNAPSI). Aims: We aimed to validate the PANSS-6 ratings obtained via the SNAPSI using the PANSS-6 scores extracted from the PANSS-30 ratings obtained via the comprehensive Structured Clinical Interview for PANSS (SCI-PANSS) as the gold-standard reference. Methods: The PANSS-6 ratings based on the SNAPSI and the PANSS-30 ratings based on the SCI-PANSS were conducted by independent raters with established inter-rater reliability. Results: Seventy-seven inpatients with schizophrenia ( Mage = 35.1 ± 11.7 years; males = 57%; paranoid schizophrenia = 75%) participated in the study. The intraclass correlation coefficient (ICC) of the PANSS-6 total scores obtained using the SNAPSI and the PANSS-30-derived PANSS-6 total scores via the SCI-PANSS was 0.77 ( p < 0.001). The ICC for the PANSS-6 total score and the PANSS-30-derived PANSS-8 (Andreasen’s remission criteria) was 0.75 ( p < 0.001). Spearman’s rank correlation coefficient for changes in PANSS-6 total scores via the SNAPSI and changes in PANSS-30-derived PANSS-6 total scores was 0.70 ( p < 0.001). Conclusions: Using the SNAPSI to rate the PANSS-6 enables a focused and brief assessment of the severity of core symptoms of schizophrenia, which facilitates measurement-based care and clinical decision making in the treatment of schizophrenia.

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