The Scale for the Assessment of Negative Symptoms (SANS): Conceptual and Theoretical Foundations

1989 ◽  
Vol 155 (S7) ◽  
pp. 49-52 ◽  
Author(s):  
Nancy C. Andreasen

The Scale for the Assessment of Negative Symptoms (SANS) was the first instrument developed in order to provide for comprehensive assessment of negative symptoms in schizophrenia (Andreasen, 1982, 1983). It consists of five scales that evaluate five different aspects of negative symptoms: alogia, affective blunting, avolition-apathy, anhedonia-asociality, and attentional impairment. Each of these negative symptoms can be rated globally, but in addition detailed observations are made in order to achieve the global rating. It is complemented by a Scale for the Assessment of Positive Symptoms (SAPS), which permits detailed evaluation and global ratings of hallucinations, delusions, positive formal thought disorder and bizarre behaviour (Andreasen, 1984). Taken together, the two scales provide a comprehensive set of rating scales in order to measure the symptoms of schizophrenia and to assess their change over time.

1992 ◽  
Vol 160 (2) ◽  
pp. 253-256 ◽  
Author(s):  
Elizabeth J. B. Davis ◽  
Milind Borde ◽  
L. N. Sharma

Cognitive impairment, negative and positive symptoms, primitive release reflexes, and age/temporal disorientation were assessed in 20 male patients meeting the DSM–III–R criteria for chronic schizophrenia and Schooler & Kane's criteria for TD. The control group comprised 20 age-matched male chronic schizophrenic patients without TD. Significant associations were found between TD, cognitive impairment, some negative symptoms, and formal thought disorder. These associations were independent of other illness and treatment variables. The severity of TD correlated significantly with that of cognitive impairment.


1990 ◽  
Vol 157 (1) ◽  
pp. 41-49 ◽  
Author(s):  
A. M. Mortimer ◽  
C. E. Lund ◽  
P. J. McKenna

Two studies are reported. In the first, of 62 schizophrenic patients, no correlation between negative symptom scores (rated blindly) and any measure of positive symptoms was found. This independence was confirmed by factor and cluster analyses, which left the question of a third ‘disorganisation’ class of schizophrenic symptoms open. In the second study, of 80 patients, formal thought disorder separated unequivocally into ‘positive formal thought disorder’ and ‘alogia’ syndromes on the basis of correlations with positive and negative symptoms. Catatonic motor disorder also showed evidence of a corresponding positive: negative division, although this only emerged when severity or chronicity of illness was controlled for. Cognitive impairment showed a broad range of affiliations and its particular correlation with negative symptoms was perhaps artefactual.


Author(s):  
István Bitter

Negative symptoms of schizophrenia represent deficits in different domains, e.g. loss or diminution in emotions, thinking and movement. Persistent primary negative symptoms are considered to be part of the schizophrenia disease process and represent an unmet need for treatment, while secondary negative symptoms are associated with positive symptoms of schizophrenia, other mental disorders (e.g. depression, substance abuse), extrapyramidal symptoms, social deprivation, etc. Validated rating scales are helpful in the evaluation and measurement of negative symptoms. Current consensus supports the focus on the following five domains (five ‘As’): blunted affect, alogia, anhedonia, asociality, and avolition.


2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S53-S54
Author(s):  
Berna Yalincetin ◽  
Emre Bora ◽  
Berna Binnur Akdede ◽  
Köksal Alptekin

Abstract Background Severe impairment in interpersonal functioning is a common feature of schizophrenia. Deficits in communicative abilities are likely to be among the important factors contributing to social dysfunction in schizophrenia. Difficulties in pragmatic language abilities including understanding intended meaning, beyond explicit and literal content of conversational statements can significantly hamper interpersonal and occupational functioning. An important aspect of pragmatic inference is the ability to derive scalar implicatures (SIs), which are based on linguistic expressions like some, or, often etc. For deriving SIs, one need to go beyond simple semantic and logical level. To date, only a single study has investigated SIs in schizophrenia (Wampers et al 2018). In this study, people with psychosis were less likely to derive SIs than controls. A preliminary analysis of 17 patients with schizophrenia in the same study also showed that better ToM was associated with a higher ability to derive SIs Importantly, the association with schizophrenia and abnormalities in pragmatic infererence might be mediated by clinical features of this illness including formal thought disorder and negative symptoms. Also, difficulties in pragmatic inferences might potentially be secondary to neurocognitive dysfunction rather than being primary deficits. No previous study has investigated clinical and neurocognitive correlates of impairment in ability to derive SIs in schizophrenia. Methods The study included 79 patients with schizophrenia-spectrum disorders (66 schizophrenia and 13 schizoaffective disorder) and 49 healthy controls who completed a SI task. SAPS, SANS were also administered. Comprehension of irony, metaphor and faux pas were assessed using verbal story tasks. A subgroup of patients were also administered a comprehensive neuropsychological battery and two ToM tasks (Hinting task and RMET (Reading the Mind from the Eyes). Results There were no significant group difference between schizophrenia and healthy controls for age (F=0.69, p=0.41) and gender (Chi square=2.2, p=0.13). The schizophrenia sample had a shorter duration of education compared to the healthy controls (F=27.2, p<0.001). The patients with schizophrenia had significant impairment in understanding the SIs (F=8.2, p=0.005). Comprension impairment of SIs were significantly associated with SANS negative symptoms (r=-0.29, p= 0.009) but not with SAPS positive formal thought disorder (r=-0.09, p=0.44) and symptoms ratings for hallucinations and delusions. Understanding SIs in schizophrenia was significantly related to better performance in RMET (r=0.34, p=0.036) and irony comprehension (r=-0.38, p=0.001). Discussion Schizophrenia is associated with significant deficits in understanding pragmatic utterances. These deficits were significantly related to some aspects of social cognition but not neurocognition. Current findings do not support the proposed relationship between formal thought disorder and pragmatic abnormalities in schizophrenia. These findings might have implications in management of social functioning deficits in schizophrenia.


1986 ◽  
Vol 148 (5) ◽  
pp. 587-589 ◽  
Author(s):  
Michael R. Trimble

The terms positive and negative symptoms have slipped into the language of contemporary psychiatry with comparative ease. It is not uncommon for these expressions to be used with little explanation, both at meeting and in written communications, with the implicit understanding that their meaning is understood and that somehow they are of value to our knowledge of psychopathology. However, that there are no clear guide-lines at present for our use of these terms is shown from a recent survey of psychiatrists' opinions from a market research company (Martin Hamblin Research-Personal Communication). As part of a series of questions asked to many psychiatrists of differing age, geographical location, and status, they were asked about the meaning of these terms, positive and negative symptoms and the proportion of schizophrenic patients having them. Of the categories quoted by Crow (1980–81) as positive symptoms, 68% considered that delusions were positive symptoms, 63% hallucinations, and only 35% thought disorder. In contrast, 18% thought that behaviour disturbance was a positive symptom, a similar figure (15%) being given for passivity feelings. Considerable variation was noted, however, with hallucinations being considered positive by only 33% of London psychiatrists, thought disorder by only 11% of those qualified 16–25 years, and one-quarter of all registrars and psychiatrists from Midland Health Districts considered passivity feelings to fall into this category. Even greater disagreement was recorded for negative symptoms. Thus, the symptom most often associated with this category was apathy, by 52% of respondents. Only 26% considered that withdrawal was a negative symptom, the percentage data for lack of motivation and blunting of affect being 37% and 15% respectively.


2010 ◽  
Vol 39 (2) ◽  
pp. 129-138 ◽  
Author(s):  
Neil Thomas ◽  
Susan Rossell ◽  
John Farhall ◽  
Frances Shawyer ◽  
David Castle

Background: Cognitive behavioural therapy has been established as an effective treatment for residual psychotic symptoms but a substantial proportion of people do not benefit from this treatment. There has been little direct study of predictors of outcome, particularly in treatment targeting auditory hallucinations. Method: The Psychotic Symptom Rating Scales (PSYRATS) and Positive and Negative Syndrome Scale (PANSS) were administered pre- and post-therapy to 33 people with schizophrenia-related disorders receiving CBT for auditory hallucinations in a specialist clinic. Outcome was compared with pre-therapy measures of insight, beliefs about the origin of hallucinations, negative symptoms and cognitive disorganization. Results: There were significant improvements post-treatment on the PSYRATS and PANSS Positive and General Scales. Improvement on the PSYRATS was associated with lower levels of negative symptoms, but was unrelated to overall insight, delusional conviction regarding the origins of hallucinations, or levels of cognitive disorganization. Conclusions: Lack of insight and presence of formal thought disorder do not preclude effective cognitive-behavioural treatment of auditory hallucinations. There is a need to further understand why negative symptoms may present a barrier to therapy.


2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S222-S223
Author(s):  
Tatiana Baxter ◽  
Hyeon-Seung Lee ◽  
Lénie Torregrossa ◽  
Seoyeon Kim ◽  
Sohee Park

Abstract Background Schizophrenia has been suggested to be a disorder of social communication, which depends on the way language is used to convey thoughts, beliefs, feelings, and intentions. Everyday language can also reveal personality, emotions, and social skills of the speaker. Extensive past research affirms the central importance of language and thought disorder as diagnostic features of schizophrenia, mostly focused on the neurocognitive aspects of language output collected during clinical interviews, and not on the social nature of language. In this study, we examined narratives written in response to viewing social scenes by individuals with schizophrenia (SZ) and matched controls (CO) using an automated computational linguistics and statistical-based text analysis tool that computes socially-relevant variables. Methods 23 individuals with schizophrenia (SZ) and 23 demographically matched controls (CO) were shown paintings of social situations, and were asked to write reflections describing what they thought and felt about these scenes. Two pictures were presented consecutively. There was no time limit. Resulting narratives were analyzed with the Linguistic Inquiry and Word Count program (LIWC; Pennebaker et al, 2015). LIWC computes basic linguistic variables such as the % of self-referring and non-self-referring pronouns, social and emotion words, and cognitive items. LIWC also generates 4 complex variables: formal and logical thinking patterns (“analytic”); social status or confidence (“clout”); authenticity, and emotional tone. Clinical symptoms in SZ were assessed using the Scale for the Assessment of Positive Symptoms (SAPS) and the Scale for the Assessment of Negative Symptoms (SANS). For all participants, the UCLA Loneliness Scale, the National Adult Reading Test (NART), and the Edinburgh Handedness Inventory (EHI) were administered. Results The two groups did not differ in NART or EHI. There was no group difference in the number of words produced. SZ produced greater number of pronouns than CO but this effect was driven by a higher % of self-referring pronouns in SZ than CO, with no group difference in non self-referring pronouns. For complex variables, CO scored significantly higher in authenticity than SZ but no group differences were observed in clout, analytics, or emotional tone. Loneliness was higher in SZ compared with CO. There were no other significant group differences. In SZ, pronoun use was correlated with positive symptoms (especially with ratings of hallucinations, bizarre behavior, delusions of mind-reading and thought broadcasting) and inversely correlated with negative symptoms (avolition, apathy and motor retardation). Social words were inversely correlated with SAPS Thought Disorder. Clout was inversely correlated with SANS Alogia and SAPS Thought Disorder. Authenticity was correlated with SANS Anhedonia and Asociality. In CO, loneliness was correlated with the % negative emotion words and NART was correlated with total number of emotion words. Discussion We used an automated linguistic analysis tool to extract information relevant to social communication from written narratives. We found group differences in the use of pronouns and authenticity. We also observed associations of clinical symptoms with certain social aspects of language use in schizophrenia. One advantage of automated text analysis tools is the minimization of implicit biases inherent in ratings of interviews. Limitations of this study include lack of direct social functioning measures and the sample size. Future work will incorporate linguistic text analysis within a social paradigm to directly examine the role of language use in social functioning.


2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S171-S171
Author(s):  
Berna Yalincetin ◽  
Emre Bora ◽  
Berna Binnur Akdede ◽  
Köksal Alptekin

Abstract Background Current scales of formal thought disorder (FTD) in schizophrenia have been shown to hold considerable inadequacies: 1. The concept of FTD is usually limited to positive and negative symptoms of schizophrenia 2. There is no much consideration about pragmatic disturbances. 3. There are significant inconsistencies in measurements of posFTD and negFTD dimensions (eg, merely focusing on the positive dimension); 4. As to the comprehensive scales of posFTD and negFTD, administration or assessment is time-consuming for routine clinical use and they are not user friendly. Besides, some of the FTD scales include the utilization of materials such as pictures, figures, or extended structured interviews to be able to provide speech samples of the patient. Developing a new FTD assessment tool that can be practically applied in clinic might help clinicans in diagnosis, treatment and follow-up. The aim of our study was to develop a new scale for assessment of FTD and evaluate the reliability and validity of this scale. We named our new FTD scale as Dokuz Eylul Thought Disorder Scale (DETDS). The originality of this scale is based on the fact that it involves assessment of pragmatic comprehension as well as positive and negative FTD and it can be administered and scored practically in routine clinical examination. Methods This study included 130 patients with schizophrenia and 35 controls. For assessing the reliability of this new scale, internal consistency, test-retest and interrater reliability analyses were conducted. The validity of the scale was assessed with concurrent validity and factor analysis methods. Results In the study, Cronbach’s was 0.86. The new scale has a good test-retest (r=0.83) and interrater (ICC=0.985) reliability. The posFTD subscale of the new scale showed high correlation with the posFTD subscale of the Scale for the Assessment of Positive Symptoms (SAPS) (r=0.95, p<0.001) and negFTD subscale of our scale showed high correlation with the alogia subscale of the Scale for the Assessment of Negative Symptoms (SANS) (r=0.95, p<0.001) and impoverishment of thought subscale of the Thought and Language Index (TLI) (r=0.66, p<0.001). The factor analysis revealed a 3-factor solution which explained 74.6% of the variance: 1. Positive Formal Thought Disorder, 2. Negative Formal Thought Disorder, 3. Pragmatic Comprehension Disorder. Discussion Our findings showed that DETDS is a reliable and valid scale which can be used in assessing FTD in patients with schizophrenia in routine clinical use. Unlike most scales of FTD that are available in the literature, but similar to SANS, SAPS, and PANSS, it is practical to use because it is based on clinical interview. Another strength of DETDS is that it intensifies the posFTD and negFTD dimensions and scores them hierarchically in terms of severity. The fact that the new scale covers pragmatic comprehension disorders also presents an innovation to the literature.


2009 ◽  
Vol 15 (1) ◽  
pp. 5 ◽  
Author(s):  
Liezl Koen ◽  
Regan Jonathan ◽  
Dana JH Niehaus

<p><strong>Objective.</strong> Worldwide, cannabis is the most widely used illicit substance, and it has been identified as a correlate in schizophrenia samples for poorer symptomatic and functional outcomes in many international studies. The object of this retrospective study was to identify the prevalence of cannabis use/abuse and the demographic and clinical correlates therefor in a large homogeneous South African schizophrenia population.</p><p><strong>Methods.</strong> As part of a large genetic study, 547 subjects with a diagnosis of schizophrenia were recruited. Demographic and clinical data were collected and each participant underwent a urinary drug screen. Use/abuse of cannabis was defined as using cannabis more than 21 times in a single year. Subjects with and without cannabis use/abuse were statistically compared. <strong></strong></p><p><strong>Results.</strong> Significant differences between the two groups were found in terms of gender, marital status, age of onset of schizophrenia, number of hospitalisations and relapses, alcohol abuse, smoking, the Scale for the Assessment of Positive Symptoms (SAPS) scores for hallucinations, delusions, bizarre behaviour and formal thought disorder, and the Scale for the Assessment of Negative Symptoms (SANS) score for avolition/apathy. <strong></strong></p><p><strong>Conclusion.</strong> The prevalence of cannabis use/abuse in this study was high, and our findings were comparable with those of previous international studies. Abuse/use started mainly in the teenage years, was more prevalent among males than females, and was associated with negative overall outcomes. There was also a positive correlation between cannabis and nicotine and alcohol use/abuse. Determination of cannabis abuse based solely on history was found to be reliable, and urine cannabis testing appeared to be of limited value in routine management of this group of schizophrenic patients.</p>


1989 ◽  
Vol 155 (S7) ◽  
pp. 41-44 ◽  
Author(s):  
Eve C. Johnstone

It has become customary to classify the typical abnormalities of the mental state of schizophrenic patients into positive and negative features, with reference to behavioural excesses and deficits. Positive features are pathological by their presence and negative features represent the loss of some normal function. Positive features are generally considered to include delusions, hallucinations and positive formal thought disorder (Fish, 1962). Some studies (e.g. Johnstone et al, 1978) have also included incongruity of affect under this heading. Negative features include affective flattening, poverty of speech, retardation, apathy, lack of sociability. There is some evidence that the clinical correlates of positive and negative features may not be the same (Owens & Johnstone, 1980). Some workers (Andreasen & Olsen, 1982) but not others (Pogue-Geile & Harrow, 1984) have found that among schizophrenic patients positive and negative symptoms were negatively correlated. Although the nature of the relationship between positive and negative features is not entirely established and may not be simple (Wing, 1978) certain generalisations may be applied: (a)Positive features are characteristic of earlier and negative of later phases of the illness (Pfohl & Winokur, 1982).(b)The effects of drugs upon positive features are greater than those upon negative features. Thus neuroleptics produce more marked improvement (Johnstone et al, 1978; Angrist et al, 1980) and amphetamine more marked exacerbation (Angrist et al, 1980) of positive than of negative features.(c)Positive features have been said to be relatively variable and negative features relatively stable (Ovchinnikov, 1968; Snezhnevsky, 1968).


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