Positive and Negative Syndrome Scale

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Positive and Negative Syndrome Scale
Purposemeasures severity of individuals with schizophrenia

The Positive and Negative Syndrome Scale (PANSS) is a medical scale used for measuring symptom severity of patients with schizophrenia. It was published in 1987 by Stanley Kay, Lewis Opler, and Abraham Fiszbein. It is widely used in the study of antipsychotic therapy. The scale is the "gold standard" for evaluating the effects of psychopharmacological treatments. [1] [2]

Contents

The name refers to the two types of symptoms in schizophrenia, as defined by the American Psychiatric Association: positive symptoms, which refer to an excess or distortion of normal functions (e.g., hallucinations and delusions), and negative symptoms, which represent a diminution or loss of normal functions. Some of these functions which may be lost include normal thoughts, actions, ability to tell fantasies from reality, and the ability to properly express emotions. [3]

The PANSS is a relatively brief interview, requiring 45 to 50 minutes to administer. [4] The interviewer must be trained to a standardized level of reliability. [5]

Interview items

To assess a patient using PANSS, an approximately 45-minute clinical interview is conducted. The patient is rated from 1 to 7 on 30 different symptoms based on the interview as well as reports of family members or primary care hospital workers. [6]

Positive scale

7 Items, (minimum score = 7, maximum score = 49)

Negative scale

7 Items, (minimum score = 7, maximum score = 49)

General Psychopathology scale

16 Items, (minimum score = 16, maximum score = 112)

PANSS Total score minimum = 30, maximum = 210

Scoring

As 1 rather than 0 is given as the lowest score for each item, a patient can not score lower than 30 for the total PANSS score. Scores are often given separately for the positive items, negative items, and general psychopathology. In their original publication on the PANSS scale, Stanley Kay and colleagues tested the scale on 101 adult patients (20-68 years-old) with schizophrenia [4] and the mean scores were,

Based on meta-analytic results, an alternative five-factor solution of the PANSS was proposed with positive symptoms, negative symptoms, disorganization, excitement, and emotional distress. [7]

See also

Related Research Articles

Psychosis is a condition of the mind that results in difficulties determining what is real and what is not real. Symptoms may include delusions and hallucinations, among other features. Additional symptoms are incoherent speech and behavior that is inappropriate for a given situation. There may also be sleep problems, social withdrawal, lack of motivation, and difficulties carrying out daily activities. Psychosis can have serious adverse outcomes.

<span class="mw-page-title-main">Schizophrenia</span> Mental disorder with psychotic symptoms

Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations, delusions, and disorganized thinking. Other symptoms include social withdrawal, and flat affect. Symptoms typically develop gradually, begin during young adulthood, and in many cases never become resolved. There is no objective diagnostic test; diagnosis is based on observed behavior, a psychiatric history that includes the person's reported experiences, and reports of others familiar with the person. To be diagnosed with schizophrenia, the described symptoms need to have been present for at least six months or one month. Many people with schizophrenia have other mental disorders, especially substance use disorders, depressive disorders, anxiety disorders, and obsessive–compulsive disorder.

<span class="mw-page-title-main">Thought disorder</span> Disorder of thought form, content or stream

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Disorganized schizophrenia, or hebephrenia, was a subtype of schizophrenia prior to 2013. Subtypes of schizophrenia were no longer recognized as separate conditions in the DSM 5, published in 2013. The disorder is no longer listed in the 11th revision of the International Classification of Diseases (ICD-11).

<span class="mw-page-title-main">Thought broadcasting</span> Delusion that others can hear ones thoughts

Thought broadcasting is a type of delusional condition in which the affected person believes that others can hear their inner thoughts, despite a clear lack of evidence. The person may believe that either those nearby can perceive their thoughts or that they are being transmitted via mediums such as television, radio or the internet. Different people can experience thought broadcasting in different ways. Thought broadcasting is most commonly found among people that have a psychotic disorder, specifically schizophrenia.

Paraphrenia is a mental disorder characterized by an organized system of paranoid delusions with or without hallucinations and without deterioration of intellect or personality.

<span class="mw-page-title-main">Grandiose delusions</span> Subtype of delusion

Grandiose delusions (GD), also known as delusions of grandeur or expansive delusions, are a subtype of delusion that occur in patients with a wide range of psychiatric disorders, including two-thirds of patients in a manic state of bipolar disorder, half of those with schizophrenia, patients with the grandiose subtype of delusional disorder, frequently in narcissistic personality disorder, and a substantial portion of those with substance abuse disorders. GDs are characterized by fantastical beliefs that one is famous, omnipotent, wealthy, or otherwise very powerful. The delusions are generally fantastic and typically have a religious, science fictional, or supernatural theme. There is a relative lack of research into GD, in contrast to persecutory delusions and auditory hallucinations. Around 10% of healthy people experience grandiose thoughts at some point in their lives but do not meet full criteria for a diagnosis of GD.

Within the field of clinical trials, rating is the process by which a human evaluator subjectively judges the response of a patient to a medical treatment. The rating can include more than one treatment response. The accessor is normally an independent observer other than the patient, but the accessor can also be the patient. Furthermore, some clinical outcomes can only be assessed by the patient.

The Brief Psychiatric Rating Scale (BPRS) is a rating scale which a clinician or researcher may use to measure psychiatric symptoms such as depression, anxiety, hallucinations and unusual behaviour. The scale is one of the oldest, most widely used scales to measure psychotic symptoms and was first published in 1962.

Childhood schizophrenia is similar in characteristics of schizophrenia that develops at a later age, but has an onset before the age of 13 years, and is more difficult to diagnose. Schizophrenia is characterized by positive symptoms that can include hallucinations, delusions, and disorganized speech; negative symptoms, such as blunted affect and avolition and apathy, and a number of cognitive impairments. Differential diagnosis is problematic since several other neurodevelopmental disorders, including autism spectrum disorder, language disorder, and attention deficit hyperactivity disorder, also have signs and symptoms similar to childhood-onset schizophrenia.

The diagnosis of schizophrenia, a psychotic disorder, is based on criteria in either the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, or the World Health Organization's International Classification of Diseases (ICD). Clinical assessment of schizophrenia is carried out by a mental health professional based on observed behavior, reported experiences, and reports of others familiar with the person. Diagnosis is usually made by a psychiatrist. Associated symptoms occur along a continuum in the population and must reach a certain severity and level of impairment before a diagnosis is made. Schizophrenia has a prevalence rate of 0.3-0.7% in the United States

A religious delusion is defined as a delusion, or fixed belief not amenable to change in light of conflicting evidence, involving religious themes or subject matter. Religious faith, meanwhile, is defined as a belief in God or a religious doctrine in the absence of evidence. Psychologists, scientists, and philosophers have debated the distinction between the two, which is subjective and cultural.

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The Scale for the Assessment of Negative Symptoms (SANS) is a rating scale that mental health professionals use to measure negative symptoms in schizophrenia. Negative symptoms are those conspicuous by their absence—lack of concern for one's appearance, and lack of language and communication skills, for example. Nancy Andreasen developed the scale and first published it in 1984. SANS splits assessment into five domains. Within each domain it rates separate symptoms from 0 (absent) to 5 (severe). The scale is closely linked to the Scale for the Assessment of Positive Symptoms (SAPS), which was published a few years later. These tools are available for clinicians and for research.

Within psychological testing, the Scale for the Assessment of Positive Symptoms (SAPS) is a rating scale to measure positive symptoms in schizophrenia. The scale was developed by Nancy Andreasen and was first published in 1984. SAPS is split into 4 domains, and within each domain separate symptoms are rated from 0 (absent) to 5 (severe). The scale is closely linked to the Scale for the Assessment of Negative Symptoms (SANS) which was published a few years earlier.

<span class="mw-page-title-main">Tactile hallucination</span>

Tactile hallucination is the false perception of tactile sensory input that creates a hallucinatory sensation of physical contact with an imaginary object. It is caused by the faulty integration of the tactile sensory neural signals generated in the spinal cord and the thalamus and sent to the primary somatosensory cortex (SI) and secondary somatosensory cortex (SII). Tactile hallucinations are recurrent symptoms of neurological diseases such as schizophrenia, Parkinson's disease, Ekbom's syndrome and delerium tremens. Patients who experience phantom limb pains also experience a type of tactile hallucination. Tactile hallucinations are also caused by drugs such as cocaine and alcohol.

References

  1. Liechti, Stacy; Capodilupo, Gianna; Opler, Douglas J.; Opler, Mark; Yang, Lawrence H. (2017-12-01). "A Developmental History of the Positive and Negative Syndrome Scale (PANSS)". Innovations in Clinical Neuroscience. 14 (11–12): 12–17. ISSN   2158-8333. PMC   5788246 . PMID   29410932.
  2. Opler, Mark G.A.; Yavorsky, Christian; Daniel, David G. (2017-12-01). "Positive and Negative Syndrome Scale (PANSS) Training". Innovations in Clinical Neuroscience. 14 (11–12): 77–81. ISSN   2158-8333. PMC   5788255 . PMID   29410941.
  3. "Mental Health and Schizophrenia". WebMD. Retrieved 2019-07-29.
  4. 1 2 Kay SR, Fiszbein A, Opler LA (1987). "The positive and negative syndrome scale (PANSS) for schizophrenia". Schizophr Bull. 13 (2): 261–76. doi: 10.1093/schbul/13.2.261 . PMID   3616518.
  5. John Hunsley; Eric J. Mash (2008), A Guide to Assessments that Work, Oxford University Press US, ISBN   978-0-19-531064-1
  6. Kay, Stanley R. (1991), Positive and Negative Syndromes in Schizophrenia, Routledge Mental Health, pp. 33–36, ISBN   978-0-87630-608-6
  7. Vandergaag, M.; Hoffman, T.; Remijsen, M.; Hijman, R.; Dehaan, L.; Vanmeijel, B.; Vanharten, P.; Valmaggia, L.; Dehert, M.; Cuijpers, A.; Wiersma, D. (2006-07-01). "The five-factor model of the Positive and Negative Syndrome Scale II: A ten-fold cross-validation of a revised model". Schizophrenia Research. 85 (1–3): 280–287. doi:10.1016/j.schres.2006.03.021. ISSN   0920-9964. PMID   16730429. S2CID   9097109.