Large-Scale Evaluation of the Positive and Negative Syndrome Scale (PANSS) Symptom Architecture in Schizophrenia

Abstract

Although the Positive and Negative Syndrome Scale (PANSS) is widely utilized in schizophrenia research, variability in specific item loading exist, hindering reproducibility and generalizability of findings across schizophrenia samples. We aim to establish a common metric PANSS factor structure from a large multi-ethnic sample and validate it against a meta-analysis of existing PANSS models. Schizophrenia participants (N = 3511) included in the current study were part of the Singapore Translational and Clinical Research Program (STCRP) and the Clinical Antipsychotic Trials for Intervention Effectiveness (CATIE). Exploratory Factor Analysis (EFA) was conducted to identify the factor structure of PANSS and validated with a meta-analysis (N = 16,171) of existing PANSS models. Temporal stability of the PANSS model and generalizability to individuals at ultra-high risk (UHR) of psychosis were evaluated. A five-factor solution best fit the PANSS data. These were the i) Positive, ii) Negative, iii) Cognitive/disorganization, iv) Depression/anxiety and v) Hostility factors. Convergence of PANSS symptom architecture between EFA model and meta-analysis was observed. Modest longitudinal reliability was observed. The schizophrenia derived PANSS factor model fit the UHR population, but not vice versa. We found that two other domains, Social Amotivation (SA) and Diminished Expression (DE), were nested within the negative symptoms factor. Here, we report one of the largest transethnic factorial structures of PANSS symptom domains (N = 19,682). Evidence reported here serves as crucial consolidation of a common metric PANSS that could aid in furthering our understanding of schizophrenia.

Effect of personalized nursing based on quantitative evaluation strategies on remission of first-episode schizophrenia comparing to usual care: a systematic review and meta-analysis

“…PANSS is an internationally accepted schizophrenia symptom severity assessment table, which is divided into 3 domains (positive symptoms, negative symptoms, and general psychiatric symptoms), and can be used to diagnose schizophrenia. Clinically, a PANSS score <60 points is often used as the cut-off line for disease diagnosis, while a PANSS score >80 points indicates a moderate grade, and a score PANSS >120 points indicates a severe grade (32,33). Thus, the reduction in PANSS scores shows the effectiveness of the personalized nursing model with a quantification-based evaluation strategy.…”

The Multi-Dimensional Structure of Psychotic Disorders

“…This study has the goal to investigate this meta-structure of behavior in psychotic disorders in a sample of early psychosis and chronic schizophrenia patients. Much previous research has focused on the latent structure of psychosis symptoms as measured using the Positive and Negative Symptom Scale (PANSS), where a five-factor structure has been established (for a meta-analysis, see Lim et al, 2021). Some of this work made use of samples consisting of early psychosis patients (Emsley et al, 2003;Langeveld et al, 2013), or including them in addition to chronic schizophrenia patients (Reininghaus et al, 2013).…”