Modeling psychological function in patients with schizophrenia with the PANSS: an international multi-center study

Abstract

Background. The aim of the current study was to explore the changing interrelationships among clinical variables through the stages of schizophrenia in order to assemble a comprehensive and meaningful disease model. Methods. Twenty-nine centers from 25 countries participated and included 2358 patients aged 37.21 ± 11.87 years with schizophrenia. Multiple linear regression analysis and visual inspection of plots were performed. Results. The results suggest that with progression stages, there are changing correlations among Positive and Negative Syndrome Scale factors at each stage and each factor correlates with all the others in that particular stage, in which this factor is dominant. This internal structure further supports the validity of an already proposed four stages model, with positive symptoms dominating the first stage, excitement/hostility the second, depression the third, and neurocognitive decline the last stage. Conclusions. The current study investigated the mental organization and functioning in patients with schizophrenia in relation to different stages of illness progression. It revealed two distinct “cores” of schizophrenia, the “Positive” and the “Negative,” while neurocognitive decline escalates during the later stages. Future research should focus on the therapeutic implications of such a model. Stopping the progress of the illness could demand to stop the succession of stages. This could be achieved not only by both halting the triggering effect of positive and negative symptoms, but also by stopping the sensitization effect on the neural pathways responsible for the development of hostility, excitement, anxiety, and depression as well as the deleterious effect on neural networks responsible for neurocognition.

PsiOvi Staging Model for Schizophrenia (PsiOvi SMS): A New Internet Tool for Staging Patients with Schizophrenia

“…In cognition, significant domains emerged: processing speed and visual learning assessed with Trail Making Test – Part A and Brief Visuospatial Memory Test-Revised, respectively. Different cognitive dimensions have also been included in previous staging models [ 4 , 9 , 10 - 13 , 16 , 18 , 21 , 64 ]. However, it is worth noting the findings of Lin et al [ 71 ], who demonstrated that processing speed and visual learning and memory tests were the best predictors of global cognition in schizophrenia.…”

“…The 12 profilers included in PsiOvi SMS pertain to the following five dimensions: psychopathology, clinical features, functioning, cognition, and biomarkers. Although other authors have also proposed these dimensions and primarily psychopathology [4,[11][12][13]64], and functioning [8,9,10,16,65,66], most models do not provide information on how to evaluate them.…”

“…Since then, different theoretical staging models have been proposed, ranging from the simplest, which includes only psychotic psychopathology and functioning [8], to the most complex, which also comprises affective symptoms, cognition, neuroimaging, and biological and endophenotypic markers [9,10]. In this regard, the recently developed models based solely on the Positive and Negative Syndrome Scale (PANSS) deserve a separate mention [11][12][13]. Additionally, we have noticed a growing interest in validating some of the proposed theoretical models [6] for the purpose of establishing their validity and/or improving them [14][15][16][17][18][19][20][21][22].…”

The effect of first- and second-generation antipsychotics on brain morphology in schizophrenia: A systematic review of longitudinal magnetic resonance studies with a randomized allocation to treatment arms

“…The literature includes a large number of naturalistic studies and overall it suggests that there is some brain volume loss over time both in medicated and in unmedicated patients with schizophrenia (Ahmed et al, 2015; Andreasen et al, 2013; Baaré et al, 2001; Boonstra et al, 2011; Chaves et al, 2015; Gur et al, 1998; Ho et al, 2003b; Hu et al, 2020; Kraguljac et al, 2019; Kubota et al, 2015; Li et al, 2019; Lin et al, 2019; Lyall et al, 2021; Narr et al, 2005, Van Haren et al, 2011; Veijola et al, 2014; Vita et al, 2012; Xiao et al, 2018). An important problem in the interpretation of findings is that a significant number of patients with schizophrenia are complete or partially treatment resistance already since the first episode (Demjaha et al, 2017), while the natural history of the disease is highly heterogeneous (Ciompi, 1980; Dragioti et al, 2017; Fountoulakis et al, 2019, 2021a,b). Duration of untreated psychosis seems to have an adverse impact also (Correll et al, 2018; Howes et al, 2021).…”

Gender, age at onset, and duration of being ill as predictors for the long-term course and outcome of schizophrenia: an international multicenter study

“…Recently, a staging method has been proposed, 1 , 2 and its main contribution is that it proposes the presence of four main stages of illness progress, with a specific aspect of symptomatology being dominant at each stage (Figure 1). This model is identical for both genders.…”