T111. Panss Negative Symptom Dimensions Across Geographical Regions: Implications for Social, Linguistic and Cultural Consistency

Abstract

BackgroundRecognizing the discrete dimensions that underlie negative symptoms in schizophrenia and how these dimensions are conceptualized across geographical regions may result in better understanding and treatment. The expressive-experiential distinction has been shown to have vast importance in relation to functional outcomes in schizophrenia. Previous studies have shown that the PANSS may not be equivalently rated across counties and cultures, suggesting regional differences in both symptom expression and rater judgment of symptom severity. Items that perform in markedly different ways across demographic, regional, cultural, or clinical severity characteristics may not offer valid representations of the target construct. 1) Will the expressive and experiential dimensions of the PANSS vary over 15 geographical regions and will the item ratings defining each dimension manifest similar reliability across these regions? 2) In large multi-center, international trials where data are combined, which of the two dimensions are disposed to social, linguistic and cultural inconsistency?MethodsData was obtained for the baseline PANSS visits of 6,889 subjects. Using Confirmatory Factor Analysis (CFA), we examined whether the expressive-experiential distinction would be replicated in our sample. We investigated the validity of the expressive-experiential distinction using Differential Item Functioning (DIF; Mantel-Haenszel) across 15 geographical regions – South America-Mexico, Austria-Germany, Belgium-Netherlands, Brazil, Canada, Nordic regions (Denmark, Finland, Norway, Sweden), France, Great Britain, India, Italy, Poland, Eastern Europe (Romania, Slovakia, Ukraine, Croatia, Estonia, Czech Republic), Russia, South Africa, and Spain - as compared to the United States.ResultsExpressive Deficit: More DIF was observed for items in the Expressive deficit factor than for items relating to experiential deficits. The following regions showed at least moderate to large DIF for all items: Austria-Germany, Nordic, France, and Poland. Of all the items, N3 Poor Rapport showed the most moderate and large DIF (n = 13; 86.67%) across countries, with 7 countries reporting large DIF. Similarly, N6 Lack of Spontaneity and Flow of Conversation showed moderate and large DIF for 66.67% countries (n=10). Experiential Deficit: Item G16 Active Social Avoidance reported negligible DIF for 14 of the 15 countries investigated (93.33%). Large DIF was observed for N2 Emotional Withdrawal and N4 Passive Apathetic Social Withdrawal for Brazil and India. Seven regions demonstrated no DIF across all items of the PANSS experiential deficit factor (South America-Mexico, Belgium-Netherlands, Nordic, Great Britain, Eastern Europe, Russia, and Spain). Overall, there were many fewer observed items with large DIF for PANSS experiential domain.DiscussionThese results suggest that the PANSS Negative Symptoms Factor can be better represented by a two-factor model than by a single-factor model. Additionally, the results show significant differences in ratin...

Differential improvement of negative-symptom subfactors after cognitive remediation in low-functioning individuals with schizophrenia

“…In exploratory and confirmatory factor analyses, Liemburg et al (2013) found an “expressive deficit” (or expressive negative) subfactor that includes flat affect (N1 of the Negative PANSS items), poor rapport (N3), lack of spontaneity and flow of conversation (N6), mannerisms and posturing (G5), motor retardation (G7), and disturbance of volition (G13), and a “social amotivation” (or experiential negative) subfactor comprising emotional withdrawal (N2), passive/apathetic social withdrawal (N4), and active social avoidance (G16). This two-subfactor structure using PANSS negative item data from different patient samples was replicated by several other studies (Fervaha et al, 2014; Jang et al, 2016; Khan et al, 2017; Stiekema et al, 2016) confirming the same PANSS items for the social amotivation subfactor. For the expressive negative subfactor, PANSS items were the same across studies except for the PANSS disturbance of volition item (G13), which was included in only two studies (Liemburg et al, 2013; Stiekema et al, 2016), but not in the other three studies (Fervaha et al, 2014; Jang et al, 2016; Khan et al, 2017).…”

The efficacy of cariprazine in negative symptoms of schizophrenia: Post hoc analyses of PANSS individual items and PANSS-derived factors

“…To assess the multidimensional aspect of negative symptoms, changes from baseline to week 26 on the individual items of the PANSS-FSNS were evaluated. Additional PANSS-derived factors for negative symptoms [30][31][32][33] were located through an extensive search of the literature and our data were further analyzed using these models ( Table 1). Factors of interest in other domains (supplementary Table 1), including disorganized thoughts (items N5, P2, G5, G10-11, G13, G15) [24], prosocial function (items N2, N4, N7, P3, P6, G16) [34], and cognition (items N5, N7, P2, G10-11) [35], were also evaluated.…”

Predictors of social functioning in patients with higher and lower levels of reduced emotional experience: Social cognition, social competence, and symptom severity

“…Further, when social competence, social cognition, and negative symptoms were used to predict social outcomes, it was also found that the same amount of variance, 32%, was shared with social outcomes. Only two of the PANSS negative symptoms predicted everyday social outcomes, passiveapathetic social withdrawal and active social avoidance, and these symptoms were found to load on a factor reflecting reduced emotional experience in a very large sample study (n=6889; Khan et al, 2017).…”

“…A two-factor model of expression and experience was created and tested in several samples in a study by Khan et al (2017). The model as also examined for its link to functional outcomes (Harvey et al, 2017;Strassnig et al, 2018).…”

“…In a very recent study (Strassnig, et al, 2018) we examined 554 patients with schizophrenia who had been rated for their everyday functioning and assessed with the Positive and Negative Syndrome Scale (PANSS;Kay, 1991). We used the PANSS reduced emotional experience factor identified by Khan et al (2017) and Harvey et al (2017) to separate patients with less than moderate symptoms from patients with moderate or greater severity levels of these symptoms. We then correlated symptom severity with three elements of informant rated everyday outcomes: vocational functioning, everyday activities, and interpersonal functions.…”