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Positive and Negative Syndrome Scale for Schizophrenia (PANSS)

Questions

1.Delusions (Beliefs which are unfounded, unrealistic, and idiosyncratic)?
2.CONCEPTUAL DISORGANISATION - Disorganised process of thinking characterised by disruption of goal-directed sequencing, e.g. circumstantiality, loose associations, tangentiality, gross illogicality or thought block.)?
3.HALLUCINATORY BEHAVIOUR - Verbal report or behaviour indicating perceptions which are not generated by external stimuli. These may occur in the auditory, visual, olfactory or somatic realms?
4.EXCITEMENT - Hyperactivity as reflected in accelerated motor behaviour, heightened responsivity to stimuli, hypervigilance or excessive mood lability?
5.GRANDIOSITY - Exaggerated self-opinion and unrealistic convictions of superiority, including delusions of extraordinary abilities, wealth, knowledge, fame, power and moral righteousness?
6.SUSPICIOUSNESS/PERSECUTION - Unrealistic or exaggerated ideas of persecution, as reflected in guardedness, ad distrustful attitude, suspicious hypervigilance or frank delusions that others mean harm?
7.HOSTILITY - Verbal and nonverbal expressions of anger and resentment, including sarcasm, passive-aggressive behaviour, verbal abuse and assualtiveness?
8.BLUNTED AFFECT - Diminished emotional responsiveness as characterised by a reduction in facial expression, modulation of feelings and communicative gestures?
9.EMOTIONAL WITHDRAWAL - Lack of interest in, involvement with, and affective commitment to life’s events?
10.POOR RAPPORT - Lack of interpersonal empathy, openness in conversation and sense of closeness, interest or involvement with the interviewer. This is evidenced by interpersonal distancing and reduced verbal and nonverbal communication?
11.PASSIVE/APATHETIC SOCIAL WITHDRAWAL - Diminished interest and initiative in social interactions due to passivity, apathy, anergy or avolition. This leads to reduced interpersonal involvements and neglect of activities of daily living?
12.DIFFICULTY IN ABSTRACT THINKING - Impairment in the use of the abstract-symbolic mode of thinking, as evidenced by difficulty in classification, forming generalisations and proceeding beyond concrete or egocentric thinking in problem-solving tasks?
13.LACK OF SPONTANEITY AND FLOW OF CONVERSATION - Reduction in the normal flow of communication associated with apathy, avolition, defensiveness or cognitive deficit. This is manifested by diminished fluidity and productivity of the verbal interactional process?
14.STEREOTYPED THINKING - Decreased fluidity, spontaneity and flexibility of thinking, as evidenced in rigid, repetitious or barren thought content?
15.SOMATIC CONCERN - Physical complaints or beliefs about bodily illness or malfunctions. This may range from a vague sense of ill being to clear-cut delusions of catastrophic physical disease?
16.ANXIETY - Subjective experience of nervousness, worry, apprehension or restlessness, ranging from excessive concern about the present or future to feelings of panic?
17.GUILT FEELINGS - Sense of remorse or self-blame for real or imagined misdeeds in the past?
18.TENSION - Overt physical manifestations of fear, anxiety, and agitation, such as stiffness, tremor, profuse sweating and restlessness?
19.MANNERISMS AND POSTURING – Unnatural movements or posture as characterised be an awkward, stilted, disorganised, or bizarre appearance?
20.DEPRESSION - Feelings of sadness, discouragement, helplessness and pessimism?
21.MOTOR RETARDATION – Reduction in motor activity as reflected in slowing or lessening or movements and speech, diminished responsiveness of stimuli, and reduced body tone?
22.UNCOOPERATIVENESS - Active refusal to comply with the will of significant others, including the interviewer, hospital staff or family, which may be associated with distrust, defensiveness, stubbornness, negativism, rejection of authority, hostility or belligerence?
23.UNUSUAL THOUGHT CONTENT - Thinking characterised by strange, fantastic or bizarre ideas, ranging from those which are remote or atypical to those which are distorted, illogical and patently absurd?
24.DISORIENTATION - Lack of awareness of one’s relationship to the milieu, including persons, place and time, which may be due to confusion or withdrawal?
25.POOR ATTENTION - Failure in focused alertness manifested by poor concentration, distractibility from internal and external stimuli, and difficulty in harnessing, sustaining or shifting focus to new stimuli?
26.LACK OF JUDGEMENT AND INSIGHT - Impaired awareness or understanding of one’s own psychiatric condition and life situation. This is evidenced by failure to recognise past or present psychiatric illness or symptoms, denial of need for psychiatric hospitalisation or treatment, decisions characterised by poor anticipation or consequences, and unrealistic short-term and long-range planning?
27.DISTURBANCE OF VOLITION – Disturbance in the wilful initiation, sustenance and control of one’s thoughts, behaviour, movements and speech?
28.POOR IMPULSE CONTROL - Disordered regulation and control of action on inner urges, resulting in sudden, unmodulated, arbitrary or misdirected discharge of tension and emotions without concern about consequences?
29.PREOCCUPATION - Absorption with internally generated thoughts and feelings and with autistic experiences to the detriment of reality orientation and adaptive behaviour?
30.ACTIVE SOCIAL AVOIDANCE - Diminished social involvement associated with unwarranted fear, hostility, or distrust?

About

The Positive and Negative Syndrome Scale (PANSS) was published in 1987 by Stanley Kay, Lewis Opler, and Abraham Fiszbein. It’s a scale used for measuring symptom severity of schizophrenia, and widely used in the study of psychopharmacologic therapy. The scale was based off the Psychopathology Rating Schedule (PRS) and the Brief Psychiatric Rating Scale (BPRS). The PANSS is a 30-item clinician-administered rating scale, but requires 45 to 50 minutes to be administered by a subject matter expert. The interviewer must be trained to a standardized level of reliability. The PANSS has been published officially across 40 languages and is used internationally in mostly clinical research.

The scale has mostly been used to inventory, grade and follow the symptoms in schizophrenia. It quantifies 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. The PANSS is composed of 3 subscales: Positive Scale, Negative Scale, and General Psychopathology Scale. Each subscale is rated with 1 to 7 points ranging from absent to extreme. The range for the Positive and Negative Scales is 7-49, and the range for the General Psychopathology Scale is 16-112. The total PANSS score is simply the sum of the sub scales. In addition to these measures, a Composite Scale is scored by subtracting the negative score from the positive score. This yields a bipolar index that ranges from –42 to +42, which is essentially a difference score reflecting the degree of predominance of one syndrome in relation to the other.

The PANSS has been studied for its psychometric properties, and the data shows adequate Internal consistency, good test-retest reliability, and inter-rater reliability. In addition the PANSS has been researched in quality of life studies, functional status, natural history of schizophrenia and treatment outcomes. It has most of its evidence base to support its use for grading the severity of schizophrenia symptoms, staging of schizophrenia and treatment progress with medications. There is limited research that explains the degree of improvement in the total or subscale PANSS scores and how it is clinically important, or which break points for scores are best used for grading the severity of schizophrenia.

References

Kay SR.

Psychiatr Q. 1990;61(3):163-178.

Kay SR, Opler LA, Lindenmayer JP.

Br J Psychiatry Suppl. 1989 Nov;(7):59-67

Kay SR, Opler LA, Lindenmayer JP.

Psychiatry Res. 1988 Jan;23(1):99-110

Kay SR, Fiszbein A, Opler LA.

Schizophr Bull. 1987;13(2):261-76

Peralta V, Cuesta MJ.

Psychiatry Research. 1994;53(1):31-40.

Fountoulakis KN, Dragioti E, Theofilidis AT, et al.

International Journal of Neuropsychopharmacology. 2019;22(11):681-697

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1. Delusions (Beliefs which are unfounded, unrealistic, and idiosyncratic)?

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