Symptom changes in five dimensions of the Positive and Negative Syndrome Scale in refractory psychosis
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Refractory psychosis units currently have little information regarding which symptoms profiles should be expected to respond to treatment. In the current study, we provide this information using structural equation modeling of Positive and Negative Syndrome Scale (PANSS) ratings at admission and discharge on a sample of 610 patients admitted to a treatment refractory psychosis program at a Canadian tertiary care unit between 1990 and 2011. The hypothesized five-dimensional structure of the PANSS fit the data well at both admission and discharge, and the latent variable scores are reported as a function of symptom dimension and diagnostic category. The results suggest that, overall, positive symptoms (POS) responded to treatment better than all other symptoms dimensions, but for the schizoaffective and bipolar groups, greater response on POS was observed relative to the schizophrenia and major depression groups. The major depression group showed the most improvement on negative symptoms and emotional distress, and the bipolar group showed the most improvement on disorganization. Schizophrenia was distinct from schizoaffective disorder in showing reduced treatment response on all symptom dimensions. These results can assist refractory psychosis units by providing information on how PANSS symptom dimensions respond to treatment and how this depends on diagnostic category.
KeywordsRefractory psychosis Positive and Negative Syndrome Scale (PANSS) Structural equation modeling Schizophrenia Schizoaffective disorder Depression
TSW is supported by career investigator awards from the Canadian Institutes of Health Research (CIHR) and the Michael Smith Foundation for Health Research (MSFHR). KJ is supported by post-doctoral fellowship awards from the Mind Foundation of BC and MITACS. Research at Riverview Hospital, and now in the BC Psychosis Program, is supported by BC Mental Health and Addictions Services.
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
- 1.Addington D, Bouchard R-H, Goldberg J, Honer WG, Malla AK, Norman RM, Tempier R, Berzins S (2005) Clinical practice guidelines: treatment of schizophrenia. Can J Psychiatr 50:1S–56SGoogle Scholar
- 5.Cheniaux E, Landeira-Fernandez J, Lessa Telles L, Lessa JL, Dias A, Duncan T, Versiani M (2008) Does schizoaffective disorder really exist? A systematic review of the studies that compared schizoaffective disorder with schizophrenia or mood disorders. J Affect Disord 106:209–217PubMedCrossRefGoogle Scholar
- 11.Fusar-Poli P, Broome MR, Matthiasson P, Woolley JB, Mechelli A, Johns LC, Tabraham P, Bramon E, Valmaggia L, Williams SC, McGuire P (2011) Prefrontal function at presentation directly related to clinical outcome in people at ultrahigh risk of psychosis. Schizophr Bull 37:189–198PubMedCentralPubMedCrossRefGoogle Scholar
- 12.Guy W (ed) (1976) Clinical global impressions. In: ECDEU assessment manual for psychopharmacology. Revised DHEW Pub. (ADM). National Institute for Mental Health, Rockville, pp 218–222 Google Scholar
- 20.Kay SR, Opler LA, Lindenmayer JP (1989) The Positive and Negative Syndrome Scale (PANSS): rationale and Standardisation. Br J Psychiatry 155:59–65Google Scholar
- 29.May P, Dencker S, Hubbard J, Midha K, Liberman R (1988) A systematic approach to treatment resistance in schizophrenic disorders. In: Dencker S, Kulhanek F (eds) Treatment resistance in schizophrenia. Vieweg, Braunschweig, Weisbaden, pp 22–33Google Scholar
- 39.van der Gaag M, Hoffman T, Remijsen M, Hijman R, de Haan L, van Meijel B, van Harten PN, Valmaggia L, de Hert M, Cuijpers A, Wiersma D (2006) The five-factor model of the Positive and Negative Syndrome Scale II: a ten-fold cross-validation of a revised model. Schizophr Res 85:280–287PubMedCrossRefGoogle Scholar
- 40.White L, Harvey PD, Opler L, Lindenmayer JP (1997) Empirical assessment of the factorial structure of clinical symptoms in schizophrenia. A multisite, multimodel evaluation of the factorial structure of the Positive and Negative Syndrome Scale. The PANSS Study Group. Psychopathology 30:263–274PubMedCrossRefGoogle Scholar