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Symptom changes in five dimensions of the Positive and Negative Syndrome Scale in refractory psychosis

  • Todd S. WoodwardEmail author
  • Kwanghee Jung
  • Geoffrey N. Smith
  • Heungsun Hwang
  • Alasdair M. Barr
  • Ric M. Procyshyn
  • Sean W. Flynn
  • Mark van der Gaag
  • William G. Honer
Original Paper

Abstract

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.

Keywords

Refractory psychosis Positive and Negative Syndrome Scale (PANSS) Structural equation modeling Schizophrenia Schizoaffective disorder Depression 

Notes

Acknowledgments

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.

References

  1. 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
  2. 2.
    Agid O, Kapur S, Remington G (2008) Emerging drugs for schizophrenia. Expert Opin Emerg Drugs 13:479–495PubMedCrossRefGoogle Scholar
  3. 3.
    Andreasen NC, Carpenter WT Jr, Kane JM, Lasser RA, Marder SR, Weinberger DR (2005) Remission in schizophrenia: proposed criteria and rationale for consensus. Am J Psychiatr 162:441–449PubMedCrossRefGoogle Scholar
  4. 4.
    Benabarre A, Vieta E, Colom F, Martínez-Arán A, Reinares M, Gastó C (2001) Bipolar disorder, schizoaffective disorder and schizophrenia: epidemiologic, clinical and prognostic differences. Eur Psychiatr 16:167–172CrossRefGoogle Scholar
  5. 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
  6. 6.
    Ciapparelli A, Dell’Osso L, Pini S, Chiavacci MC, Fenzi M, Cassano GB (2000) Clozapine for treatment-refractory schizophrenia, schizoaffective disorder, and psychotic bipolar disorder: a 24-month naturalistic study. J Clin Psychiatr 61:329–334CrossRefGoogle Scholar
  7. 7.
    Crumlish N, Whitty P, Clarke M, Browne S, Kamali M, Gervin M, McTigue O, Kinsella A, Waddington JL, Larkin C, O’Callaghan E (2009) Beyond the critical period: longitudinal study of 8-year outcome in first-episode non-affective psychosis. Br J Psychiatr 194:18–24CrossRefGoogle Scholar
  8. 8.
    Daniels BA, Kirkby KC, Hay DA, Mowry BJ, Jones IH (1998) Predictability of rehospitalisation over 5 years for schizophrenia, bipolar disorder and depression. Aust N Z J Psychiatry 32:280CrossRefGoogle Scholar
  9. 9.
    Efron B (1981) Nonparametric estimates of standard error: the jackknife, the bootstrap and other methods. Biometrika 68:589–599CrossRefGoogle Scholar
  10. 10.
    Emsley R, Rabinowitz J, Torreman M (2003) The factor structure for the Positive and Negative Syndrome Scale (PANSS) in recent-onset psychosis. Schizophr Res 61:47–57PubMedCrossRefGoogle Scholar
  11. 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. 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
  13. 13.
    Hwang H, Malhotra NK, Kim Y, Tomiuk MA, Hong S (2010) A comparative study on parameter recovery of three approaches to structural equation modeling. J Mark Res 47:699–712CrossRefGoogle Scholar
  14. 14.
    Hwang H, Takane Y (2004) Generalized structured component analysis. Psychometrika 69:81–99CrossRefGoogle Scholar
  15. 15.
    Johnstone E, Frith CD, Crow TJ, Carney MWP, Price JS (1978) Mechanism of the antipsychotic effect in the treatment of acute schizophrenia. Lancet 311:848–851CrossRefGoogle Scholar
  16. 16.
    Jöreskog KG (1970) A general method for analysis of covariance structures. Biometrika 57:239–251CrossRefGoogle Scholar
  17. 17.
    Kapur S (2003) Psychosis as a state of aberrant salience: a framework linking biology, phenomenology, and pharmacology in schizophrenia. Am J Psychiatry 160:13–23PubMedCrossRefGoogle Scholar
  18. 18.
    Kay SR, Fiszbein A, Opler LA (1987) The Positive and Negative Syndrome Scale (PANSS) for Schizophrenia. Schizophr Bull 13:261–276PubMedCrossRefGoogle Scholar
  19. 19.
    Kay SR, Opler LA, Lindenmayer J-P (1988) Reliability and validity of the positive and negative syndrome scale for schizophrenics. Psychiatry Res 23:99–110PubMedCrossRefGoogle Scholar
  20. 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
  21. 21.
    Kriston L, Härter M, Scholl I (2012) A latent variable framework for modeling dyadic measures in research on shared decision-making. Z Evid Fortbild Qual Gesundh wesen 106:253–263CrossRefGoogle Scholar
  22. 22.
    Lancon C, Auquier P, Nayt G, Reine G (2000) Stability of the five-factor structure of the Positive and Negative Syndrome Scale (PANSS). Schizophr Res 42:231–239PubMedCrossRefGoogle Scholar
  23. 23.
    Leucht S, Kane J, Etschel E, Kissling W, Hamann J, Engel RR (2006) Linking the PANSS, BPRS, and CGI: clinical implications. Neuropsychopharmacology 31:2318–2325PubMedCrossRefGoogle Scholar
  24. 24.
    Levine SZ, Rabinowitz J (2007) Revisiting the 5 dimensions of the Positive and Negative Syndrome Scale. J Clin Psychopharmacol 27:431–436PubMedCrossRefGoogle Scholar
  25. 25.
    Levine SZ, Rabinowitz J, Engel R, Etschel E, Leucht S (2008) Extrapolation between measures of symptom severity and change: an examination of the PANSS and CGI. Schizophr Res 98:318–322PubMedCrossRefGoogle Scholar
  26. 26.
    Liddle PF, Ngan ETN, Duffield G, Kho K, Warren AJ (2002) The signs and symptoms of psychotic illness: a rating scale. Br J Psychiatry 180:45–50PubMedCrossRefGoogle Scholar
  27. 27.
    Lindenmayer JP (2000) Treatment refractory schizophrenia. Psychiatr Q 71:373–384PubMedCrossRefGoogle Scholar
  28. 28.
    Mass R, Schoemig T, Hitschfeld K, Wall E, Haasen C (2000) Psychopathological syndromes of schizophrenia: evaluation of the dimensional structure of the positive and negative syndrome scale. Schizophr Bull 26:167–177PubMedCrossRefGoogle Scholar
  29. 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
  30. 30.
    McElroy SL, Dessain EC, Pope HG Jr, Cole JO, Keck PE Jr, Frankenberg FR, Aizley HG, O’Brien S (1991) Clozapine in the treatment of psychotic mood disorders, schizoaffective disorder, and schizophrenia. J Clin Psychiatry 52:411–414PubMedGoogle Scholar
  31. 31.
    Murru A, Pacchiarotti I, Nivoli AM, Grande I, Colom F, Vieta E (2011) What we know and what we don’t know about the treatment of schizoaffective disorder. Eur Neuropsychopharm 21:680–690CrossRefGoogle Scholar
  32. 32.
    Reichenberg A, Rieckmann N, Harvey PD (2005) Stability in schizophrenia symptoms over time: findings from the Mount Sinai Pilgrim Psychiatric Center Longitudinal Study. J Abnorm Psychol 114:363–372PubMedCrossRefGoogle Scholar
  33. 33.
    Schottle D, Schimmelmann BG, Conus P, Cotton SM, Michel C, McGorry PD, Karow A, Naber D, Lambert M (2012) Differentiating schizoaffective and bipolar I disorder in first-episode psychotic mania. Schizophr Res 140:31–36PubMedCrossRefGoogle Scholar
  34. 34.
    Smith GN, MacEwan GW, Ancill RJ, Honer WG, Ehmann TS (1992) Diagnostic confusion in treatment-refractory psychotic patients. J Clin Psychiatry 53:197–200PubMedGoogle Scholar
  35. 35.
    Souza JS, Kayo M, Tassell I, Martins CB, Elkis H (2013) Efficacy of olanzapine in comparison with clozapine for treatment-resistant schizophrenia: evidence from a systematic review and meta-analyses. CNS Spectr 18:82–89PubMedCrossRefGoogle Scholar
  36. 36.
    Suzuki T, Remington G, Arenovich T, Uchida H, Agid O, Graff-Guerrero A, Mamo DC (2011) Time course of improvement with antipsychotic medication in treatment-resistant schizophrenia. Br J Psychiatry 199:275–280PubMedCrossRefGoogle Scholar
  37. 37.
    Tenenhaus M (2008) Component-based Structural Equation Modelling. Total Qual Manag Bus 19:871–886CrossRefGoogle Scholar
  38. 38.
    van den Oord EJ, Adkins DE, McClay J, Lieberman J, Sullivan PF (2009) A systematic method for estimating individual responses to treatment with antipsychotics in CATIE. Schizophr Res 107:13–21PubMedCentralPubMedCrossRefGoogle Scholar
  39. 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. 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

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Todd S. Woodward
    • 1
    • 2
    Email author
  • Kwanghee Jung
    • 3
  • Geoffrey N. Smith
    • 1
    • 2
  • Heungsun Hwang
    • 4
  • Alasdair M. Barr
    • 5
  • Ric M. Procyshyn
    • 1
    • 2
  • Sean W. Flynn
    • 1
  • Mark van der Gaag
    • 6
    • 7
  • William G. Honer
    • 1
    • 2
  1. 1.Department of PsychiatryUniversity of British ColumbiaVancouverCanada
  2. 2.BC Mental Health and Addictions Research InstituteVancouverCanada
  3. 3.Department of PediatricsUniversity of Texas Health Science CenterHoustonUSA
  4. 4.Department of PsychologyMcGill UniversityMontrealCanada
  5. 5.Department of Anesthesiology, Pharmacology and TherapeuticsUniversity of British ColumbiaVancouverCanada
  6. 6.Department of Clinical Psychology and EMGO Institute for Health and Care ResearchVU UniversityAmsterdamThe Netherlands
  7. 7.Parnassia Psychiatric InstituteThe HagueThe Netherlands

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