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Reducing guesswork
in schizophrenia treatment
PANSS can target and gauge therapy, predict outcomes
M edia
e a lth
d e n HA. Opler,
Lewis
on ly PhD
MD,
Do
w ColumbiaseUniversity College of Physicians and
Lecturer in psychiatry
u
t a l
pyrigh ersonSurgeons
Co Fo r p New York, NY
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Table 1
PANSS
Table 2
5 - Moderate severe Presence of numerous well-formed delusions that are tenaciously held
and occasionally interfere with the patients thinking, social relations, or
behavior
7 - Extreme Presence of a stable set of delusions that are either highly systematized
or very numerous, and that dominate major facets of the patient's life.
This behavior frequently results in inappropriate and irresponsible action
that may jeopardize the safety of the patient or others
a universal means of communicating information tom subscale items (P1-P7), 7 negative symptom
about a patients clinical status. subscale items (N1-N7), and 16 general psycho-
pathology symptom items (G1-G16) (Table 1,
PANSS SCORING SYSTEM page 77). Each item has a definition and a basis
The PANSS includes 30 items, each rated from 1 for rating. The first question you need to answer
(absent) to 7 (extreme). In theory, a patient rated when rating a patient is whether the item is
absent (or 1) on all items would receive a total absent or present.
score of 30, and a patient rated extreme (or 7) How it works. For example, the PANSS defines
on all items would receive a total score of 210. In delusions as beliefs that are unfounded, unrealis-
the real world, though, no one sees these tic, and idiosyncratic, and the basis for rating is
extremes. Stable outpatients usually score 60 to thought content expressed during the interview
80. Inpatients scores rarely exceed 80 to 150, even and its influence on the patients social relations
in treatment refractory cases. and behavior as reported from primary care work-
The 30 items are arranged as 7 positive symp- ers or family. If the definition does not apply to
continued on page 81
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your patient, you rate this item 1 or absent. If the GAUGING SYMPTOM SEVERITY
definition does apply, anchoring points for each Treatment planning. Clinicians at the Rochester
level of severity are provided (Table 2, page 78), (New York) Psychiatric Center use the PANSS to
and you decide which anchoring point best assess symptom severity in inpatients with schiz-
describes the patients functioning during the ophrenia and other psychotic disorders.
interview and the preceding week. Within 1 week of admission, patients are
Time required. In research, gathering informant evaluated on the 30 items by a team of experi-
information, conducting the interview, and gener- enced PANSS raters. Symptoms identified by the
ating reliable ratings takes 45 to 60 minutes. In PANSS become targets in individualized treat-
clinical settings, if you know your patient and can ment plans. Follow-up PANSS assessments help
function as informant and interviewer, you proba- determine if treatment has improved the selected
bly can obtain accurate ratings in 30 to 45 minutes. symptoms.
Ideally, you would use the Structured Clinical Tracking patient progress. Florida State Hospital
Interview for the PANSS (SCI-PANSS), though uses the PANSS to track
clinicians who know this instru- progress of patients with serious
ment well may prefer a less struc- mental illnesses. Data collected over
tured interview that covers all Usual PANSS scores 8 years from >19,000 PANSS assess-
areas of inquiry. Accurate PANSS are 60 to 80 for stable ments in a multilingual, multicultural
scores are easy to generate on all 30 outpatients and population suggests that the PANSS:
items by combining information aids in decision making for med-
rarely exceed 80
from the interview with informa- ical and nonmedical aspects of care for
to 150 for inpatients
tion about how the patient has individual patients
functioned in the past week. can help determine if changes in
PANSS ratings are not meant to be agency prescribing practices affect
obtained after every patient contact but rather as patient symptom profiles and severity,
often as needed to guide clinical treatment. For one indicator of how policy and guidelines trans-
example, you might obtain a PANSS rating: late into patient care.9
when an inpatient is first admitted Monitoring depression. In Geha Psychiatric Hos-
before starting a new medication pital in Tel Aviv, Israel, treatment outcomes
weeks or months later to gauge the new improved when the PANSS was used to measure
treatments effect. severity of symptomsparticularly depression
Training is vital to becoming a reliable PANSS in an inpatient population of adolescents with
rater and is offered at venues such as the schizophrenia.10 PANSS items can measure dys-
American Psychiatric Associations annual meet- phoria, including anxiety, tension, and guilt feel-
ing. Other options include workshops or self- ings. Clinicians now routinely use the PANSS to
training materials from The PANSS Institute (see assess patients symptoms at admission and for
Related resources). periodic follow-up.
The PANSS manuala complete individual
kit costs approximately $200or licenses to use PREDICTING OUTCOMES
multiple copies are available from the copyright The PANSS has been shown to predict course of
holder, MultiHealth Systems, Inc. (see Related illness and treatment response, functional out-
resources). comes (including aggression), and long-term
PANSS
Functional outcomes. Steinert et al14 used the symptom severity and treatment results.
PANSS to rate 199 inpatients within 24 hours of
admission into an acute psychiatric ward. After Bottom
continued on page 84
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A FREE clinical
resource for NPs and PAs PANSS
Featuring timely and relevant journal articles Outcome measurement in psychiatry: a critical review. Washington,
DC: American Psychiatric Press; 2002.
National and local conference alerts, and more! Dr. Lewis A. Opler receives royalties from MultiHealth Systems, Inc. on sales of
the Positive and Negative Syndrome Scale (PANSS) Manual, the Structured
Clinical Interview for the PANSS (SCI-PANSS), and the Informant
Questionnaire for the PANSS (IQ-PANSS).
ACKNOWLEDGEMENT
This work was supported in part by NIMH grant K24 MH01699 (DM).