Is the PANSS (Positive and Negative Syndrome Scale) instrument for schizophrenia being used correctly?

Senior professor discusses an issue with a student

The PANSS (Positive and Negative Syndrome Scale) is one of the most important rating instruments for patients with schizophrenia. Kay’s original 1987 article on PANSS has been cited more than 4,000 times making it one of the most frequently cited schizophrenia articles on PubMed.

Despite its common use there still seems to be profound uncertainty within the psychiatric community regarding its mathematical properties. The pitfall relates to the calculation of proportions (including percent changes), which are used in common outcome criteria like response.

Researchers from the Ludwig Maximilians University in Munich have conducted a systematic review to investigate the scope of incorrect PANSS calculations. They have searched for articles published in the top ten psychiatric journals using the terms “PANSS” and “response”. All articles containing percent changes were included and methods of percent change calculation were analysed.

They discovered that the majority of authors (62%) actually appear to use incorrect calculations. In most instances the method of calculation was not described in the manuscript.

The authors concluded:

These alarming results underline the need for standardised procedures for PANSS calculations.

Whilst the search criteria used here (just looking at the top ten impact psychiatric journals) could hardly be considered worthy of a systematic review, these results do suggest that there is an issue here that warrants further investigation.

Obermeier M, Schennach-Wolff R, Meyer S, Möller HJ, Riedel M, Krause D, Seemüller F. Is the PANSS used correctly? a systematic review. BMC Psychiatry. 2011 Jul 18;11:113.

Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull. 1987;13:261–276.

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Andre Tomlin

Andre Tomlin

André Tomlin is an Information Scientist with 20 years experience working in evidence-based healthcare. He's worked in the NHS, for Oxford University and since 2002 as Managing Director of Minervation Ltd, a consultancy company who do clever digital stuff for charities, universities and the public sector. Most recently André has been the driving force behind the Mental Elf and the National Elf Service; an innovative digital platform that helps professionals keep up to date with simple, clear and engaging summaries of evidence-based research. André is a Trustee at the Centre for Mental Health and an Honorary Research Fellow at University College London Division of Psychiatry. He lives in Bristol with his wife, dog and three little elflings.

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