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Symptom rating scales and outcome in schizophrenia

  • Ann M. Mortimer (a1)
Abstract
Background

Symptom rating scales are now well established in schizophrenia research buttheir scores are notthe same as outcome

Aims

To appraise the usefulness of symptom rating scales in evaluating the outcome of people with schizophrenia

Method

Literature on the use of the Brief Psychiatric Rating Scale (BPRS) the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression (CGI) in schizophrenia research was studied

Results

Scales were designed to make diagnoses, to categorise patients, syndromes or both, and to demonstrate antipsychotic efficacy, as well as to measure outcome. There is much redundancy both between and within scales. Early work suggests limited concurrent validity with external outcome variables. Data are at best ordinal and there are particular difficulties in equating outcome with percentage changes in scores. The concept of remission, which uses absolute item score thresholds with a duration criterion, is a promising outcome measure

Conclusions

Symptom rating scale scores can only comprise a limited part of outcome measurement. Standardised remission criteria may present advantages in outcome research

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References
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Addington, D., Addington, J., Maticka-Tyndale, E., et al (1992) Reliability and validity of a depression rating scale for schizophrenics. Schizophrenia Research, 6, 201208.
American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorder (4th edn). APA.
Andreasen, N. (1982) Negative symptoms in schizophrenia: definition and reliability. Archives of General Psychiatry, 39, 784788.
Andreasen, N. (1984a) Scale for the Assessment of Negative Symptoms (SANS). Univeristy of Iowa.
Andreasen, N. (1984b) Scale for the Assessment of Positive Symptoms (SAPS). University of Iowa.
Andreasen, N. & Olsen, S. (1982) Negative v positive schizophrenia: definition and validation. Archives of General Psychiatry, 39, 789794.
Andreasen, N., Carpenter, W., Kane, J., et al (2005) Remission in schizophrenia: proposed criteria and rationale for consensus. American Journal of Psychiatry, 162, 441449.
Andrews, G., Peters, L., & Teeson, M. (1994) The Measurement of Consumer Outcome in Mental Health. Australian Health Outcomes Collaboration.
Bell, M., Milstein, R., Beam-Goulet, J., et al (1992) The Positive and Negative Syndrome Scale and the Brief Psychiatric Rating Scale. Reliability, comparability and predictive validity. Journal of Nervous and Mental Disorders, 180, 723728.
Bell, M., Lysaker, P., Milstein, R., et al (1994) Concurrent validity of the cognitive component of schizophrenia: relationship of PANSS scores to neuropsychological assessment. Psychiatry Research, 54, 5158.
Beneke, M. & Rasmus, W. (1992) Clinical Global Impressions (ECDEU): some critical comments. Pharmacopsychiatry, 25, 171176.
Birsoz, S., Isik, E., Yargic, I., et al (2006) Remission in schizophrenia: a utopia or a goal? Klinik Psik of armakoloji Buelteni, 16, 128132.
Bozikas, V., Kosmidis, M., Gamvrula, K., et al (2004) Clock Drawing Test in patients with schizophrenia. Psychiatry Research, 121, 229238.
Chadwick, P. & Birchwood, M. (1995) The omnipotence of voices. II: The Beliefs About Voices Questionnaire (BAVQ). British Journal of Psychiatry, 166, 773776.
Collins, A., Remington, G., Coulter, K., et al (1996) Depression in schizophrenia: a comparison of three measures, Schizophrenia Research, 20, 205209.
Cramer, J., Rosenheck, R., Xu, W., et al (2001) Detecting improvement in quality of life and symptomatology in schizophrenia. Schizophrenia Bulletin, 27, 227234.
Crow, T. (1980) Positive and negative schizophrenic symptoms and the role of dopamine. British Journal of Psychiatry, 137, 383386.
d'Amato, T., Rochet, T., Dalery, J., et al (1992) Relationship between symptoms rated with the Positive and Negative Syndrome Scale and Brain Measures in schizophrenia. Psychiatry Research, 44, 5562.
Delmonte, P., Gabrielli, F., Gibertie, F., et al (1970) Diagnostic classification concepts among Italian psychiatrists. Archivio di Psicologia Neurologia e Psychiatria, 6, 531553.
Dunayevich, E., Sethuraman, G., Enerson, M., et al (2006) Characteristics of two alternative schizophrenia remission definitions: relationship to clinical and quality of life outcomes. Schizophrenia Research, 86, 300308.
Eckert, S., Diamond, P., Miller, A., et al (1996) A comparison of instrument sensitivity to negative symptom change. Psychiatry Research, 63, 6775.
Emsley, R., Oosthuizen, P., Joubert, A., et al (1999) Depressive and anxiety symptoms in patients with schizophrenia and schizophreniform disorder. Journal of Clinical Psychiatry, 60, 747751.
Emslie, G., Rush, A., Weinberg, W., et al (1997) A double-blind, randomized, placebo-controlled trial of fluoxetine in children and adolescents with depression. Archives of General Psychiatry, 54, 10311037.
Engelsmann, F. & Formankova, M. (1967) Abbreviated Psychiatric Evaluation Scale (Overall-Gorham). Ceskoslovenska Psychiatrie, 63, 297306.
Engelsmann, F., Finar, O., Pichot, P., et al (1970) International comparison of diagnostic patterns. Transcultural Psychiatric Research Review, 7, 130137.
Fresan, A., De la Fuente-Sandoval, C., Loyzaga, C., et al (2005) A forced five-dimensional factor analysis and concurrent validity of the Positive and Negative Syndrome Scalein Mexican schizophrenic patients. Schizophrenia Research, 72, 123129.
Gharabawi, G., Rodriguez, S., Turkoz, I., et al (2005) Exploring the evidence for a relationship between symptomatic remission and functioning in patients with schizophrenia. Neuropsychopharmacology, 30 (suppl. 1), s1s270.
Good, K., Rabinowitz, J., Whitehorn, D., et al (2004) The relationship of neuropsychological test performance with the PANSS in antipsychotic naive, first-episode psychosis patients. Schizophrenia Research, 68, 1119.
Guy, W. (1976) Clinical Global Impression. In ECDEU Assessment Manual for Psychopharmacology (revised), pp. 217221. National Institute of Mental Health.
Hamera, E., Schneider, J., Potocky, M., et al (1996) Validity of self-administered symptom scales in clients with schizophrenia and schizoaffective disorders. Schizophrenia Research, 19, 213219.
Hamilton, S., Revicki, D., Genduso, L., et al (1998) Olanzapine versus placebo and haloperidol: quality of life and efficacy results of the North American doubleblind trial. Neuropsychopharmacology, 18, 4149.
Haro, J., Kamath, S., Ochoa, S., et al (2003) The Clinical Global Impression-Schizophrenia scale: a simple instrument to measure the diversity of symptoms present in schizophrenia. Acta Psychiatrica Scandinavica, 107 (suppl. 416), 1623.
Hedlund, J. & Vieweg, B. (1980) The brief psychiatric rating scale (BPRS): a comprehensive review. Journal of Operational Psychiatry, 11, 4865.
Kane, J., Honigfeld, G., Singer, J., et al (1988) Clozapine for the treatment-resistant schizophrenic. A double-blind comparison with chlorpromazine. Archives of General Psychiatry, 45, 789796.
Kay, S., Fiszbein, A., & Opler, L. (1987) The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13, 262276.
Kay, S., Opler, L., & Lindenmayer, J. (1988) Reliability and validity of the Positive and Negative Syndrome Scale for schizophrenia. Psychiatry Research, 23, 99110.
Kay, S., Opler, L., & Lindenmayer, J. (1989) The Positive and Negative Syndrome Scale (PANSS): rationale and standardisation. British Journal of Psychiatry, 155 (suppl. 7), 5967.
Kissling, W., Heres, S., Lloyd, K., et al (2005) Direct transition tolong-acting risperidone-analysis of long-term efficacy. Journal of Psychopharmacology, 19, 1521.
Krauss, H., Marwinski, K., Held, T., et al (1998) Reliability and validity of the premorbid adjustment scale (PAS) in a German sample of schizophrenic and schizoaffective patients. European Archives of Psychiatry in Clinical Neuroscience, 248, 277281.
Lasser, R., Bossie, C., Gharabawi, G., et al (2005) Remission in schizophrenia: results from al-year study of long-acting risperidone injection. Schizophrenia Research, 77, 215227.
Leucht, S. & Engel, R. (2006) The relative sensitivity of the Clinical Global Impressions Scale and the Brief Psychiatric Rating Scalein antipsychoticdrug trials. Neuropsychopharmacology, 31, 406412.
Leucht, S. & Lasser, R. (2006) The concepts of remission and recovery in schizophrenia. Pharmacopsychiatry, 39, 161170.
Leucht, S., Kane, J., Kissling, W., et al (2005a) Clinical implications of Brief Psychiatric Rating Scale scores. British Journal of Psychiatry, 187, 366371.
Leucht, S., Kane, J., Kissling, W., et al (2005b) What does the PANSS mean? Schizophrenia Research, 79, 231238.
Leucht, S., Kane, J., Etschel, E., et al (2006) Linking the PANSS, BPRS, and CGI: clinical implications. Neuropsychopharmacology, 18.
Lindenmayer, J., Kay, S. & Friedman, C. (1986) Negative and positive schizophrenic syndromes after the acute phase: A prospective follow-up. Comprehensive Psychiatry, 27, 276286.
Lindenmayer, J., Bernstein-Hyman, R. & Grochowski, S. (1994) A new five factor model of schizophrenia. Psychiatric Quarterly, 65, 299322.
Lindenmayer, J., Brown, E., Baker, R., et al (2004) An excitement subscale of the Positive and Negative Syndrome Scale. Schizophrenia Research, 68, 331337.
Liu, S., Hwu, H. & Chen, W. (1997) Clinical sympton dimensions and deficits on the Continuous Performance Test in schizophrenia. Schizophrenia Research, 25, 211219.
Marshall, M., Lockwood, A., Bradley, C., et al (2000) Unpublished rating scales: a major source of bias in randomised controlled trials of treatments for schizophrenia. British Journal of Psychiatry, 176, 249252.
Mass, R., Schoemig, T., Hitschfeld, K., et al (2000) Psychopathological syndromes of schizophrenia: evaluation of the dimensional structure of the positive and negative syndrome scale. Schizophrenia Bulletin, 26, 167177.
McGorry, P., Goodwin, R. & Stuart, G. (1988) The development, use, and reliability of the brief psychiatric rating scale (nursing modification)-an assessment procedure for the nursing team in clinical and research settings. Comprehensive Psychiatry, 29, 575587.
Mortimer, A. & Spence, S. (2001) The Management of Negative Symptons of Schizophrenia. Science Press.
Murray, R. & Van Os, J. (1998) Predictors of outcome in schizophrenia. Journal of Clinical Psychopharmacology, 18, 2S4S.
Nasrallah, H. (2006) Improving patient outcomes in schizophrenia; achieving remission. Journal of Psychopharmacology, 20, 5761.
Norman, R., Malla, A., Cortese, L., et al (1996) A study of the interrelationship between and comparative interrater reliability of the SAPS, SANS and PANSS. Schizophrenia Research, 19, 7385.
Overall, J. & Gorham, D. (1962) The Brief Psychiatric Rating Scale. Psychological Reports, 10, 799812.
Overall, J. & Pfefferbaum, B. (1982) The Brief Psychiatric Rating Scale for Children. Psychopharmacology Bulletin, 18, 1016.
Overall, J. E. & Rhoades, H. M. (1982) Refinement of phenomenological classification in clinical psychopharmacology research. Psychopharmacology, 77, 2430.
Overall, J. & Beller, S. (1984) The Brief Psychiatric Rating Scale (BPRS) in geropsychiatric research: I. Factor structure on an inpatient unit. Journal of Gerontology, 39, 187193.
Overall, J. & Gorham, D. (1988) The Brief Psychiatric Rating Scale (BPRS): recent developments in ascertainment and scaling. Psychopharmacology Bulletin, 24, 9799.
Peralta, V. & Cuesta, M. (1994) Psychometric properties of the Positive and Negative Syndrome Scale (PANSS) in schizophrenia. Psychiatry Research, 53, 3140.
Perry, P., Sanger, T. & Beasley, C. (1997) Olanzapine plasma concentrations and clinical response in acutely ill schizophrenic patients. Journal of Clinical Psychopharmacology, 17, 472477.
Pogue-Geile, M. & Harrow, M. (1984) Negative and positive symptoms in schizophrenia and depression: A follow up. Schizophrenia Bulletin, 10, 371387.
Rabinowitz, J., Mehnert, A. & Eerdekens, M. (2006) To what extent do the PANSS and CGI-S overlap? Journal of Clinical Psychopharmacology, 26, 303307.
Ritsner, M., Blumenkrantz, H., Dubinsky, T., et al (2006) The detection of neurocognitive decline in schizophrenia using the Mindstreams Computerized Cognitive Test Battery. Schizophrenia Research, 82, 3949.
Rocca, P., Bellino, S., Calvarese, P., et al (2005) Depressive and negative symptomsin schizophrenia: different effects on clinical features. Comprehensive Psychiatry, 46, 304310.
Schuldberg, D., Quinlan, D. & Glazer, W. (1999) Positive and negative symptomsand adjustmentin severely mentally ill outpatients. Psychiatry Research, 85, 177188.
Sethuraman, G., Taylor, C., Enerson, M., et al (2005) A retrospective comparison of cumulative time spent in remission during treatment with olanzapine or risperidone among patients with schizophrenia. Schizophrenia Research, 79, 337340.
Singh, M. & Kay, S. (1975) A comparative study of haloperidol and chlorpromazine in terms of clinical effects and therapeutic reversal; with benztropine in schizophrenia: theorectical implications for potency differences among neuroleptics. Psychopharmacologia, 43, 103113.
Spearing, M., Post, R., Leverich, G., et al (1997) Modification of the Clinical Global Impression (CGI) scale for use in bipolar illness: the CGI-BP. Psychiatry Research, 73, 159171.
Steinert, T., Wolfle, M. & Gebhardt, R. (2000) Measurement of violence duringin-patient treatment and association with psychopathology. Acta Psychiatrica Scandinavica, 102, 107112.
Tiihonen, J., Wahlbeck, K., Lonnqvist, J., et al (2006) Effectiveness of antipsychotic treatments in anationwide cohort of patients in community care after first hospitalisation due to schizophrenia and schizoaffective disorder: observational follow-up study. British Medical Journal, 333, 224.
Van den Oord, E., Rujescu, D., Robies, J., et al (2006) Factor structure and external validity of the PANSS revisited. Schizophrenia Research, 82, 213223.
van der Gaag, M., Cuijpers, A., Hoffman, T., et al (2006a) The five-factor model of the Positive and Negative Syndrome Scale I: confirmatory factor analysis fails to confirm 25 published five-factor solutions. Schizophrenia Research, 85, 273279.
van der Gaag, M., Hoffman, T., Remijsen, M., et al (2006b) The five-factor model of the Positive and Negative Syndrome ScaleII: aten-fold cross-validation of a revised model. Schizophrenia Research, 85, 273279.
Van Os, J., Fahy, T., Jones, P., et al (1996) Psychopathological syndromes in the functional psychoses: associations with course and outcome. Psychological Medicine, 26, 161176.
Van Os, J., Burns, T., Cavallero, R., et al (2006) Standardized remission criteriain schizophrenia. Acta Psychiatrica Scandinavica, 113, 9195.
Ventura, J., Neuchterlein, K. S. K., Gutkind, D., et al (2000) Symptom dimensions in recent-onset schizophrenia and mania: aprincipal components analysis of the 24-item Brief Psychiatric Rating Scale. Psychiatry Research, 97, 129135.
Welham, J., Stedman, T. & Clair, A. (1999) Choosing negative symptom instruments: issues of representation and redundancy, Psychiatry Research, 87, 4756.
White, L. (2005) Interpreting the PANSS: measures, factors and models. Schizophrenia Research, 79, 349351.
Wolthaus, J., Dingemans, P., Schene, A., et al (2000) Component structure of the Positive and Negative Syndrome Scale (PANSS) in patients with recent-onset schizophrenia and spectrum disorders. Psychopharmacology, 150, 399403.
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Symptom rating scales and outcome in schizophrenia

  • Ann M. Mortimer (a1)
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