Thank you for everything you do. Calc Function Calcs that help predict probability of a disease Diagnosis. Subcategory of 'Diagnosis' designed to be very sensitive Rule Out. Disease is diagnosed: prognosticate to guide treatment Prognosis.
Numerical inputs and outputs Formula. Med treatment and more Treatment. Suggested protocols Algorithm. Disease Select Specialty Select Chief Complaint Select Organ System Select Log In.
Email Address. Password Show. Or create a new account it's free. Forgot Password? Sign In Required. To save favorites, you must log in. Creating an account is free, easy, and takes about 60 seconds.
This study demonstrates that NSA-4 ofters accuracy comparable to the NSA in rating negative symptoms in patients with schizophrenia [ 20 ]. The CGI-SCH scale assesses the positive, negative, depressive, cognitive symptoms, and overall severity of schizophrenia [ 21 ]. This study concluded the CGI-SCH scale is a valid, reliable instrument to evaluate severity and treatment response in schizophrenia. Administering the instrument is simple, concise, and quick, which makes it an appropriate scale for use in observational studies and in routine clinical practice [ 21 ].
The severity of illness category evaluates the situation during the week previous to the assessment, while the degree of change category evaluates the change from the previous evaluation. Each category contains five different ratings positive, negative, depressive, cognitive, and global that are evaluated using a seven-point ordinal scale. The CGI-SCH lacks good interrater reliability, sensitivity to change, and low correlation coefficient for depression rating [ 21 ].
In , the National Institute of Mental Health held a consensus development conference on negative symptoms. Both measures are becoming widely used and various research studies have demonstrated good psychometric properties for each scale.
The study published in a schizophrenia bulletin provides the first direct psychometric comparison of these scales [ 26 ]. In this study, 65 outpatient patients diagnosed with schizophrenia or schizoaffective disorder completed clinical interviews, questionnaires, and neuropsychological testing. Results indicated that both measures had good internal consistency, convergent validity, and discriminate validity.
Moderate convergence occurred for avolition and asociality items, and low convergence was seen among anhedonia items. Findings from this study suggest that both scales have good psychometric properties [ 26 ]. Using a diverse sample of outpatients with schizophrenia or schizoaffective disorder, the researchers assessed the structure, interpreter agreement, test-retest reliability, and convergent and discriminant validity of the item tool. Results were promising. The scales demonstrated good internal consistency, test-retest stability, and interrater agreement.
The CAINS also showed strong convergent validity, which was determined by linkages with other measures of negative symptoms. CAINS, though brief, is also comprehensive and employable across a wide range of research and clinical contexts [ 27 ]. A study published in Schizophrenia Research highlighted the fact that patients with schizophrenia, especially those who have persistent and clinically significant negative symptoms PNS , have the poorest functional outcomes and quality of life [ 28 ].
The presence of negative symptoms represent an unmet therapeutic need for large numbers of patients with schizophrenia. There is not one psychosocial treatment model that has been established that could address the entire constellation of PNS. MOVE was a home based multi-modal treatment that employed a number of cognitive and behavioral principles to address the broad range of factors contributing to PNS and their functional consequences.
Patients were assessed at baseline and every three months with multiple measures of negative symptoms. Thus far, both have exhibited promising psychometric properties [ 29 ]. Findings from previous research studies indicate that the CAINS is brief yet comprehensive and employable across a wide range of research and clinical contexts. Negative symptoms are resistant to treatment and impede functional recovery in schizophrenia.
The CAINS and BNSS are two scales that explore psychometric domains, including negative symptoms, different aspects of anhedonia, and interest in social relationships with others. Both scales use 13 items to assess negative symptoms [ 27 ]. It is anticipated that prospective clinical trials enrolling those with negative symptoms will demonstrate the relative sensitivity to change and global suitability of the BNSS and CAINS vs.
Multiple studies have found that regardless of the scale used to assess negative symptoms, strong correlations exist between higher negative symptom scores and poorer social functioning [ 27 , 28 , 30 ] Overall CAINS and BNSS are attractive for both their reliability and their concise accessible format. CAINS and BNSS continue to evaluate patients' primary diagnosis on the basis of negative symptoms, with no integration of other aspects of the patients' social and cognitive functioning.
Furthermore, CAINS scales are not strongly related to depression, agitation, or positive symptoms [ 27 ]. Since then, our understanding of negative symptoms has been evolved and currently there are newer rating scales reviewing the validity of negative symptoms.
This is the biggest difference between the older and newer scales. It is clear that the newer negative symptom scales represent progress in the understanding of schizophrenia psychopathology.
However, they still neglect to address the psychosocial and cognitive factors that are useful outcome measures. While there are many different scales available to assess positive and negative symptoms of schizophrenia, a scale that is simpler, accessible, user-friendly, incorporates a multidimensional model of schizophrenia, addresses the psychosocial and cognitive component, and helps us better understand the severity and psychopathology of schizophrenia has yet to be developed.
National Center for Biotechnology Information , U. J Addict Res Ther. Author manuscript; available in PMC Feb 8. Author information Copyright and License information Disclaimer. Copyright notice.
This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
The publisher's final edited version of this article is available at J Addict Res Ther. See other articles in PMC that cite the published article. Abstract Scales measuring positive and negative symptoms in schizophrenia remain the primary mo Scales measuring positive and negative symptoms in schizophrenia remain the primary mode of assessing and diagnosing schizophrenia by clinicians and researchers.
Keywords: Schizophrenia, Psychopathology, Mental health, Clinical practice. Nature of scoring SANS measures negative symptoms on a 25 item, 6-point scale. Nature of scoring PANSS is comprised of 30 distinct items organized into three independent subscales with scoring that ranges from 30 to points [ 13 ]. Nature of scoring It is a semi-structured 16 item interview, utilizing the five factors: 1.
Criticism The main limitation of the NSA is its high reliance on functioning or behaviors, even for experiential symptoms, such as reduced social drive, whose severity is measured by type and frequency of social interactions [ 19 ].
Criticisms The CGI-SCH lacks good interrater reliability, sensitivity to change, and low correlation coefficient for depression rating [ 21 ]. Nature of scoring The CAINS and BNSS are two scales that explore psychometric domains, including negative symptoms, different aspects of anhedonia, and interest in social relationships with others.
Criticisms CAINS and BNSS continue to evaluate patients' primary diagnosis on the basis of negative symptoms, with no integration of other aspects of the patients' social and cognitive functioning. Conclusion The older scales were developed more than 30 years ago. Psycho-pharmacological research supports the PANSS' construct, discriminative, convergent, and predictive validity, as well as its drug sensitivity, when used longitudinally. The PANSS is not designed to rate negative symptoms exclusively, rather, it is a comprehensive scale for the assessment of psychopathology Kay et al.
Outdated, lengthy. PANSS and SANS have been criticized Blanchard et al because they include items that measure cognitive functioning attention bias or abstract thinking , which have been now recognized as a distinct category from negative symptoms Harvey et al Most commonly used ratings scale. Widely used to assess response to antipsychotic therapy. Commonly used in both academic and pharmaceutical industry trials.
Scale for Assessment of Positive Symptoms. SAPS- Andreasen, [ 32 ]. Total of 34 items, measures hallucinations, delusions, bizarre behavior and thought disorder.
Recognizes positive symptoms. Has good validity and inter-rater reliability for positive symptoms Andreasen et al. Cannot be used alone. Used in conjunction with SANS. Screening scale for assessment of positive symptoms. Cannot be measured It varies. Clinician rated. The SANS as originally published had 25 items. Andreasen, [ 34 ] Separates negative symptoms from positive symptoms and depression.
Cannot be used alone; need SAPS. SANS helps the clinician track treatment progress. It is widely used in both academic and pharmaceutical industry trials. Kring [ 35 ]. This represents an important and novel addition. It varies. It is comprised of two scales that are scored separately.
Motivational and pleasure scale Nine- items and Expression Scale four-items 1 Facialexpression 2 Vocalexpression 3 Expressivegestures 4 Quality ofspeech. Download Free PDF. Harry Minas. A short summary of this paper. Download Download PDF. Translate PDF. Minasasbv G. StuarPb, S. Singhb- and D. Received 20 January revision received 9 June ; accepted 9 June Recently, the validity of the simple dichotomy between positive and negative symptoms in psychosis has been questioned.
In recent years research on schizophrenia has External validation of the distinction between increasingly focused on positive and negative negative and positive symptoms has come from symptoms. The distinction between the two symp- studies of the relationship between symptoms and tom types was initially based on clinical phenome- medication response Johnstone et al. A contrast was made between positive or Angrist et al.
There and neuropsychological performance has been, however, some disagreement concerning Owens and Johnstone, ; Green and Walker, the allocation of individual symptoms to the posi- ; Kemali et al. These studies essentially tive or negative groups Walker and Lewine, Correspondence to: I. However, they have been suggestive of further in the SAPS, was not explored.
Bilder et al. Similarly, score. However, many items did not correlate well Liddle a noted different neuropsychological with their own sub-scale scores.
For example, all deficits were associated with different positive delusions were grouped together regardless of type, symptom complexes-delusions and hallucina- but many of these were not highly correlated with tions were correlated with figure-ground resolution the sub-scale sum of items score for delusions impairments while a syndrome comprised of posi- and were also very poorly correlated with global tive thought disorder and inappropriate affect was ratings of delusions.
This could be due to the correlated with impairments in visual selection and possibility that these items are not measuring the tracking, visuospatial memory and word recogni- same underlying construct or it may reflect the tion memory.
Kulkarni et al. It has therefore been difficult to determine the degree to which this internal release and the severity of delusions, suggestive of consistency analysis actually supports the structure a specific link between delusions and dopaminergic of the scales.
Given these ambiguities. A more appro- as the Scale for the Assessment of Positive Symp- priate way to approach the problem is to examine toms SAPS and the Scale for the Assessment of inter-item correlations for the total item pool.
The and Grove, sub-scales were validated by results of these two analyses were inconsistent with demonstrating internal consistency within the each other, although both yielded four factors. Correlations between items from tive symptoms were spread across two separate different sub-scales were not reported. When factors while Andreasen and Olsen found internal consistency techniques were applied to the that all negative symptoms loaded on a single SANS, it was found that each sub-scale had an factor together with hallucinations and delusions acceptably high alpha coefficient, although each which were negatively loaded on this factor.
Andreasen and Grove SAPS and SANS and obtained a simpler solution, interpreted such a slight reduction in corre- with all the negative symptoms loading onto a lation as indicative of the validity of the sub-scales, single factor, hallucinations and delusions on a since any reduction in the correlation would indi- second, and bizarre behavior and formal thought cate that additional variance is explained by the disorder on a third.
Andreasen and Grove item. These studies, which have used ses of psychotic disorder formed the sample. Diag- a variety of measurement scales and different nostic information was elicited using the Royal samples, clearly suggest that the two-syndrome Park Multidiagnostic Instrument for Psychoses model is an inadequate representation of the range McGorry et al.
McGorry et al. All subjects, following The aim of this study was to determine the explanation of the aims and procedures of the number, and characteristics, of dimensions study, gave written and witnessed consent to parti- required to adequately account for the common cipation. No admissions to the research ward of a metropolitan previous study of the SAPS and SANS has exam- psychiatric hospital, with admission conditional ined the dimensionality of the complete set of upon meeting both inclusion age between 15 items.
The studies referred to above have generally and 45 and clinical presentation suggestive of the studied small samples of psychotic patients, have presence of psychotic disorder and exclusion used global SAPS and SANS measures or have DSM-III diagnosis of organic mental disorder, used different scales.
In the process of exploring mental retardation and inadequate English fluency this issue the present study examines the adequacy criteria.
It does this by use of correlational diagnostic category. The analysis was based on the X2 statistic. When significant differences were technique of multidimensional scaling, augmented found, the Scheffe post-hoc procedure with an by cluster analysis of variables.
These techniques alpha of 0. In addition, although the which is then open to interpretation. In the study of positive and negative symp- disorder patients to have more admissions than toms it would seem that a narrow focus on schizo- the rest of the sample. Similar inspection of the phrenia is premature and will perhaps provide only means for age of onset of illness suggests a lower a limited view of the relationship between positive age of onset in schizophreniform and unipolar and negative symptoms.
This study therefore depressed patients in comparison to the rest of the included a diagnostically heterogeneous sample of sample. However, the differences are not great, psychotic patients. Education: Education score. Admissions: Number of admissions. This makes it particularly consists of patients with recent onset of psychotic suitable for the analysis of data based on ordinal disorder.
For many of the subjects this was the measures such as rating scales. A detailed compari- first psychotic episode.
Prodrome duration was son of this method with the more conventional clearly different between the groups with a greater technique of principal components analysis may duration in schizophrenic subjects than in other be found in Davison The principal advan- diagnostic groups.
A matrix of Pearson correlations between all pos- This is particularly true for many applications of sible pairs of symptoms negative and positive factor analysis which assume that the matrix has was generated for the whole sample. The principal a simple structure discrete clusters of items. MDS method used to examine the structure of the corre- can identify many other types of structure.
It lation matrix was non-metric multidimensional produces an unrotated solution which must then scaling MDS Schiffman et al. This makes it This is a graphical method which attempts easier to replicate findings than is the case with to represent the correlation matrix as a map, where factor analysis, where the final solution usually a the correlation between each pair of symptoms is set of loadings is dependent on the particular represented as a distance, so that strongly corre- methods used for factor extraction and rotation.
In non-metric scaling, were excluded from further analysis. The criterion this distance function is not assumed to be linear. Similar criteria have been sive or agitated behavior, bizarre behavior, bizarre used in other studies, e. In social and sexual behavior from the SAPS and addition, items with low communalities were iden- blocking, poor grooming and hygiene from the tified.
It is important to identify such variables as SANS. The item inappropriate affect was removed each may require anYadditional dimension to pro- from the scaling solution given that cluster analysis duce an acceptable multidimensional scaling solu- showed that it did not fit uniquely with any single tion.
Theoretically, items with low communalities symptom dimension as discussed in more detail do not share common variance with other scale below despite its reasonable base rate and border- items and may constitute poorly represented line communality value.
A good fit was obtained in two usually the maximum number for ease of inter- dimensions. The adequacy of the fit in multidimen- pretation, the inclusion of such variables can make sional scaling is a function of the correspondence it impossible to obtain an acceptable fit.
0コメント