This is a Sample version of the

Positive Negative Syndrome Scale (PANSS) The full version of Positive Negative Syndrome Scale (PANSS) comes without ‘sample’ watermark. . The full complete version includes –  Overview information  Scoring instructions  PANSS detailed analysis scoring forms  SCI-PANSS Structured Clinical Interview  This is a 45 page complete PANSS kit. Buy full version here -

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Positive Negative Syndrome Scale (PANSS) Overview: The PANSS is based on findings that schizophrenia comprises at least two distinct syndromes. The positive syndrome consists of productive symptoms, while the negative syndrome consists of deficit features. This distinction is useful when developing treatment plans because you can focus on the type of symptoms the patient is experiencing. It is also useful when studying the effects of medication (e.g., in clinical drug trials) because it allows you to determine which type of symptoms are being affected. The PANSS ratings are based on all information pertaining to a specified period, usually the previous week. The information derives from both clinical interview and reports of primary care staff (if institutionalized) or family members. The latter is the essential source for assessing social impairment, including items of impulse control, hostility, passive withdrawal, and active social avoidance. All other ratings accrue from a 30- to 40-minute semi-formalized psychiatric interview that permits direct observation of affective, motor, cognitive, perceptual, attentional, integrative, and interactive functions. In the first 10-15 minutes, patients are encouraged to discuss their history, circumstances surrounding their hospitalization, their current life situation, and their symptoms. The object of this phase is to establish rapport and allow the patient to express areas of concern. Therefore, the interviewer at this point assumes a nondirective, unchallenging posture to observe, as unobtrusively as possible, the nature of thought processes and content, judgment and insight, communication and rapport, and affective and motor responses. Deviant material from the first segment of the interview is probed during the second phase, lasting another 10-15 minutes, through prototypic leading questions that progress from unprovocative, non-specific inquiry (e.g., How do you compare to the average person? Are you special in some ways?) to more direct probe of pathological themes(e.g., Do you have special or unusual powers? Do you consider yourself famous? Are you on a special mission from God?). The object now is to assess productive symptoms that can be judged from the patient's report and elaborations thereof, such as hallucinations, delusional ideation, suspiciousness, and grandiosity. For this purpose, the interviewer attempts to establish first the presence of symptoms and next their severity, which is generally weighted according to the prominence of abnormal manifestations, their frequency of occurrence, and their disruptive impact on daily functioning. The third and most focused phase of the interview, requiring another 5-10 minutes, involves a series of specific questions to secure information on mood state, anxiety, orientation to three spheres, and abstract reasoning ability. The evaluation of abstract reasoning, for example, consists of a range of questions on concept formulation (e.g., How area train and bus alike?) and proverb interpretation, which are varied in content when using the PANSS for repeated assessment. After all the essential rating information is obtained, the final 5-10 minutes of the interview are allocated for more directive and forceful probing of areas where the patient appeared defensive, ambivalent, or uncooperative. For example, a patient who avoided forthright acknowledgment of having a psychiatric disorder may be challenged for a decisive statement. In this last phase, therefore, the patient is subjected to greater stress and testing of limits, which may be necessary to proceed beyond the social demand characteristics inherent in the interview situation and to explore susceptibility to disorganization. The

interview procedure thereby lends itself to observation of physical manifestations (e.g., tension, mannerisms and posturing, excitement, and blunting of affect), interpersonal behavior (e.g., poor rapport, uncooperativeness, hostility, and impaired attention), cognitiveverbal processes (e.g., conceptual disorganization, stereotyped thinking, and lack of spontaneity and flow of conversation), thought content (e.g., grandiosity, somatic concern, guilt feelings, and delusions), and response to structured questioning (e.g., disorientation, anxiety, depression, and difficulty in abstract thinking).

GENERAL RATING INSTRUCTIONS Data gathered from this assessment procedure are applied to the PANSS ratings. Each of the 30 items is accompanied by a specific definition as well as detailed anchoring criteria for all seven rating points. These seven points represent increasing levels of psychopathology, as follows: 1- absent 2- minimal 3- mild 4- moderate 5- moderate severe 6- severe 7- extreme In assigning ratings, one first considers whether an item is at all present, as judging by its definition. If the item is absent, it is scored 1, whereas if it is present one must determine its severity by reference to the particular criteria from the anchoring points. The highest applicable rating point is always assigned, even if the patient meets criteria for lower points as well. In judging the level of severity, the rater must utilize a holistic perspective in deciding which anchoring point best characterizes the patient’s functioning and rate accordingly, whether or not all elements of the description are observed. The rating points of 2 to 7 correspond to incremental levels of symptom severity: • A rating of 2 (minimal) denotes questionable or subtle or suspected pathology, or it also may allude to the extreme end of the normal range. • A rating of 3 (mild) is indicative of a symptom whose presence is clearly established but not pronounced and interferes little in day-to-day functioning. • A rating of 4 (moderate) characterizes a symptom which, though representing a serious problem, either occurs only occasionally or intrudes on daily life only to a moderate extent. • A rating of 5 (moderate severe) indicates marked manifestations that distinctly impact on one’s functioning but are not all-consuming and usually can be contained at will. • A rating of 6 (severe) represents gross pathology that is present very frequently, proves highly disruptive to one’s life, and often calls for direct supervision. • A rating of 7 (extreme) refers to the most serious level of psychopathology, whereby the manifestations drastically interfere in most or all major life functions, typically necessitating close supervision and assistance in many areas. This is the end of the sample PANSS overview and preliminary rating instructions. The full complete version includes complete scoring instructions.

The Structured Clinical Interview for the Positive and Negative Syndrome Scale (SCI-PANSS) Patient Name: Interviewer: Date: Positive and Negative Syndrome Scale (PANSS) is a 30-point, symptoms strength (1-7) rating instrument to find and score positive, negative and other symptoms of schizophrenia. Each point represents a defined symptom and symptom severity is set at a level of 1-7. In order to rate a patient requires information from various sources. Information may partly come from mail staff report, the family of the patient, but essentially you get information basis of a 30-45 minute formal (structured) clinical interview. If you can it would be beneficial if you can video tape the interview so you can look back on it for reference. It is important that the formal interview followed up with information from caregivers or family members who have had close contact with the patient the past week. This interview consists of non-direct, semi-structured, structured and direct phases. To obtain an optimal objective, standardized scale, is a structured interview important. A structured interview is structured in such a way that the interviewer simultaneously conversing with the patient and systematically extracts information about the different psychopathology. Symptoms that cannot be assessed by means of questioning during the interview are to be assessed from the patient's behavior (eg retardation, ability to cooperate), or on the basis of daily life such as mail staff and patient's family can provide reports (for example, poor impulse control, The purpose of the SCI-PANSS is to provide information if the patient has symptoms of schizophrenia and the severity of these symptoms. The interview includes both yes-no questions and open-ended questions, giving the interviewer the opportunity to find existing clinical manifestations and manifestation consider the nature and content. The interview is structured by decision tree model. This means that a follow-up question is dependent on the contents of previous answers. If such assessment of a patient's judgment and insight disease, the interviewer can ask the patient: "Do you have a problem that needs treatment?". If the patient answers yes to that, the interviewer can ask whether the patient is experiencing the problem as psychological difficulties. If the patient says no, the interviewer can ask: "In your opinion, do you think that you need to take medicine?". The interview should start with a non-direct phase to establish contact and "warm up" for both patient and interviews. Then follow the structured phase. It is during this phase that the set points (symptoms) are reviewed. The general rule for ratings of severity is based on the following principles:

Score from 1 to 7 assesses the degree of presence of the psychopathological manifestation. 1- absent 2- minimal 3- mild 4- moderate 5- moderate severe 6- severe 7- extreme The interview will standardize and facilitate the goal of PANSS. If multiple interviewers assess a patient, the results should be relatively similar.

 Data on - Lack of Spontaneity and Flow of Conversation,” (N6) “Poor Rapport,” (N3) and “Conceptual Disorganization” (P2) “Hi, I’m… We’re going to be spending the next 30 to 45 minutes talking about you and your reasons for being here. Maybe you can start out by telling me something about yourself and your background?” (Instructions to interviewer: Allow at least 5 minutes for a non-directive phase serving to establish rapport in the context of an overview before preceding to the specific questions listed below.)

 Data on “Anxiety” (G2) Have you been feeling worried or nervous in the past week? IF NO: Would you say that you’re usually calm and relaxed? IF YES: What’s been making you feel nervous (worried, uncalm, unrelaxed)? Just how nervous have you been feeling? Have you been shaking at times, or has your heart been racing? Do you get into a state of panic? Has your sleep, eating, or participation in activities been affected?

 Data on “Delusions” (P1) and “Unusual Thought Content” (G9) Have things been going well for you? Has anything been bothering you lately? Can you tell me something about your thoughts on life and its purpose? Do you follow a particular philosophy? Some people tell me they believe in the Devil; what do you think? Can you read other people’s minds? IF YES: How does this work? Can other people read your mind? IF YES: How can they do that? Is there any reason that someone would want to read your mind? Who controls your thoughts? This is the end of the sample version of SCI-PANSS. Full version includes complete question criteria.

Positive Negative Syndrome Scale (PANSS) By Stanley R. Kay, Ph.D., Lewis A. Opler, M.D., Ph.D., & Abraham Fiszbein, M.D.

Once you have completed the Structured Clinical Interview (SCI-PANSS). Fill out the following forms for a full detailed analysis of symptoms. Patient Information Patient

Date

Day

M t h.

Y e ar

Time

Hour

M in

Personal notes

Scoring Procedure Tick appropriate box for each item

P1. Delusions Beliefs which are unfounded, unrealistic, and idiosyncratic. Basis for rating thought content expressed in the interview and its influence on social relations and behavior.

1 Absent - Definition does not apply

2 Minimal - Questionable pathology; may be at the upper extreme of normal limits.

3 Mild - Presence of one or two delusions which are vaque, uncrystallized, and not tenaciously held. Delusions do not interfere with thinking, social relations, or behavior.

4 Moderate - Presence of either a kaleidoscopic array of poorly formed, unstable delusions or of a few wellformed delusions that occasionally interfere with thinking, social relations, or behavior. 5 Moderate severe - Presence of numerous well-formed delusions that are tenaciously held and occasionally interfere with thinking, social relations, or behavior. 6 Severe - Presence of a stable set of delusions which are crystallized, possibly systematized, tenaciously held , and clearly interfere with thinking, social relations, and behavior. 7 Extreme - Presence of a stable set of delusions which are either highly systematized or very numerous, and which dominate major facets of the patient's life. This frequently results in inappropriate and irresponsible action, which may even jeopardize the safety of the patient or others.

This is the end of the ‘sample version’ PANSS Detailed analyses scoring forms. The full complete version has 30 sets of scoring critera, plus the PANSS QuikScore Form.