Positive and Negative Syndrome Scale (PANSS) & PANSS-6 for Schizophrenia

Measures symptom severity of schizophrenia in the context of response to therapy in clinical trials.

Refer to the text below the calculator for more information on the original scale and the 6-item shorter version.


The Positive and Negative Syndrome Scale (PANSS) was published in 1987 by Kay et al. and is currently internationally used in clinical research to measure the prevalence of positive and negative syndromes in schizophrenia.

It has been studied for its psychometric properties, and the data shows adequate internal consistency, good test-retest reliability, and inter-rater reliability.

It was recently demonstrated in acutely exacerbated schizophrenia that a 6-item version (PANSS-6) of the 30-item was scalable and able to adequately separate the antipsychotic efficacy from placebo.


PANSS is composed of 3 subscales: Positive Scale, Negative Scale, and General Psychopathology Scale. The range for the Positive and Negative Scales is 7 – 49 whilst for the General Psychopathology is 16 – 112.

Additionally, a Composite Scale can be derived by subtracting the negative from the positive score, which is reflective of a bipolar index, the degree of predominance of one syndrome in relation to the other.
PANSS-6 consists of items P1, P2, P3 from the Positive Scale and items N1, N4 and N6 from the Negative Scale.


Positive Scale
P1Delusions Beliefs which are unfounded, unrealistic and idiosyncratic
P2Conceptual disorganization Disorganized process of thinking characterized by disruption of goal-directed sequencing
P3Hallucinatory behavior Verbal report or behavior indicating perceptions which are not generated by external stimuli
P4Excitement Hyperactivity as reflected in accelerated motor behavior, heightened responsivity to stimuli, hypervigilance, or excessive mood lability
P5Grandiosity Exaggerated self-opinion and unrealistic convictions of superiority, including delusions of extraordinary abilities, wealth, knowledge, fame, power, and moral righteousness
P6Suspiciousness Unrealistic or exaggerated ideas of persecution, as reflected in guardedness, distrustful attitude, suspicious hypervigilance, or frank delusions that others mean harm
P7Hostility Verbal and nonverbal expressions of anger and resentment, including sarcasm, passive-aggressive behavior, verbal abuse, and assaultiveness
Negative Scale
N1Blunted affect Diminished emotional responsiveness as characterized by a reduction in facial expression, modulation of feelings, and communicative gestures
N2Emotional withdrawal Lack of interest in, involvement with, and affective commitment to life’s events
N3Poor rapport Lack of interpersonal empathy, openness in conversation, and sense of closeness, interest, or involvement with the interviewer
N4Passive-apathetic social withdrawal Diminished interest and initiative in social interactions due to passivity, apathy, anergy, or avolition
N5Difficulty in abstract thinking Impairment in the use of the abstract-symbolic mode of thinking, as evidenced by difficulty in classification, forming generalizations, and proceeding beyond concrete or egocentric thinking in problem-solving tasks
N6Lack of spontaneity and flow of conversation Reduction in the normal flow of communication associated with apathy, avolition, defensiveness, or cognitive deficit
N7Stereotyped thinking Decreased fluidity, spontaneity, and flexibility of thinking, as evidenced in rigid, repetitious, or barren thought content
General Psychopathology Scale
G1Somatic concern Physical complaints or beliefs about bodily illness or malfunctions
G2Anxiety Subjective experience of nervousness, worry, apprehension, or restlessness, ranging from excessive concern to feelings of panic about the present or future
G3Guilt feelings Sense of remorse or self-blame for real or imagined misdeeds in the past
G4Tension Overt physical manifestations of fear, anxiety, and agitation, such as stiffness, tremor, profuse sweating, and restlessness
G5Mannerisms and posturing Unnatural movements or posture as characterized be an awkward, stilted, disorganized, or bizarre appearance
G6Depression Feelings of sadness, discouragement, helplessness, and pessimism
G7Motor retardation Reduction in motor activity as reflected in slowing or lessening of movements and speech, diminished responsiveness of stimuli, and reduced body tone
G8Uncooperativeness Active refusal to comply with the will of significant others, including the interviewer, hospital staff or family, which may be associated with distrust, defensiveness, stubbornness, negativism, rejection of authority, hostility, or belligerence
G9Unusual thought content Thinking characterized by strange, fantastic, or bizarre ideas, ranging from those which are remote or atypical to those which are distorted, illogical, and patently absurd
G10Disorientation Lack of awareness of one’s relationship to the milieu, including persons, place, and time, which may be due to confusion or withdrawal
G11Poor attention Failure in focused alertness manifested by poor concentration, distractibility from internal and external stimuli, and difficulty in harnessing, sustaining, or shifting focus to new stimuli
G12Lack of judgement and insight Impaired awareness or understanding of one’s own psychiatric condition and life situation
G13Disturbance of volition Disturbance in the willful initiation, sustenance, and control of one’s thoughts, behavior, movements, and speech
G14Poor impulse control Disordered regulation and control of action on inner urges, resulting in sudden, unmodulated, arbitrary, or misdirected discharge of tension and emotions without concern about consequences
G15Preoccupation Absorption with internally generated thoughts and feelings and with autistic experiences to the detriment of reality orientation and adaptive behavior
G16Active social avoidance Diminished social involvement associated with unwarranted fear, hostility, or distrust
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Positive Scale
P1Delusions Beliefs which are unfounded, unrealistic and idiosyncratic
P2Conceptual disorganization Disorganized process of thinking characterized by disruption of goal-directed sequencing
P3Hallucinatory behavior Verbal report or behavior indicating perceptions which are not generated by external stimuli
Negative Scale
N1Blunted affect Diminished emotional responsiveness as characterized by a reduction in facial expression, modulation of feelings, and communicative gestures
N4Passive-apathetic social withdrawal Diminished interest and initiative in social interactions due to passivity, apathy, anergy, or avolition
N6Lack of spontaneity and flow of conversation Reduction in the normal flow of communication associated with apathy, avolition, defensiveness, or cognitive deficit
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PANSS explained

The Positive and Negative Syndrome Scale (PANSS) was published in 1987 by Kay et al. and is currently internationally used in clinical research to measure the prevalence of positive and negative syndromes in schizophrenia.

It is used to inventory, grade and follow the positive, negative and general psychopathology symptoms.

Positive and Negative Syndrome Scale (PANSS)
Positive Scale
P1 Delusions Beliefs which are unfounded, unrealistic and idiosyncratic
P2 Conceptual disorganization Disorganized process of thinking characterized by disruption of goal-directed sequencing
P3 Hallucinatory behavior Verbal report or behavior indicating perceptions which are not generated by external stimuli
P4 Excitement Hyperactivity as reflected in accelerated motor behavior, heightened responsivity to stimuli, hypervigilance, or excessive mood lability
P5 Grandiosity Exaggerated self-opinion and unrealistic convictions of superiority, including delusions of extraordinary abilities, wealth, knowledge, fame, power, and moral righteousness
P6 Suspiciousness Unrealistic or exaggerated ideas of persecution, as reflected in guardedness, distrustful attitude, suspicious hypervigilance, or frank delusions that others mean harm
P7 Hostility Verbal and nonverbal expressions of anger and resentment, including sarcasm, passive-aggressive behavior, verbal abuse, and assaultiveness
Negative Scale
N1 Blunted affect Diminished emotional responsiveness as characterized by a reduction in facial expression, modulation of feelings, and communicative gestures
N2 Emotional withdrawal Lack of interest in, involvement with, and affective commitment to life’s events
N3 Poor rapport Lack of interpersonal empathy, openness in conversation, and sense of closeness, interest, or involvement with the interviewer
N4 Passive-apathetic social withdrawal Diminished interest and initiative in social interactions due to passivity, apathy, anergy, or avolition
N5 Difficulty in abstract thinking Impairment in the use of the abstract-symbolic mode of thinking, as evidenced by difficulty in classification, forming generalizations, and proceeding beyond concrete or egocentric thinking in problem-solving tasks
N6 Lack of spontaneity and flow of conversation Reduction in the normal flow of communication associated with apathy, avolition, defensiveness, or cognitive deficit
N7 Stereotyped thinking Decreased fluidity, spontaneity, and flexibility of thinking, as evidenced in rigid, repetitious, or barren thought content
General Psychopathology Scale
G1 Somatic concern Physical complaints or beliefs about bodily illness or malfunctions
G2 Anxiety Subjective experience of nervousness, worry, apprehension, or restlessness, ranging from excessive concern to feelings of panic about the present or future
G3 Guilt feelings Sense of remorse or self-blame for real or imagined misdeeds in the past
G4 Tension Overt physical manifestations of fear, anxiety, and agitation, such as stiffness, tremor, profuse sweating, and restlessness
G5 Mannerisms and posturing Unnatural movements or posture as characterized be an awkward, stilted, disorganized, or bizarre appearance
G6 Depression Feelings of sadness, discouragement, helplessness, and pessimism
G7 Motor retardation Reduction in motor activity as reflected in slowing or lessening of movements and speech, diminished responsiveness of stimuli, and reduced body tone
G8 Uncooperativeness Active refusal to comply with the will of significant others, including the interviewer, hospital staff or family, which may be associated with distrust, defensiveness, stubbornness, negativism, rejection of authority, hostility, or belligerence
G9 Unusual thought content Thinking characterized by strange, fantastic, or bizarre ideas, ranging from those which are remote or atypical to those which are distorted, illogical, and patently absurd
G10 Disorientation Lack of awareness of one’s relationship to the milieu, including persons, place, and time, which may be due to confusion or withdrawal
G11 Poor attention Failure in focused alertness manifested by poor concentration, distractibility from internal and external stimuli, and difficulty in harnessing, sustaining, or shifting focus to new stimuli
G12 Lack of judgement and insight Impaired awareness or understanding of one’s own psychiatric condition and life situation
G13 Disturbance of volition Disturbance in the willful initiation, sustenance, and control of one’s thoughts, behavior, movements, and speech
G14 Poor impulse control Disordered regulation and control of action on inner urges, resulting in sudden, unmodulated, arbitrary, or misdirected discharge of tension and emotions without concern about consequences
G15 Preoccupation Absorption with internally generated thoughts and feelings and with autistic experiences to the detriment of reality orientation and adaptive behavior
G16 Active social avoidance Diminished social involvement associated with unwarranted fear, hostility, or distrust

PANSS has been studied for its psychometric properties, and the data shows adequate internal consistency, good test-retest reliability, and inter-rater reliability.

It is composed of 3 subscales: Positive Scale, Negative Scale, and General Psychopathology Scale. Each of the 30 items is rated on a 7-point scale:

  • Absent (+1)
  • Minimal (+2)
  • Mild (+3)
  • Moderate (+4)
  • Moderate-severe (+5)
  • Severe (+6)
  • Extreme (+7)

The range for the Positive and Negative Scales is 7 – 49 whilst for the General Psychopathology is 16 – 112.

Additionally, a Composite Scale can be derived by subtracting the negative from the positive score, which is reflective of a bipolar index, the degree of predominance of one syndrome in relation to the other.

Results in relation to schizophrenia severity can be interpreted as follows:

PANSS Score Schizophrenia Severity
≤57 Not ill
58 - 74 Mildly ill
75 - 94 Moderately ill
95 - 115 Markedly ill
≥116 Severely ill

The scale should be administered by a trained clinician and takes around 45 to 50 minutes to go through. It has been translated in 40 languages and is internationally used in clinical research about quality of life, functional status and schizophrenia treatment outcomes.

 

PANSS-6 explained

A 6-item version (PANSS-6) of the 30-item was found to be scalable and able to adequately separate the antipsychotic efficacy from placebo, in acutely exacerbated schizophrenia. Its validity and sensitivity was tested in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) outpatient study. The scale was found to adequately measure severity, remission and antipsychotic efficacy related to core positive and negative schizophrenia symptoms.

The 6 items of the PANSS-6 are drawn from the positive and negative scales as follows and are rated on the same 7-item scale as the original 30 items:

PANSS-6
P1 Delusions Beliefs which are unfounded, unrealistic and idiosyncratic
P2 Conceptual disorganization Disorganized process of thinking characterized by disruption of goal-directed sequencing
P3 Hallucinatory behavior Verbal report or behavior indicating perceptions which are not generated by external stimuli
N1 Blunted affect Diminished emotional responsiveness as characterized by a reduction in facial expression, modulation of feelings, and communicative gestures
N4 Passive-apathetic social withdrawal Diminished interest and initiative in social interactions due to passivity, apathy, anergy, or avolition
N6 Lack of spontaneity and flow of conversation Reduction in the normal flow of communication associated with apathy, avolition, defensiveness, or cognitive deficit
 

About the Original PANSS Study

The 30-item PANSS was conceived in a study by Kay et al. as an operationalized, drug-sensitive instrument that provides balanced representation of positive and negative symptoms and gauges their relationship to one another and to global psychopathology.

Study of 101 schizophrenics found the PANSS results to be normally distributed and supported their reliability and stability. Review of five studies involving the PANSS showed its criterion-related validity with antecedent, genealogical, and concurrent measures, its predictive validity, its drug sensitivity, and its utility for both typological and dimensional assessment.

 

PANSS-6 Derivation and Validation

Østergaard et al. tested the scalability of several versions of the PANSS by means of parametric Rasch rating scale model. Neither PANSS-30, PANSS-14 nor PANSS-8 was scalable, but the PANSS-6 was and also captured superior symptom reduction and higher remission rates during treatment with haloperidol and sertindole versus placebo.

PANSS-6 validity and sensitivity was tested in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) outpatient study. In the 577 subjects cohort, (PANSS-30 and PANSS-6 assessed at baseline, month 1, 3 and 6), PANSS-6 was found to be scalable whereas PANSS-30 was not.

In the 1432 subjects in the intention-to-treat (ITT) sample, PANSS-6 and PANSS-30 total scores were highly correlated (Spearman correlation coefficient = 0.86).

PANSS-6 also identified symptom remission with an accuracy of 0.99 (95% confidence interval = 0.99-0.99).

 

References

Original reference

Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull. 1987; 13(2):261-76.

Østergaard SD, Lemming OM, Mors O, Correll CU, Bech P. PANSS-6: a brief rating scale for the measurement of severity in schizophrenia. Acta Psychiatr Scand. 2016; 133(6):436-44.

Validation

Levine SZ, Rabinowitz J, Engel R, Etschel E, Leucht S. Extrapolation between measures of symptom severity and change: an examination of the PANSS and CGI. Schizophr Res. 2008; 98(1-3):318-22.

Østergaard SD, Foldager L, Mors O, Bech P, Correll CU. The Validity and Sensitivity of PANSS-6 in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Study. Schizophr Bull. 2018 Feb 15;44(2):453-462.

Other references

Peralta V, Cuesta MJ. Psychometric properties of the positive and negative syndrome scale (PANSS) in schizophrenia. Psychiatry Res. 1994; 53(1):31-40.


Specialty: Psychiatry

System: Nervous

Objective: Diagnosis

Type: Scale

No. Of Items: 30, 6

Year Of Study: 1987 & 2016

Abbreviation: PANSS, PANSS-6

Article By: Denise Nedea

Published On: June 14, 2024

Last Checked: June 14, 2024

Next Review: June 14, 2029