MDCalc

Positive and Negative Syndrome Scale (PANSS) for Schizophrenia

Measures the prevalence of positive and negative syndromes in schizophrenia.

A few points to consider when using this scale:

  • Always assign the highest applicable rating for each variable.
  • Ensure the patient understands the reference period and time frame, typically “past one week”.
  • Variables are not based solely on patient interviews but can also incorporate input from third-party reporters.

Positive Scale

Delusions

Beliefs which are unfounded, unrealistic, and idiosyncratic

Conceptual disorganization

Disorganized process of thinking characterized by disruption of goal-directed sequencing

Hallucinatory behavior

Verbal report or behavior indicating perceptions which are not generated by external stimuli

Excitement

Hyperactivity as reflected in accelerated motor behavior, heightened responsivity to stimuli, hypervigilance, or excessive mood lability

Grandiosity

Exaggerated self-opinion and unrealistic convictions of superiority, including delusions of extraordinary abilities, wealth, knowledge, fame, power, and moral righteousness

Suspiciousness

Unrealistic or exaggerated ideas of persecution, as reflected in guardedness, distrustful attitude, suspicious hypervigilance, or frank delusions that others mean harm

Hostility

Verbal and nonverbal expressions of anger and resentment, including sarcasm, passive-aggressive behavior, verbal abuse, and assaultiveness

Negative Scale

Blunted affect

Diminished emotional responsiveness as characterized by a reduction in facial expression, modulation of feelings, and communicative gestures

Emotional withdrawal

Lack of interest in, involvement with, and affective commitment to life’s events

Poor rapport

Lack of interpersonal empathy, openness in conversation, and sense of closeness, interest, or involvement with the interviewer

Passive-apathetic social withdrawal

Diminished interest and initiative in social interactions due to passivity, apathy, anergy, or avolition

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

Lack of spontaneity and flow of conversation

Reduction in the normal flow of communication associated with apathy, avolition, defensiveness, or cognitive deficit

Stereotyped thinking

Decreased fluidity, spontaneity, and flexibility of thinking, as evidenced in rigid, repetitious, or barren thought content

General Psychopathology Scale

Somatic concern

Physical complaints or beliefs about bodily illness or malfunctions

Anxiety

Subjective experience of nervousness, worry, apprehension, or restlessness, ranging from excessive concern to feelings of panic about the present or future

Guilt feelings

Sense of remorse or self-blame for real or imagined misdeeds in the past

Tension

Overt physical manifestations of fear, anxiety, and agitation, such as stiffness, tremor, profuse sweating, and restlessness

Mannerisms and posturing

Unnatural movements or posture as characterized be an awkward, stilted, disorganized, or bizarre appearance

Depression

Feelings of sadness, discouragement, helplessness, and pessimism

Motor retardation

Reduction in motor activity as reflected in slowing or lessening of movements and speech, diminished responsiveness of stimuli, and reduced body tone

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

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

Disorientation

Lack of awareness of one’s relationship to the milieu, including persons, place, and time, which may be due to confusion or withdrawal

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

Lack of judgement and insight

Impaired awareness or understanding of one’s own psychiatric condition and life situation

Disturbance of volition

Disturbance in the willful initiation, sustenance, and control of one’s thoughts, behavior, movements, and speech

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

Preoccupation

Absorption with internally generated thoughts and feelings and with autistic experiences to the detriment of reality orientation and adaptive behavior

Active social avoidance

Diminished social involvement associated with unwarranted fear, hostility, or distrust

Result:

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Advice
  • Scores can guide treatment decisions, including adjustments to antipsychotic choice or dosage.
  • There is no consensus on what constitutes a clinically meaningful score change. Research settings have often used a 20–30% reduction as a marker of improvement; however, smaller changes may still be significant in clinical practice, particularly in individuals with severe or treatment-resistant disease.
  • For patients with stable or improved scores, consider transitioning to less intensive monitoring.
  • If scores indicate worsening, explore potential causes such as medication adherence issues, comorbidities, or psychosocial stressors, and adjust the treatment plan accordingly.
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