The Brief Negative Symptom Scale: Psychometric Properties

The participants in the NIMH-MATRICS Consensus Development Conference on Negative Symptoms recommended that an instrument be developed that measured blunted affect, alogia, asociality, anhedonia, and avolition. The Brief Negative Symptom Scale (BNSS) is a 13-item instrument designed for clinical trials and other studies that measures these 5 domains. The interrater, test–retest, and internal consistency of the instrument were strong, with respective intraclass correlation coefficients of 0.93 for the BNSS total score and values of 0.89–0.95 for individual subscales. Comparisons with positive symptoms and other negative symptom instruments supported the discriminant and concurrent validity of the instrument.     

A Negative Symptom Rating Scale

Renewed interest in the role of negative symptoms in "defect state" schizophrenia calls for the design of a standardized, easy to use, reliable, and valid instrument to assess these aspects of psychopathology. In order to measure negative symptoms, we developed the Negative Symptom Rating Scale (NSRS). We report on the design, interrater reliability, and construct-validation of NSRS against the most frequently used negative symptom scales or subscales. In summary, the NSRS is a short, sensitive, highly specific, reliable, and apparently valid instrument for measuring negative symptoms in schizophrenia.     

Toward the Next Generation of Negative Symptom Assessments: The Collaboration to Advance Negative Symptom Assessment in Schizophrenia

Negative symptoms in schizophrenia are related to poor functional outcome, persistent over time, a source of burden for caregivers, and only minimally responsive to currently available medications. A major challenge to developing efficacious interventions concerns the valid and reliable assessment of negative symptoms. In a recent consensus statement on negative symptoms, a central recommendation was the need to develop new assessment approaches that address the limitations of existing instruments. In the current report, we summarize the background and rationale for the Collaboration to Advance Negative Symptom Assessment in Schizophrenia (CANSAS). The CANSAS project is an National Institute of Mental Health-funded multisite study that is constructing a next-generation negative symptom scale, the Clinical Assessment Interview for Negative Symptoms (CAINS). The CAINS is being developed within a data-driven iterative process that seeks to ensure the measure’s reliability, validity, and utility for both basic psychopathology and treatment development research.     

Validation of a 4-item Negative Symptom Assessment (NSA-4): a short, practical clinical tool for the assessment of negative symptoms in schizophrenia

The 16‐item Negative Symptom Assessment (NSA‐16) scale is a validated tool for evaluating negative symptoms of schizophrenia. The psychometric properties and predictive power of a four‐item version (NSA‐4) were compared with the NSA‐16. Baseline data from 561 patients with predominant negative symptoms of schizophrenia who participated in two identically designed clinical trials were evaluated. Ordered logistic regression analysis of ratings using NSA‐4 and NSA‐16 were compared with ratings using several other standard tools to determine predictive validity and construct validity. Internal consistency and test–retest reliability were also analyzed. NSA‐16 and NSA‐4 scores were both predictive of scores on the NSA global rating (odds ratio = 0.83–0.86) and the Clinical Global Impressions–Severity scale (odds ratio = 0.91–0.93). NSA‐16 and NSA‐4 showed high correlation with each other (Pearson r = 0.85), similar high correlation with other measures of negative symptoms (demonstrating convergent validity), and lesser correlations with measures of other forms of psychopathology (demonstrating divergent validity). NSA‐16 and NSA‐4 both showed acceptable internal consistency (Cronbach α, 0.85 and 0.64, respectively) and test–retest reliability (intraclass correlation coefficient, 0.87 and 0.82). This study demonstrates that NSA‐4 offers accuracy comparable to the NSA‐16 in rating negative symptoms in patients with schizophrenia. Copyright © 2011 John Wiley & Sons, Ltd.     

Symptom dimensions in recent-onset schizophrenia and mania: a principal components analysis of the 24-item Brief Psychiatric Rating Scale

Previous four- and five-factor solutions of the 18-item Brief Psychiatric Rating Scale (BPRS) suggested the possibility of an affective dimension in psychosis. A principal components analysis was used to analyze psychiatric symptom data rated on an expanded 24-item version of the BPRS. BPRS data were collected during a period of acute psychotic and affective illness with 114 young adult, recent-onset schizophrenia and schizoaffective patients and 27 bipolar manic patients. Principal components analyses of the 18-item and 24-item BPRS indicated a four-factor solution was the most interpretable. Principal components analysis of the 24-item BPRS produced a clear mania factor characterized by high loadings from items added to the 18-item BPRS, which included elevated mood, motor hyperactivity, and distractibility. This factor solution suggests that the 24-item BPRS allows for an expanded assessment of affective symptoms relating to a manic dimension. Potentially important symptoms that were added to the traditional 18-item version, namely suicidality, bizarre behavior, and self-neglect, also make clear contributions to other factors.     

Disentangling the symptoms of schizophrenia: Network analysis in acute phase patients and in patients with predominant negative symptoms

BackgroundThe Positive and Negative Syndrome Scale (PANSS) is widely used in schizophrenia and has been divided into distinct factors (5-factor models) and subfactors. Network analyses are newer in psychiatry and can help to better understand the relationships and interactions between the symptoms of a psychiatric disorder. The aim of this study was threefold: (a) to evaluate connections between schizophrenia symptoms in two populations of patients (patients in the acutely exacerbated phase of schizophrenia and patients with predominant negative symptoms [PNS]), (b) to test whether network analyses support the Mohr 5 factor model of the PANSS and the Kahn 2 factor model of negative symptoms, and finally (c) to identify the most central symptoms in the two populations.MethodsUsing pooled baseline data from four cariprazine clinical trials in patients with acute exacerbation of schizophrenia (n = 2193) and the cariprazine–risperidone study in patients with PNS (n = 460), separate network analyses were performed. Network structures were estimated for all 30 items of the PANSS.ResultsWhile negative symptoms in patients with an acute exacerbation of schizophrenia are correlated with other PANSS symptoms, these negative symptoms are not correlated with other PANSS symptoms in patients with PNS. The Mohr factors were partially reflected in the network analyses. The two most central symptoms (largest node strength) were delusions and uncooperativeness in acute phase patients and hostility and delusions in patients with PNS.ConclusionsThis network analysis suggests that symptoms of schizophrenia are differently structured in acute and PNS patients. While in the former, negative symptoms are mainly secondary, in patients with PNS, they are mainly primary. Further, primary negative symptoms are better conceptualized as distinct negative symptom dimensions of the PANSS.     

产后精神分裂症患者临床特征分析

背景 分娩可能使女性产生强烈的应激反应,并在一定程度上诱发精神心理问题,甚至导致女性精神分裂症患者疾病复发。目前国内关于产后精神分裂症临床特征及治疗的研究有限。目的 探讨产后精神分裂症患者的临床特征,为其临床治疗提供参考。方法 纳入2012年—2020年在广州医科大学附属脑科医院成人精神科女病区住院治疗的、符合《精神障碍诊断与统计手册(第4版)》(DSM-IV)精神分裂症诊断标准的24例产后精神分裂症患者(产后组),同期纳入住院治疗的48例非产后女性精神分裂症患者(对照组)。收集两组患者基本资料、阳性和阴性症状量表(PANSS)评定结果及出院带药情况。结果 产后组首次发病及精神疾病家族史阳性的比例均高于对照组,差异均有统计学意义(χ²=9.321、5.240,P<0.05或0.01)。与对照组相比,产后组PANSS兴奋因子评分更高(t=-2.220,P<0.05),阴性症状因子评分更低(t=3.377,P<0.01)。出院带药方面,产后组抗精神病药物剂量高于对照组(t=-2.095,P<0.05),联合苯二氮?类药物和抗抑郁药物的比例均高...     

Negative symptoms in schizophrenia: comments from a clinical psychology perspective

The NIMH-MATRICS Consensus Statement on Negative Symptoms is covered from the perspective of Clinical Psychology. The neurobiological model implicit in the Statement can be criticized on the basis that it is scientifically restrictive and narrow and poorly serves clinical practice and service development. Aspects of the Statement relating to psychological treatments are discussed.     

A placebo-controlled comparison of zotepine versus chlorpromazine in patients with acute exacerbation of schizophrenia

OBJECTIVE: The aim of this study was to evaluate the efficacy of zotepine in the treatment of acute episodes of schizophrenia. METHOD: Patients with acute exacerbation of schizophrenia (DSM-III-R criteria; n = 158) were allocated on a random, double-blind basis to receive zotepine (150 or 300 mg/day), chlorpromazine (300 or 600 mg/day) or placebo for 8 weeks. Symptoms were assessed on the BPRS, SANS and CGI scales at baseline and weeks 1, 2, 4, 6 and 8 and patients were assessed at these times for adverse effects. Analysis was by analysis of variance on the intent-to-treat population, with last observation carried forward. RESULTS: Mean BPRS scores improved statistically significantly more with zotepine than chlorpromazine (point estimate of difference -12.4, 95% CI -18.3 to -6.5) or placebo (point estimate of difference -12.7, 95% CI -18.6 to -6.8). Zotepine produced significantly fewer extrapyramidal symptoms (EPS) than chlorpromazine. CONCLUSION: Zotepine is an effective antipsychotic with low propensity for EPS.     

Dorsolateral prefrontal cortex volume in patients with deficit or nondeficit schizophrenia

Deficit schizophrenia (DS) represents a promising putative clinical subtype of schizophrenia and is characterized by the presence of primary and enduring negative symptoms. Previous studies have often reported a reduced amount of gray matter within prefrontal and temporal cortices in schizophrenia subjects with prevailing negative symptoms; however, the evidence concerning brain structural abnormalities in patients with DS remains controversial. The aim of the present study was to investigate whether patients with DS differed from those with nondeficit schizophrenia (NDS) with respect to the volume of the dorsolateral prefrontal cortex (DLPFC) and hippocampus, two brain areas considered as key regions in the pathogenesis of schizophrenia. In the present study a 3D-T1w MR imaging procedure and an extensive clinical assessment was carried out in 18 patients with schizophrenia, (10 DS and 8 NDS). 3D MPRAGE images were preprocessed with SPM software and two regions of interest (hippocampus and DLPFC) were manually traced to obtain their gray matter volumes. We found a significant reduction of DLPFC in the entire schizophrenia group, with respect to healthy subjects. Although the subgroup of patients with DS had a more severe clinical picture and more impaired social functioning, the DLPFC volume reduction was greater in NDS than in DS patients. In conclusion, according to our structural neuroimaging findings, DS patients, although characterized by a more severe clinical picture and a worse outcome, show less neurobiological abnormalities.     

The Brief Negative Symptom Scale: Validation in a multicenter Brazilian study

BackgroundNegative symptoms are a core feature of schizophrenia. The Brief Negative Symptom Scale (BNSS) is a scale developed to measure negative symptoms in schizophrenia.MethodsThe present study aimed to examine the construct validity of BNSS, by using convergent and divergent validities as well as factor analysis, in a Brazilian sample of 111 outpatients diagnosed with schizophrenia by DSM-5. Patients were evaluated by the Brazilian version of the BNSS and positive and negative subscales of the Positive and Negative Syndrome Scale (PANSS).ResultsAssessment of patients by both instruments revealed an excellent internal consistency (Cronbach's alpha = 0.938) or inter-rater reliability (ICC = 0.92), as well as a strong correlation between BNSS and Marder negative PANSS (r = 0.866) and a weak correlation of the instrument with the positive PANSS (r = 0.292), thus characterizing convergent and discriminant validities, respectively. The exploratory factor analysis identified two distinct factors, namely, motivation/pleasure and emotional expressivity, accounting for 68.63% of the total variance.ConclusionThe study shows that the Brazilian version of the BNSS has adequate psychometric properties and is a reliable instrument for the assessment of negative symptoms in schizophrenia, either for clinical practice or research.     

The factorial structure of the schedule for the deficit syndrome in schizophrenia

Deficit schizophrenia (DS) is considered a distinct subtype within the diagnosis of schizophrenia. While the common assumption is that DS represents a single, cohesive domain of psychopathology, the factorial structure of DS has not been investigated. We assessed 52 individuals with DSM-IV diagnoses of schizophrenia with DS. A principal component analysis (PCA) was conducted on the symptoms of the Schedule for the Deficit Syndrome. The PCA resulted in 2 distinct factors explaining 73.8% of the variance. Factor 1 (avolition) is made up of symptoms of curbing of interests, diminished sense of purpose, and diminished social drive. Factor 2 (emotional expression) is made up of symptoms of restricted affect, diminished emotional range, and poverty of speech. The results indicate that DS is best characterized by these 2 factors. The great majority of participants (86%) displayed DS symptoms from both factors. On average, participants had 4.19 (S.D. = 1.39) symptoms that were primary, enduring, and at least moderate in severity. The mean severity of symptoms was 2.25 (S.D. = 1.06). We discuss possible links between the obtained factors and putative neurobiological mechanisms, as well as directions for future research.     

氯氮平合并丙咪嗪治疗衰退期精神分裂症阴性症状的对照研究

目的　评价氯氮平合并丙咪嗪对衰退期精神分裂症阴性症状的治疗效果。方法　将 38例以阴性症状为主的衰退期精神分裂症患者随机分成两组 ,进行为期 12周的对照研究。分别用氯氮平合并丙咪嗪(治疗组 )和氯氮平 (对照组 )治疗。采用BPRS、SANS和TESS评定标准进行评定。结果　无论治疗组还是对照组治疗前后SANS评分差异无显著性 (P >0 .0 5 )。两组治疗前后SANS评分差异无显著性 (P >0 .0 5 )。结论　氯氮平合并丙咪嗪对衰退期精神分裂症阴性症状的疗效与单用氯氮平疗效相仿 ,丙咪嗪对改善阴性症状无效     

EPA guidance on treatment of negative symptoms in schizophrenia

Negative symptoms of schizophrenia remain a major therapeutic challenge. The progress in the conceptualization and assessment is not yet fully reflected by treatment research. Nevertheless, there is a growing evidence base regarding the effects of biological and psychosocial interventions on negative symptoms. The importance of the distinction between primary and secondary negative symptoms for treatment selection might seem evident, but the currently available evidence remains limited. Good clinical practice is recommended for the treatment of secondary negative symptoms. Antipsychotic treatment should be optimized to avoid secondary negative symptoms due to side effects and due to positive symptoms. For most available interventions, further evidence is needed to formulate sound recommendations for primary, persistent, or predominant negative symptoms.However, based on currently available evidence recommendations for the treatment of undifferentiated negative symptoms (including both primary and secondary negative symptoms) are provided. Although it has proven difficult to formulate an evidence-based recommendation for the choice of an antipsychotic, a switch to a second-generation antipsychotic should be considered for patients who are treated with a first-generation antipsychotic. Antidepressant add-on to antipsychotic treatment is an option. Social skills training is recommended as well as cognitive remediation for patients who also show cognitive impairment. Exercise interventions also have shown promise. Finally, access to treatment and to psychosocial rehabilitation should be ensured for patients with negative symptoms. Overall, there is definitive progress in the field, but further research is clearly needed to develop specific treatments for negative symptoms.     

Brief PANSS to assess and monitor the overall severity of schizophrenia

Aims: The aim of the present study was to develop a subscale of the Positive and Negative Syndrome Scale (PANSS) that would be brief and sensitive to changes in the clinical features of schizophrenia (i.e. the Brief PANSS, or bPANSS). Methods: The PANSS before and after treatment, and the Clinical Global Impression–Change (CGI‐C) was rated for 714 schizophrenia patients. Of these, Clinical Global Impression–Severity (CGI‐S) was also evaluated in 30 of these patients. The bPANSS items were extracted from full PANSS items based on the following aims: (i) to develop a brief scale; (ii) to develop a scale sensitive to changes resulting from antipsychotic treatment; and (iii) to reflect the broad spectrum of schizophrenia symptoms. Results: The following six items were extracted to serve as the bPANSS: delusion, suspiciousness, emotional withdrawal, passive/apathetic social withdrawal, tension, and unusual thought content. The coefficients of correlation between the bPANSS and full PANSS before and after treatment were 0.86 and 0.92, respectively (both P < 0.001). The coefficient of correlation between the degrees of change in the scores for the bPANSS and the full PANSS was 0.93 (P < 0.001), and that between delta bPANSS and CGI‐C was 0.73 (P < 0.001). Conclusions: bPANSS is able to capture the overall clinical features of schizophrenia within a short assessment period.     

Negative symptoms in Alzheimer's disease: a confirmatory factor analysis

OBJECTIVE: To examine different conceptual models of negative symptoms in Alzheimer's disease. DESIGN: Confirmatory factor analysis of cross-sectional data. SUBJECTS: Alzheimer patients (n=281) admitted to a psychogeriatric observation ward. MATERIALS: Nurses' Behavioural observation scale for psychogeriatric inpatients (GIP). Global clinical ratings of severity of dementia and depression based on the Cambridge Examination for Mental Disorders of the Elderly-Dutch version (CAMDEX-N). RESULTS: A unidimensional model of dementia fitted the data poorly. Multidimensional models produced better results. In two- and three-factor models negative symptoms were separated from cognitive impairment and mood disturbances. The more severe the memory impairment, the more socially withdrawn patients were. In this sense negative symptoms may have been secondary to cognitive decline. However, no association was found between negative symptoms and mood disturbances. CONCLUSIONS: Negative symptoms are a prominent clinical feature of Alzheimer's disease and they are related to memory impairment but not to mood disturbances.     

Reliability and validity of Persian version of Brief Self-Control Scale (BSCS) in motorcyclists

Abstract

Objective: The present study aimed to investigate the validity and reliability of the Persian version of brief self-control scale (BSCS) in Iranian motorcyclists.

Methods: The original English questionnaire of BSCS has been translated into Persian using the direct-reverse approach. A total of 130 motorcyclists aged 18–65?years old in Iran–Kashan completed the questionnaire. Validity was determined by content validity methods, structural validity through factor analysis, and also the convergence and divergence validity using Spearman correlation coefficient. The intra class correlation coefficient (ICC) was calculated to estimate the reliability of the self-control tool. Reliability was calculated using Cronbach's alpha.

Results: The mean and standard deviation of the age at the time of study was 38.5?±?13.5?years old and all of the subjects were male. Cronbach's alpha coefficient of the whole questionnaire (BSCS) was 0.81, which was good in this regard. The ICC coefficient was 0.88 with confidence interval of (0.8–0.93), which confirmed the repeatability of this tool. Exploratory factor analysis (EFA) yielded a two-factor solution accounted for 42% of the observed variance.

Conclusion: This study showed that Persian version of BSCS has a good reliability and validity for self-control in the Persian language community.

• Key points

• The Brief Self-Control Scale (BSCS) has good internal consistency.

• The Brief Self-Control Scale (BSCS) has acceptable reliability.

• Brief Self-control Scale (BSCS) has acceptable validity and reliability in the population studies.

     

The incidence of negative symptoms in early schizophrenia, mania and other psychoses

Despite increasing interest in negative symptoms in schizophrenia there has been little work on their incidence in early schizophrenia or in other psychoses. This study examined 79 nondepressive psychotics within 2 years of onset of illness, diagnosed by Research Diagnostic Criteria and assessed for negative symptoms using the Scale for the Assessment of Negative Symptoms. Marked negative symptoms were observed in nearly half of patients diagnosed as suffering definite schizophrenia and were rarely found in other psychoses. Negative symptoms were not significantly correlated with positive symptoms, depression or exposure to neuroleptics, but were correlated with developing extrapyramidal side effects.     

氟桂利嗪对精神分裂症阴性症状的辅助治疗

目的:探讨抗精神病药联用氟桂利嗪辅助治疗精神分裂症阴性症状的疗效及不良反应。方法:采用双盲对照方法,对96例以阴性症状为主的住院慢性精神分裂症患者随机分为两组,在原用抗精神病药基础上,分别合用氟桂利嗪和安慰剂。疗程12周。在治疗前和治疗4、8、12周末应用阳性与阴性症状量表(PANSS)和副反应量表(TESS)评定疗效及不良反应。结果:治疗后氟桂利嗪组在阴性症状因子、情感迟钝、情感交流障碍以及被动/淡漠、社交退缩因子与安慰剂组比较显著较好(P<0.05),而不良反应差异无显著性(P>0.05)。结论:合用氟桂利嗪对改善慢性精神分裂症患者的阴性症状有增效作用,安全性较高。