Cited by 1,016Schizophrenia research and treatmentMental Health and PsychiatryPsychological Testing and Assessment

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The Positive and Negative Syndrome Scale (PANSS): Rationale and Standardisation

Kay, Stanley R., Opler, Lewis A., Lindenmayer, Jean-Pierre·1989·British Journal of Psychiatry

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Abstract

Over 75 years ago, Bleuler (1911) confronted psychiatry with the question of ‘schizophrenia’ or ‘schizophrenias'. Today we recognise the heterogeneity of the condition, but we are still groping at efforts to clarify the different subtypes or subprocesses. Over the decades there have been various attempts to subclassify schizophrenia and tease apart the syndromes, none of which has been entirely successful. More recently, as a result of the work by Crow (1980) in England and Strauss et al (1974) in the USA, it has been proposed that two distinct syndromes can be discerned from the phenomenological profiles. The positive syndrome consists of productive features superadded to the mental status, such as delusions, hallucinations, and disorganised thinking. The negative syndrome represents absence of normal functions, such as deficits in the cognitive, affective, and social realms.

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The Positive and Negative Syndrome Scale (PANSS) for schizophrenia.
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Research works printed but not linked: 2

Opler, 1987, Positive and Negative Symptoms in Psychosis: Description, Research, and Future Directions in Positive and Negative Symptoms in Psychosis: Description, Research, and Future Directions, 124
Kay, 1981, Arousal and schizophrenia: Toward a dual-process model and framework for research, JSAS Catalog of Selected Documents in Psychology, 11

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Malaspina, D., Goetz, R. R., Yale, S., Berman, A., Friedman, J. H., Trémeau, F., PRINTZ, D. J., AMADOR, X. F., Johnson, J., Brown, A. S., et al. (2000) · American Journal of Psychiatry · doi:10.1176/appi.ajp.157.6.994 · Cited by 93
Probabilistic Reversal Learning in Schizophrenia: Stability of Deficits and Potential Causal Mechanisms
Reddy, L. F., Waltz, J. A., Green, M. F., Wynn, J. K., & Horan, W. P. (2016) · Schizophrenia Bulletin · doi:10.1093/schbul/sbv226 · Cited by 98
A forced five-dimensional factor analysis and concurrent validity of the Positive and Negative Syndrome Scale in Mexican schizophrenic patients
Fresán, A., de la Fuente‐Sandoval, C., Lóyzaga, C., García‐Anaya, M., Meyenberg, N., Nicolini, H., & Apiquián, R. (2004) · Schizophrenia Research · doi:10.1016/j.schres.2004.03.021 · Cited by 92
Quantitative EEG in schizophrenia and in response to acute and chronic clozapine treatment
Knott, V., Labelle, A., Jones, B., & Mahoney, C. (2001) · Schizophrenia Research · doi:10.1016/s0920-9964(00)00165-1 · Cited by 92
Stability of expressed emotion in relatives of those with schizophrenia and its relationship with burden of care and perception of patients' social functioning
Scazufca, M., & Kuipers, E. (1998) · Psychological Medicine · doi:10.1017/s0033291797005977 · Cited by 93
“Patients’ psychopatology was assessed with the 9th version of the Present State Examination (PSE; Wing et al. 1974) and the negative scale of the Positive and Negative Syndrome Scale (PANSS; Kay et al. 1989).”
Method
Using A Pharmacy-Based Intervention To Improve Antipsychotic Adherence Among Patients With Serious Mental Illness
Valenstein, M. M., Kavanagh, J., Lee, T. A., Reilly, P., Dalack, G. W., Grabowski, J., Smelson, D. A., Ronis, D. L., Ganoczy, D. A., Woltmann, E. M., et al. (2009) · Schizophrenia Bulletin · doi:10.1093/schbul/sbp121 · Cited by 91
Response inhibition and cognitive flexibility in schizophrenia with and without comorbid substance use disorder
Thoma, P., Wiebel, B., & Daum, I. (2007) · Schizophrenia Research · doi:10.1016/j.schres.2007.02.004 · Cited by 91
Acute and Transient Psychoses
Marneros, A., & Pillmann, F. (2004) · Cambridge University Press eBooks · doi:10.1017/cbo9780511544002 · Cited by 90
Bipolar disorder and aggression
Látalová, K. (2009) · International Journal of Clinical Practice · doi:10.1111/j.1742-1241.2009.02001.x · Cited by 90
Neuropsychological correlates of schizophrenic syndromes in patients treated with atypical neuroleptics
Moritz, S., Andresen, B., Jacobsen, D., Mersmann, K., Wilke, U., Lambert, M., Naber, D., & Krausz, M. R. (2001) · European Psychiatry · doi:10.1016/s0924-9338(01)00591-0 · Cited by 88
Effects of auditory hallucinations on the mismatch negativity (MMN) in schizophrenia as measured by a modified 'optimal' multi-feature paradigm.
Fisher, D., Grant, B., Smith, D., Borracci, G., Labelle, A., & Knott, V. (2011) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2011.06.018 · Cited by 72
“…an initial clinical interview (with the primary care physician) in which volunteers were assessed with respect to inclusion and exclusion criteria, both clinical history and ratings on the Positive and Negative Syndrome Scale (PANSS; Kay et al., 1989) for schizophrenia were used for recruitment.”
Method
Volumetric abnormalities associated with cognitive deficits in patients with schizophrenia
Wolf, R. C., Höse, A., Frasch, K., Walter, H., & Vasić, N. (2008) · European Psychiatry · doi:10.1016/j.eurpsy.2008.02.002 · Cited by 88
“In order to provide additional information on positive and negative symptoms, the BPRS was complemented by the Positive and Negative Syndrome Scale [23] [PANSS], see also Table 1.”
Method
Morphology of the corpus callosum at different stages of schizophrenia: Cross-sectional study in first-episode and chronic illness
Walterfang, M., WOOD, A. G., Reutens, D. C., Wood, S. J., Chen, J., Velakoulis, D., McGorry, P. D., & Pantelis, C. (2008) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.107.041251 · Cited by 87
How stigma impacts on people with psychosis: The mediating effect of self-esteem and hopelessness on subjective recovery and psychotic experiences
Vass, V., Morrison, A. P., Law, H., Dudley, J., Taylor, P. J., Bennett, K. M., & Bentall, R. P. (2015) · Psychiatry Research · doi:10.1016/j.psychres.2015.09.042 · Cited by 100
“All met the ICD criteria for a schizophrenia spectrum diagnosis as determined by their responsible clinicians, and their symptoms were confirmed with a researcher-conducted PANSS interview (PANSS; Kay et al., 1987, 1989).”
The right profile: Mismatch negativity in schizophrenia with and without auditory hallucinations as measured by a multi-feature paradigm
Fisher, D. J., Labelle, A., & Knott, V. (2008) · Clinical Neurophysiology · doi:10.1016/j.clinph.2007.12.005 · Cited by 86
“…assessed with respect to inclusion and exclusion criteria, both clinical history and ratings on the Positive and Negative Syndrome Scale (PANSS) for schizophrenia (Kay et al., 1989) were used for allocation of volunteers to hallucinating patient (HP) and non-hallucinating patient (NP) groupings.”
Method
Measuring readiness-to-change substance misuse among psychiatric outpatients: I. Reliability and validity of self-report measures.
Carey, K. B., Maisto, S. A., Carey, M. P., & Purnine, D. M. (2001) · Journal of Studies on Alcohol · doi:10.15288/jsa.2001.62.79 · Cited by 86
Decreased plasma brain-derived neurotrophic factor levels in schizophrenic patients with tardive dyskinesia: association with dyskinetic movements
Tan, Y. L., Zhou, D. F., & Zhang, X. Y. (2004) · Schizophrenia Research · doi:10.1016/j.schres.2004.08.004 · Cited by 85
Reproductive fitness in familial schizophrenia
Bassett, A. S., Bury, A. S., Hodgkinson, K. A., & Honer, W. G. (1996) · Schizophrenia Research · doi:10.1016/0920-9964(96)00018-7 · Cited by 84
“Global Assessment of Functioning (GAF; DSMIII-R) (American Psychiatric Association, 1987) scores and Positive and Negative Symptoms Scale (PANSS) ratings of positive and negative symptoms (Kay et al., 1989) were available for 87 subjects.”
Delta-9-Tetrahydrocannabinol-Induced Dopamine Release as a Function of Psychosis Risk: 18F-Fallypride Positron Emission Tomography Study
Kuepper, R., Ceccarini, J., Lataster, J., van Os, J., van Kroonenburgh, M. J. P. G., van Gerven, J., Marcelis, M. C., Laere, K. V., & Henquet, C. (2013) · PLoS ONE · doi:10.1371/journal.pone.0070378 · Cited by 83
“Notably, D9-THC consistently induced changes in subjective perception and in scores on the BPRS (Brief Psychiatric Rating Scale) [42] or the PANSS (Positive and Negative Syndrome Scale) [26].”
MethodInfluential
The Maudsley early onset schizophrenia study
Vyas, N. S., Hadjulis, M., Vourdas, A., Byrne, P. J., & Frangou, S. (2007) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-007-0621-4 · Cited by 82
“At follow-up, their mean PANSS positive, negative and general psychopathology symptom scores were 14.06 ± 6.27, 15.94 ± 8.38 and 35.33 ± 11.94, respectively.”
Influential
Neurocognitive deficits and neurological signs in schizophrenia
Wong, A. H. C., Voruganti, L. N. P., Heslegrave, R. J., & Awad, A. G. (1997) · Schizophrenia Research · doi:10.1016/s0920-9964(96)00095-3 · Cited by 82
SCID-PANSS: Two tier diagnostic system for psychotic disorders
Kay, S. R., Opler, L. A., Spitzer, R. L., Williams, J. B. W., Fiszbein, A., & Gorelick, A. (1991) · Comprehensive Psychiatry · doi:10.1016/0010-440x(91)90085-q · Cited by 81
Targeting alpha-7 nicotinic neurotransmission in schizophrenia: A novel agonist strategy
Deutsch, S. I., Schwartz, B. L., Schooler, N. R., Brown, C. H., Rosse, R. B., & Rosse, S. M. (2013) · Schizophrenia Research · doi:10.1016/j.schres.2013.05.023 · Cited by 81
“The primary hypothesis was that galantamine/CDP-choline would reduce negative symptoms measured by the Positive and Negative Syndrome Scale (Kay et al., 1989).”
Incautious Reasoning as a Pathogenetic Factor for the Development of Psychotic Symptoms in Schizophrenia
Moritz, S., Woodward, T. S., & Hausmann, D. (2005) · Schizophrenia Bulletin · doi:10.1093/schbul/sbj034 · Cited by 81
“Schizophrenic psychopathology was assessed with the Positive andNegative Syndrome Scale (PANSS).(23) At the time of testing, 56% of the patients displayed at least mild paranoid symptoms (n = 18).”
Method
P50, N100, and P200 Auditory Sensory Gating Deficits in Schizophrenia Patients
Shen, C.-L., Chou, T., Lai, W., Hsieh, M. H., Liu, C., Liu, C., & Hwu, H. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00868 · Cited by 80
Source-based morphometry of gray matter volume in patients with schizophrenia who have persistent auditory verbal hallucinations.
Kubera, K., Sambataro, F., Vasić, N., Wolf, N. D., Frasch, K., Hirjak, D., Thomann, P. A., & Wolf, R. C. (2014) · Progress in Neuro-psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2013.11.015 · Cited by 83
The multidimensional measurement of the positive symptoms of psychosis
Steel, C., Garety, P. A., Freeman, D., Craig, E., Kuipers, E., Bebbington, P., Fowler, D., & Dunn, G. (2007) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.203 · Cited by 79
Enhancing outcomes for persons with co-occurring disorders through skills training and peer recovery support
O’Connell, M. J., Flanagan, E. H., Delphin-Rittmon, M. E., & Davidson, L. (2017) · Journal of Mental Health · doi:10.1080/09638237.2017.1294733 · Cited by 79
Quality of life and its association with psychiatric symptoms and socio-demographic characteristics among people with schizophrenia: A hospital-based cross-sectional study
Desalegn, D., Girma, S., & Abdeta, T. (2020) · PLoS ONE · doi:10.1371/journal.pone.0229514 · Cited by 74
“Positive and negative syndrome scale (PANSS) has 30 items which was rated on 7 point Likert scale (Absent = 1, minimal = 2, mild = 3, moderate = 4, moderate severe = 5, severe = 6 and extreme = 7).”
BackgroundMethodInfluential
A prospective study of Quality of life in schizophrenia in three European countries
Heider, D., Angermeyer, M. C., Winkler, I., Schomerus, G., Bebbington, P., Brugha, T. S., Azorin, J., & Toumi, M. (2007) · Schizophrenia Research · doi:10.1016/j.schres.2007.03.005 · Cited by 79
Impaired integration of disambiguating evidence in delusional schizophrenia patients
Sanford, N., Veckenstedt, R., Moritz, S., Balzan, R. P., & Woodward, T. S. (2014) · Psychological Medicine · doi:10.1017/s0033291714000397 · Cited by 79
“In the schizophrenia sample, current psychopathology was assessed with the Positive and Negative Syndrome Scale (PANSS; Kay et al. 1989).”
Method
“Don't give me that look” — Overconfidence in false mental state perception in schizophrenia
Köther, U., Veckenstedt, R., Vitzthum, F., Roesch-Ely, D., Pfueller, U., Scheu, F., & Moritz, S. (2012) · Psychiatry Research · doi:10.1016/j.psychres.2012.03.004 · Cited by 78
“The Positive and Negative Syndrome Scale (PANSS; Kay et al., 1989) was carried out by trained raters using the original semi-structured interview.”
Method
The Trauma of First Episode Psychosis: The Role of Cognitive Mediation
Jackson, C., Knott, C., Skeate, A., & Birchwood, M. J. (2004) · Australian & New Zealand Journal of Psychiatry · doi:10.1080/j.1440-1614.2004.01359.x · Cited by 77
“were assessed at intake using the PANSS [20] and were interviewed for”
Method
Alterations of mismatch negativity (MMN) in schizophrenia patients with auditory hallucinations experiencing acute exacerbation of illness
Fisher, D. J., Labelle, A., & Knott, V. (2012) · Schizophrenia Research · doi:10.1016/j.schres.2012.06.004 · Cited by 76
“At the time of admission to the study, all patient volunteers were experiencing acute exacerbation of their illness, as indicated by a score on the Positive and Negative Syndrome Scale (PANSS; Kay et al., 1989) between 60 and 120 (Sechter et al., 2002).”
Feasibility, Safety, and Efficacy of the Combination of D-Serine and Computerized Cognitive Retraining in Schizophrenia: An International Collaborative Pilot Study
D’Souza, D. C., Radhakrishnan, R., Perry, E. B., Bhakta, S. G., Singh, N. M., Yadav, R., Abi‐Saab, D., Pittman, B. P., Chaturvedi, S. K., Sharma, M. P., et al. (2012) · Neuropsychopharmacology · doi:10.1038/npp.2012.208 · Cited by 79
“Psychosis and depression were assessed using the Positive and Negative Syndrome Scale (PANSS)(Kay et al, 1989) and Calgary Depression Scale (Addington et al, 1990), respectively, at weeks 0, 2, 4, 8, and 12 of the active treatment phase of the study and at the 1-, 3-, and 6-month time points during follow-up.”
Method
Task-related fronto-striatal functional connectivity during working memory performance in schizophrenia
Quidé, Y., Morris, R. W., Shepherd, A. M., Rowland, J. E., & Green, M. J. (2013) · Schizophrenia Research · doi:10.1016/j.schres.2013.08.009 · Cited by 90
“Psychotic symptom severity was assessed using the Positive and Negative Syndrome Scale (PANSS; Kay et al., 1989).”
Method
Olanzapine compared to quetiapine in adolescents with a first psychotic episode
Arango, C., Robles, O., Parellada, M., Fraguas, D., Ruíz-Sancho, A., Medina, Ó., Zabala, A., Bombín, I., & Moreno, D. M. (2009) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-009-0749-5 · Cited by 77
“The primary outcome measure for symptom reduction was the Positive and Negative Symptoms Scale (PANSS) [18] Secondary clinical outcome measures were: the Global Assessment Scale for Children (C-GAS) [35], Clinical Global Impression-Severity score (CGI-S) [14], Hamilton Depression Rating Scale (HDRS-21) [15], and the Y…”
Method
Hillside study of risk and early detection in schizophrenia
Cornblatt, B., Obuchowski, M., Schnur, D., & O'Brien, J. (1998) · British Journal of Psychiatry · doi:10.1192/s0007125000297626 · Cited by 81
Correspondences between theory of mind, jumping to conclusions, neuropsychological measures and the symptoms of schizophrenia
Woodward, T. S., Mizrahi, R., Menon, M., & Christensen, B. K. (2009) · Psychiatry Research · doi:10.1016/j.psychres.2008.10.018 · Cited by 74
“The negative susbscale of the Positive and Negative Syndrome Scale (PANSS) correlated with the Elaboration component, but no other component-subscale correlations reached significance.”
MethodInfluential

Authors: Kay, S. R., Opler, L. A., & Lindenmayer, J.-P.
Affiliations: Albert Einstein College of Medicine (US)
NewYork–Presbyterian Hospital (US)
Corresponding author: Kay, Stanley R.
ORCID: Opler, Lewis A.
Lindenmayer, Jean-Pierre
Venue: British Journal of Psychiatry
Publisher: Royal College of Psychiatrists
Published: 1989-11
Volume: 155
Issue: S7
Pages: 59-65
ISSN: 0007-1250 (ISSN-L)
1472-1465
DOI: 10.1192/s0007125000291514
OpenAlex: W1688754235
Cited by: 1,016
References: 36
Citations by year: 2026: 22 · 2025: 21 · 2024: 28 · 2023: 30 · 2022: 24 · 2021: 36 · 2020: 30 · 2019: 33 · 2018: 39 · 2017: 53 · 2016: 38 · 2015: 43 · 2014: 37 · 2013: 53 · 2012: 48
FWCI: 6.62
Type: journal article
Language: en
Open access: closed
Licence: www.cambridge.org/core/terms (unspecified, 10505 d)
Locations: The British Journal of Psychiatry (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
Social Sciences › Psychology › Applied Psychology › Psychological Testing and Assessment
Keywords: PANSS, schizophrenia, positive symptoms, negative symptoms, symptom classification, psychometric properties, delusions, hallucinations
MeSH terms: Chronic Disease, Follow-Up Studies, Humans, Pimozide, Psychiatric Status Rating Scales, Psychometrics, Schizophrenia, Schizophrenic Psychology

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The Positive and Negative Syndrome Scale (PANSS): Rationale and Standardisation

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