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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Research works printed but not linked: 2

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Salyers, M. P., McHugo, G. J., Cook, J. A., Razzano, L. A., Drake, R. E., & Mueser, K. T. (2001) · Mental Health Services Research · doi:10.1023/a:1011519514465 · Cited by 38
The relationship between cortisol reactivity and emotional brain function is differently moderated by childhood trauma, in bipolar disorder, schizophrenia and healthy individuals
Quidé, Y., Girshkin, L., Watkeys, O. J., Carr, V. J., & Green, M. J. (2021) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-020-01190-3 · Cited by 32
Metacognitive impairments in schizophrenia are arrested at extreme levels of psychopathy: The cut-off effect.
Abu-Akel, A. M., Heinke, D. G., Gillespie, S. M., Mitchell, I., & Bo, S. (2015) · Journal of Abnormal Psychology · doi:10.1037/abn0000096 · Cited by 29
Tiempo de reacción, velocidad de procesamiento y atención sostenida en esquizofrenia: impacto sobre el funcionamiento social
Lahera, G., Ruiz, Á. Y., Brañas, A., Vicens, M., & Orozco, A. (2017) · Revista de Psiquiatría y Salud Mental · doi:10.1016/j.rpsm.2017.04.001 · Cited by 29
The effect of adjunctive telmisartan treatment on psychopathology and cognition in patients with schizophrenia
Fan, X., Song, X., Zhao, M., Jarskog, L. F., Natarajan, R., Shukair, N., Freudenreich, O., Henderson, D. C., & GOFF, D. C. (2017) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12799 · Cited by 30
“ANCOVA controlling for baseline value showed a significantly greater decrease from baseline in the PANSS total score at week 12 in the telmisartan group compared with the control group ( 3.7 8.5 vs. 0.7 8.1, P = 0.041, Cohen’s d = 0.53).”
MethodInfluential
Social cognition in “pure” delusional disorder
Bömmer, I., & Brüne, M. (2006) · Cognitive Neuropsychiatry · doi:10.1080/13546800500359994 · Cited by 29
Individualized Metacognitive Therapy Program for Patients with Psychosis (MCT+): Introduction of a Novel Approach for Psychotic Symptoms
Vitzthum, F., Veckenstedt, R., & Moritz, S. (2013) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465813000246 · Cited by 29
Deficits in context-dependent adaptive coding in early psychosis and healthy individuals with schizotypal personality traits
Kirschner, M., Haugg, A., Manoliu, A., Simon, J. J., Huys, Q. J. M., Seifritz, E., Tobler, P. N., & Kaiser, S. (2018) · Brain · doi:10.1093/brain/awy203 · Cited by 30
Schizophrenic Disorders among Turkish Migrants in Germany
Haasen, C., Yagdiran, O., Maß, R., & Krausz, M. R. (2001) · Psychopathology · doi:10.1159/000049308 · Cited by 29
High-Dose Treatment With Haloperidol: The Effect of Dose Reduction
Volavka, J., Cooper, T. B., Czobor, P., Lindenmayer, J., Citrome, L., Mohr, P., & Bark, N. M. (2000) · Journal of Clinical Psychopharmacology · doi:10.1097/00004714-200004000-00020 · Cited by 29
Volumetric White Matter Abnormalities in First-Episode Schizophrenia: A Longitudinal, Tensor-Based Morphometry Study
Whitford, T. J., Grieve, S. M., Farrow, T. F. D., Gomes, L., Brennan, J., Harris, A. W. F., Gordon, E., & Williams, L. M. (2007) · American Journal of Psychiatry · doi:10.1176/appi.ajp.164.7.1082 · Cited by 99
One-year follow-up study of first suicide attempts in first episode psychosis: Personality traits and temporal pattern
Canal‐Rivero, M., Barrigón, M. L., Garcelán, S. P., Testal, J. F. R., Giner, L., Obiols, J. E., & Ruíz-Veguilla, M. (2016) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2016.08.014 · Cited by 28
Altered experiential, but not hypothetical, delay discounting in schizophrenia.
Horan, W. P., Johnson, M. W., & Green, M. F. (2017) · Journal of Abnormal Psychology · doi:10.1037/abn0000249 · Cited by 31
Deviation from expected cognitive ability across psychotic disorders
Hochberger, W. C., Combs, T., Reilly, J. L., Bishop, J. R., Keefe, R. S. E., Clementz, B. A., Keshavan, M. S., Pearlson, G. D., Tamminga, C. A., Hill, S. K., et al. (2017) · Schizophrenia Research · doi:10.1016/j.schres.2017.05.019 · Cited by 28
Predictive timing disturbance is a precise marker of schizophrenia
Ciullo, V., Piras, F., Vecchio, D., Banaj, N., Coull, J. T., & Spalletta, G. (2018) · Schizophrenia Research Cognition · doi:10.1016/j.scog.2018.04.001 · Cited by 28
Peripheral Biomarkers in Schizophrenia: A Meta-Analysis of Microarray Gene Expression Datasets
Piras, I. S., Manchia, M., Huentelman, M. J., Pinna, F., Zai, C. C. H., Kennedy, J. L., & Carpiniello, B. (2018) · The International Journal of Neuropsychopharmacology · doi:10.1093/ijnp/pyy103 · Cited by 27
“Clinical symptom severity was assessed with the Positive and Negative Syndrome Scale (Kay et al., 1989).”
Symptom changes in five dimensions of the Positive and Negative Syndrome Scale in refractory psychosis
Woodward, T. S., Jung, K., Smith, G. N., Hwang, H., Barr, A. M., Procyshyn, R. M., Flynn, S. W., van der Gaag, M., & Honer, W. G. (2013) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-013-0460-x · Cited by 29
“This three-dimensional model is widely used due to its clinical lure [24], reliability [11, 18–20, 36] and practical utility (primarily for comparison across studies).”
Method
A Neuropsychological Study of Prefrontal Lobe Function in the Positive and Negative Subtypes of Schizophrenia
Mattson, D. T., Berk, M., & Lucas, M. (1997) · The Journal of Genetic Psychology · doi:10.1080/00221329709596685 · Cited by 28
Reduced pineal volume in male patients with schizophrenia: no relationship to clinical features of the illness
Bersani, G., Garavini, A., Iannitelli, A., Quartini, A., Nordio, M., Biasi, C. D., & Pancheri, P. (2002) · Neuroscience Letters · doi:10.1016/s0304-3940(02)00617-1 · Cited by 28
Dimensions of positive symptoms in late versus early onset psychosis
Mason, O. J., Stott, J. C. H., & Sweeting, R. (2012) · International Psychogeriatrics · doi:10.1017/s1041610212001731 · Cited by 28
“The PSYRATS has been shown to demonstrate good inter-rater reliability, internal consistency, and convergent validity with the Positive and Negative Syndrome Scale (PANNS; Kay et al., 1989) in those with chronic schizophrenia (Haddock et al., 1999) and first-episode psychosis (Drake et al., 2007).”
Method
Effectiveness and cost-effectiveness of home treatment compared with inpatient care for patients with acute mental disorders in a rural catchment area in Germany
Kilian, R., Becker, T. M., & Frasch, K. (2016) · Neurology Psychiatry and Brain Research · doi:10.1016/j.npbr.2016.01.005 · Cited by 28
Psychosocial interventions for very early and early-onset schizophrenia
Armando, M., Pontillo, M., & Vicari, S. (2015) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000000165 · Cited by 28
Negative Symptoms in Stroke Patients and Length of Hospital Stay
GALYNKER, I. I., Prikhojan, A., Phillips, E. M., Focseneanu, M., Ieronimo, C., & Rosenthal, R. N. (1997) · The Journal of Nervous and Mental Disease · doi:10.1097/00005053-199710000-00004 · Cited by 28
New pharmacotherapeutic modalities for negative symptoms in psychosis
Lindenmayer, J. (1995) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1995.tb05939.x · Cited by 28
Naltrexone does not attenuate the effects of intravenous Δ9-tetrahydrocannabinol in healthy humans
Ranganathan, M., Carbuto, M., Braley, G., Elander, J., Perry, E. B., Pittman, B. P., Radhakrishnan, R., Sewell, R. A., & D’Souza, D. C. (2012) · The International Journal of Neuropsychopharmacology · doi:10.1017/s1461145711001830 · Cited by 27
“Transient THC-induced positive and negative psychotomimetic symptoms were measured using the Positive and Negative Syndrome Scale (PANSS; Kay et al. 1989).”
Method
Substance Use in Patients With First-Episode Psychosis: Is Gender Relevant?
Arranz, B., Safont, G., Corripio, I., Ramirez, N., Dueñas, R., Pérez, V., Álvarez, E., & San, L. (2015) · Journal of Dual Diagnosis · doi:10.1080/15504263.2015.1113761 · Cited by 27
Psychopharmacologic treatment of in-patients with schizophrenia: comparing forensic and general psychiatry
Vasić, N., Segmiller, F. M., Rees, F., Jäger, M., Becker, T. M., Ormanns, N., Otte, S., Streb, J., & Dudeck, M. (2017) · Journal of Forensic Psychiatry and Psychology · doi:10.1080/14789949.2017.1332773 · Cited by 27
Duration of untreated psychosis and clinical outcomes of first episode psychosis: An observational and an instrumental variables analysis
Sullivan, S. A., Carroll, R., Peters, T. J., Amos, T., Jones, P. B., Marshall, M., Birchwood, M. J., Fowler, D. G., Johnson, S., Fisher, H. L., et al. (2018) · Early Intervention in Psychiatry · doi:10.1111/eip.12676 · Cited by 27
EEG coherence following acute and chronic clozapine in treatment-resistant schizophrenics.
Knott, V., Labelle, A., Jones, B., & Mahoney, C. (2002) · Experimental and Clinical Psychopharmacology · doi:10.1037//1064-1297.10.4.435 · Cited by 27
Inhibition of return and schizophrenia: A meta-analysis
Mushquash, A. R., Fawcett, J. M., & Klein, R. M. (2012) · Schizophrenia Research · doi:10.1016/j.schres.2011.11.034 · Cited by 27
The longitudinal association between social functioning and theory of mind in first-episode psychosis
Sullivan, S. A., Lewis, G., Möhr, C., Herzig, D., Corcoran, R., Drake, R., & Evans, J. (2013) · Cognitive Neuropsychiatry · doi:10.1080/13546805.2013.799463 · Cited by 27
Influence des troubles de la conscience sur l’auto-évaluation de la qualité de vie des patients souffrant de schizophrénie
Aghababian, V., Auquier, P., Baumstarck, K., & Lançon, C. (2010) · L Encéphale · doi:10.1016/j.encep.2010.08.011 · Cited by 27
A longitudinal analysis of the impact of social and clinical characteristics on the costs of schizophrenia treatment
Kilian, R., Matschinger, H., Becker, T. M., & Angermeyer, M. C. (2003) · Acta Psychiatrica Scandinavica · doi:10.1034/j.1600-0447.2003.00072.x · Cited by 27
“A test of this hypothesis revealed that the PANSS positive symptom subscale had indeed a positive effect on vitality while the PANSS general psychopathology subscale had a negative effect on vitality and the PANSS negative symptom subscale had no effect on vitality.”
MethodInfluential
On the use of the Positive and Negative Syndrome Scale in randomized clinical trials
Nicotra, E. F., Casu, G., Piras, S., & Marchese, G. (2015) · Schizophrenia Research · doi:10.1016/j.schres.2015.04.006 · Cited by 26
Wellbeing and resilience: mechanisms of transmission of health and risk in parents with complex mental health problems and their offspring—The WARM Study
Harder, S. K., Davidsen, K. A., MacBeth, A. M., Lange, T., Minnis, H., Andersen, M., Simonsen, E. H., Lundy, J.-M., Nyström‐Hansen, M., Trier, C. H., et al. (2015) · BMC Psychiatry · doi:10.1186/s12888-015-0692-6 · Cited by 26
“The Positive and Negative Syndrome Scale (PANSS) [21] will be used to measure psychotic and psychiatric symptoms incorporating positive, negative, disorganisation, excitement and emotional distress symptoms [22].”
The effects of antipsychotic treatment on quality of life of schizophrenic patients under naturalistic treatment conditions: An application of random effect regression models and propensity scores in an observational prospective trial
Kilian, R., & Angermeyer, M. C. (2005) · Quality of Life Research · doi:10.1007/s11136-004-5533-x · Cited by 26
“An examination of the partial effects of the independent variables showed that the effect of the PANSS on the MCS and the PCS reduced drastically after the inclusion of the CDSS depression score.”
Method
Symptom assessment in early psychosis: The use of well-established rating scales in clinical high-risk and recent-onset populations
Fulford, D., Pearson, R., Stuart, B. K., Fisher, M., Mathalon, D. H., Vinogradov, S., & Loewy, R. L. (2014) · Psychiatry Research · doi:10.1016/j.psychres.2014.07.047 · Cited by 26
Male sex may be associated with higher metabolic risk in first-episode schizophrenia patients: A preliminary study
Chen, S., Broquères-You, D., Yang, G., Wang, Z., Li, Y., Yang, F., & Tan, Y. (2015) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2015.12.001 · Cited by 26
“In male and female FEP patients, positive/negative subscale scores, general psychopathology subscale scores, PANSS total scores and disease course were not different.”
Method
Cortical folding abnormalities in patients with schizophrenia who have persistent auditory verbal hallucinations
Kubera, K. M., Thomann, P. A., Hirjak, D., Barth, A., Sambataro, F., Vasić, N., Wolf, N. D., Frasch, K., & Wolf, R. C. (2018) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2017.12.009 · Cited by 29
Structural Covariance of Cortical Gyrification at Illness Onset in Treatment Resistance: A Longitudinal Study of First-Episode Psychoses
Ajnakina, O., Das, T. K., Lally, J., Forti, M. D., Pariante, C. M., Marques, T. R., Mondelli, V., David, A. S., Murray, R. M., Palaniyappan, L. K., et al. (2021) · Schizophrenia Bulletin · doi:10.1093/schbul/sbab035 · Cited by 26
“The degree of psychopathology over the preceding week was evaluated with the 30-item Positive and Negative Syndrome Scale (PANSS), 38,39 in face-to-face interviews.”
Changes over time in frontotemporal activation during a working memory task in patients with schizophrenia
Wolf, R. C., Vasić, N., Höse, A., Spitzer, M., & Walter, H. (2007) · Schizophrenia Research · doi:10.1016/j.schres.2006.12.001 · Cited by 26
“, 2005), the BPRS was complemented by the negative symptoms subscale, as measured by the Positive and Negative Syndrome Scale (Kay et al., 1989); see also Table 1.”
Method
The longitudinal course
Marneros, A., & Pillmann, F. (2004) · Cambridge University Press eBooks · doi:10.1017/cbo9780511544002.008 · Cited by 25

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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