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.
Kay, S. R., Fiszbein, A., & Opler, L. A. (1987) · Schizophrenia Bulletin · doi:10.1093/schbul/13.2.261 · Cited by 21,378
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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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Rǎdulescu, A., & Mujica-Parodi, L. R. (2009) · Psychiatry Research Neuroimaging · doi:10.1016/j.pscychresns.2009.04.017 · Cited by 13
“Symptom severity for these patients was assessed using the Positive and Negative Syndrome Scale (Kay et al., 1989) (N=9; positive symptoms: μ=23.”
MethodInfluential
Emotion recognition in pictures of facial affect: Is there a difference between forensic and non-forensic patients with schizophrenia?
Wolfkühler, W., Majorek, K., Taş, C., Küper, C., Saimed, N., Juckel, G., & Brüne, M. (2012) · The European Journal of Psychiatry · doi:10.4321/s0213-61632012000200001 · Cited by 13
Remission of SSRI-Induced Akathisia After Switch to Nefazodone
Chelben, J., Strous, R. D., Lustig, M., & Baruch, Y. (2001) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v62n07a13 · Cited by 13
Structure/function interrelationships and illness insight in patients with schizophrenia: a multimodal MRI data fusion study
Otte, M., Schmitgen, M. M., Wolf, N. D., Kubera, K. M., Calhoun, V. D., Fritze, S., Geiger, L. S., Tost, H., Seidl, U., Meyer‐Lindenberg, A., et al. (2023) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-023-01566-1 · Cited by 13
“The Positive and Negative Syndrome Scale (PANSS) was used for detailed psychometric assessment of symptoms related to SZ [41].”
Method
The Dimensions of Auditory Hallucination in Schizophrenia: Association with Depressive Symptoms and Quality of Life
Janaki, V., Suzaily, W., Ar, A. H., Hazli, Z., & Azmawati, M. N. (2017) · IIUM Medical Journal Malaysia · doi:10.31436/imjm.v16i2.325 · Cited by 12
“Available assessment tools for instance Positive and Negative Syndrome Scale (PANSS) measures a broad range of symptoms in a single dimensional scale and it is not specific to AH per se.(14) Haddock et al (1999) argued regarding the need of using scales that could assess the dimensions of hallucinations and delusions…”
Method
Antenatal caregiving representations among expectant mothers with severe mental illness: a cross-sectional study
Røhder, K., Nyström‐Hansen, M., MacBeth, A. M., Davidsen, K. A., Gumley, A. I., Brennan, J., George, C. C., & Harder, S. K. (2019) · Journal of Reproductive and Infant Psychology · doi:10.1080/02646838.2019.1578868 · Cited by 12
Investigation of sex differences in delusion-associated cognitive biases
de Vos, C., Leanza, L., Mackintosh, A., Lüdtke, T., Balzan, R. P., Moritz, S., & Andreou, C. (2018) · Psychiatry Research · doi:10.1016/j.psychres.2018.12.121 · Cited by 11
“Severity of psychotic symptoms was assessed using the Positive and Negative Syndrome Scale (PANSS; Kay et al., 1989).”
Method
Cognitive Impairment and Perceived Stress in Schizophrenic Inpatients with Post-Traumatic Stress Disorder
Pollice, R., Bianchini, V., Conti, C., Mazza, M., Roncone, R., & CASACCHIA, M. (2010) · European Journal of Inflammation · doi:10.1177/1721727x1000800311 · Cited by 12
Minussymptomatik und kognitive Basissymptome
Klosterkötter, J. (1990) · Springer eBooks · doi:10.1007/978-3-642-76263-5_2 · Cited by 12
The implications of memory profiles in schizophrenia on vocational and neuropsychological functioning
Abi‐Saab, D., Fiszdon, J. M., BRYSON, G. J., & Bell, M. D. (2005) · Schizophrenia Research · doi:10.1016/j.schres.2004.12.014 · Cited by 12
Medical-claims databases in the design of a health-outcomes comparison of quetiapine (`Seroquel'1Seroquel is a trademark, the property of Zeneca Limited.1) and usual-care antipsychotic medication
Hong, W. W., Rak, I. W., Ciuryla, V. T., Wilson, A. M., Kylstra, J. W., Meltzer, H. Y., Carpenter, W. T., Lehman, A. F., & Arvanitis, L. A. (1998) · Schizophrenia Research · doi:10.1016/s0920-9964(98)00040-1 · Cited by 12
A Chinese version of the Psychotic Symptom Rating Scales: psychometric properties in recent-onset and chronic psychosis
Chien, W. T., Lee, I. Y.-M., & Wang, L.-Q. (2017) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s131174 · Cited by 11
Long-term efficacy, safety, and tolerability of xanomeline and trospium chloride in schizophrenia: A 52-week, open-label trial (EMERGENT-5)
Kaul, I., Claxton, A., Chaturvedi, S. A., Patel, T., Wu, H., Sawchak, S. T., & Sauder, C. L. (2026) · Schizophrenia Research · doi:10.1016/j.schres.2025.12.015 · Cited by 11
A subtype of schizophrenia patients with altered methylation level of genes related to immune cell activity
Luo, C., Pi, X., Zhang, Q., Hu, N., Xiao, Y., Sweeney, J. A., Bishop, J. R., Gong, Q., Xie, D., & Lui, S. (2024) · Psychological Medicine · doi:10.1017/s0033291724000667 · Cited by 11
Short-term outcome of first episode delusional disorder in an early intervention population
Rowland, T., Birchwood, M. J., Singh, S. P., Freemantle, N., Everard, L., Jones, P. B., Fowler, D. G., Amos, T., Marshall, M., Sharma, V. K., et al. (2018) · Schizophrenia Research · doi:10.1016/j.schres.2018.08.036 · Cited by 11
Determinants of occupational outcome in recent-onset psychosis: The role of cognition
Pothier, W., Cellard, C., Corbière, M., Villotti, P., Achim, A., Lavoie, A., Turcotte, M., Vallières, C., & Roy, M. (2019) · Schizophrenia Research: Cognition · doi:10.1016/j.scog.2019.100158 · Cited by 12
Specialized inpatient treatment for young people with early psychosis: acute-treatment and 12-month results
Siebert, S., Leopold, K., Baumgardt, J., von Hardenberg, L., Burkhardt, E., & Bechdolf, A. (2022) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-022-01379-8 · Cited by 12
“SIPD in the subgroups Non-droupouts and droupouts d DAI-10 Drug Attitudes Inventory [50, 51] e PSQ-18 Patient Satisfaction Questionnaire [52] f PANSS at Baseline (positive, negative, general, total), Positive and Negative Syndrome Scale with subscales positive and negative symptoms, general symptoms and total score [5…”
Method
Effect of anticholinergic burden on brain activity during Working Memory and real-world functioning in patients with schizophrenia
Selvaggi, P., Fazio, L., Toro, V. D., Mucci, A., Rocca, P., Martinotti, G., Cascino, G., Siracusano, A., Zeppegno, P., Pergola, G., et al. (2023) · Schizophrenia Research · doi:10.1016/j.schres.2023.08.015 · Cited by 11
“Patients with high ACB had higher PANSS total scores and higher chlorpromazine equivalents as compared with low ACB patients (both p = 0.04).”
Influential
Clinical differences between immigrants voluntarily and involuntarily admitted to acute psychiatric units: a 3-year prospective study
Iversen, V. C., BERG, J. E., SMÅVIK, R., & VAALER, A. E. (2011) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/j.1365-2850.2011.01718.x · Cited by 11
Normal-range verbal-declarative memory in schizophrenia.
Heinrichs, R. W., Parlar, M. E., & Pinnock, F. (2017) · Neuropsychology · doi:10.1037/neu0000365 · Cited by 11
Interaction of Background Noise and Auditory Hallucinations on Phonemic Mismatch Negativity (MMN) and P3a Processing in Schizophrenia
Francis, A. M., Knott, V., Labelle, A., & Fisher, D. J. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.540738 · Cited by 11
Computational Mechanism for the Effect of Psychosis Community Treatment: A Conceptual Review From Neurobiology to Social Interaction
Benrimoh, D. A., Sheldon, A. D., Sibarium, E., & Powers, A. R. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.685390 · Cited by 11
Drugs and Psychosis Project: A multi‐centre European study on comorbidity
Baldacchino, A., Blair, H. A., Scherbaum, N., Grosse-Vehne, E., Riglietta, M., Tidone, L., CRIACO, C., MARELLI, M. C., Sommer, B., Tan, L., et al. (2009) · Drug and Alcohol Review · doi:10.1111/j.1465-3362.2009.00063.x · Cited by 11
“The PANSS provided specific information on psychopathology [31,32].”
Background
Validation of the factorial structure of the Positive and Negative Syndrome Scale in use by untrained psychiatrists in routine care
Linden, M., Scheel, T., & Rettig, K. (2006) · International Journal of Psychiatry in Clinical Practice · doi:10.1080/13651500600884419 · Cited by 11
Schizophrenia-Specific Basic Symptoms
Maß, R., Weigel, S., Schneider, S., & Klepsch, R. (1998) · Psychopathology · doi:10.1159/000066234 · Cited by 11
Cognitive changes in patients with acute phase psychosis—Effects of illicit drug use
Helle, S., Gjestad, R., Johnsen, E., Kroken, R. A., Jørgensen, H. A., & Løberg, E. (2014) · Psychiatry Research · doi:10.1016/j.psychres.2014.08.062 · Cited by 11
“…were symptoms of active non-affective psychosis, determined by a score of four or over on one or more of the items Delusions, Hallucinatory behavior, Grandiosity, Suspiciousness/Persecution, or Unusual thought content from the Positive and Negative Syndrome Scale (PANSS) (Kay et al., 1989).”
BackgroundMethodInfluential
Whole brain polarity regime dynamics are significantly disrupted in schizophrenia and correlate strongly with network connectivity measures
Miller, R. L., Pearlson, G. D., & Calhoun, V. D. (2019) · PLoS ONE · doi:10.1371/journal.pone.0224744 · Cited by 11
“Higher scores on a symptom inventory [21] further suppress polarity, with positive symptoms (including psychotic symptoms such as delusions and hallucinations) exhibiting significant suppressive effects on the Polarized-High (β = −0.”
Background
Longitudinal changes in neuroanatomy and neural activity in early schizophrenia
Whitford, T. J., Farrow, T. F. D., RENNIE, C. J., Grieve, S. M., Gomes, L. J., Brennan, J., Harris, A. W. F., & Williams, L. M. (2007) · Neuroreport · doi:10.1097/wnr.0b013e3280119d31 · Cited by 11
“CPZ eqv., chlorpromazine equivalent; DUP, duration of untreated psychosis; F, female; IQ, intelligence quotient; L, left; M, male; PANSS, Positive and Negative Syndrome Scale; R, right.”
Method
Atypical antipsychotics and the negative symptoms of schizophrenia
King, D. J. (1998) · Advances in Psychiatric Treatment · doi:10.1192/apt.4.1.53 · Cited by 11
Monsters don’t bother me anymore’ forensic mental health service users’ experiences of acceptance and commitment therapy for psychosis
Davies, B. E., Morgan, S., John-Evans, H., & Deere, E. (2019) · The Journal of Forensic Psychiatry & Psychology · doi:10.1080/14789949.2019.1614650 · Cited by 9
Long-Term Safety and Efficacy of Xanomeline and Trospium Chloride in Schizophrenia: A 52-Week Open-Label Extension Trial
Kaul, I., Claxton, A., Sauder, C. L., Patel, T., Chaturvedi, S. A., Brown, D., Zhu, H., Marcus, R. N., Sawchak, S. T., & Brannan, S. K. (2026) · American Journal of Psychiatry · doi:10.1176/appi.ajp.20241186 · Cited by 11
Caffeine levels and dietary intake in smokers with schizophrenia and bipolar disorder
Rosen, R., Ramasubramani, R. S., Benowitz, N. L., Gandhi, K. K., & Williams, J. M. (2022) · Psychiatry Research · doi:10.1016/j.psychres.2022.114989 · Cited by 10
Randomized controlled trial of the glycine transporter 1 inhibitor PF-03463275 to enhance cognitive training and neuroplasticity in schizophrenia
Surti, T. S., Ranganathan, M., Johannesen, J., Gueorguieva, R. V., Deaso, E., Kenney, J. G., Krystal, J. H., & D’Souza, D. C. (2023) · Schizophrenia Research · doi:10.1016/j.schres.2023.04.010 · Cited by 11
Cognitive behavioural therapy added to standard care for first-episode and recent-onset psychosis
Mayer, S. F., Corcoran, C., Kennedy, L., Leucht, S., & Bighelli, I. (2024) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd015331.pub2 · Cited by 11
Sample ascertainment and clinical outcome measures in the Accelerating Medicines Partnership® Schizophrenia Program
Addington, J., Liu, L., Braun, A., Auther, A. M., Calkins, M. E., Cornblatt, B. A., Corcoran, C. M., Fusar‐Poli, P., Kerr, M., Mourgues, C., et al. (2025) · Schizophrenia · doi:10.1038/s41537-025-00556-7 · Cited by 10
“There is also empirical work indicating the utility and validity of the BPRS as a transdiagnostic scale 37 , which has not yet been established for other commonly used instruments in this ﬁ eld, such as the Positive and Negative Syndrome Scale 38 .”
Does compliance therapy improve use of antipsychotic medication?
Ilott, R. (2005) · British Journal of Community Nursing · doi:10.12968/bjcn.2005.10.11.19962 · Cited by 10
Eficacia de los antipsicóticos de segunda generación en el tratamiento de los síntomas negativos de esquizofrenia: un metaanálisis de ensayos clínicos aleatorizados
Darbà, J., Minoves, A., Rojo, E., Jiménez, F., & Rejas, J. (2011) · Revista de Psiquiatría y Salud Mental · doi:10.1016/j.rpsm.2011.02.005 · Cited by 10
Mentalizing Errors in Patients with Schizophrenia Who Received Psychosocial Rehabilitation: a Case-Control Study
Andrade‐González, N., Sarasa, M., García-López, A., Torres, I. L., Halverson, T. F., & Lahera, G. (2021) · Psychiatric Quarterly · doi:10.1007/s11126-020-09863-x · Cited by 13
“Positive and Negative Syndrome Scale (PANSS; Kay, Opler, & Lindenmayer [30]; Spanish version of Peralta & Cuesta [31]).”
Background
Medication Adherence and Drug Attitude Amongst Male Patients with the Methamphetamine-Induced Psychotic Disorder After Discharge: A Three Months Follow Up Study
Asadi, M., Rashedi, V., Khademoreza, N., Seddigh, R., Keshavarz‐Akhlaghi, A., Ahmadkhaniha, H., Rezvaniardestani, S.-M., Lotfi, A., & Shalbafan, M. (2021) · Journal of Psychoactive Drugs · doi:10.1080/02791072.2021.1883778 · Cited by 10

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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