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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“33 (27.7) _ _ 30 (17.8) _ _ _ PANSS 100 116 Positive, mean (sd) 14.6 (6.1) _ _ 23.3 (6.8) _ _ _ <0.001 Negative, mean (sd) 14.2 (5.2) _ _ 21.9 (10.3) _ _ _ <0.001 General, mean (sd) 29.3 (6.8) _ _ 50.3 (14.2) _ _ _ <0.001 IQ <0.001 <0.001 <0.001 <0.001 Patients, mean (sd) 87.9 (16.1) 106 −8.9 (247) 73.4 (18.2) 120 −11…”
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Method
Perceived needs and health-related quality of life in people with schizophrenia and metabolic syndrome: a “real-world” study
Medeiros-Ferreira, L., Navarro, J. B., Zúñiga-Lagares, A., Romaní, R., Muray, E., & Obiols, J. E. (2016) · BMC Psychiatry · doi:10.1186/s12888-016-1005-4 · Cited by 7
Local Oscillatory Brain Dynamics of Mind Wandering in Schizophrenia
Prieto, M., Iglesias‐Parro, S., Soriano, M. F., & Ibáñez-Molina, A. J. (2021) · Brain Sciences · doi:10.3390/brainsci11070910 · Cited by 7
“The Spanish version [62] of the Positive and Negative Syndrome Scale (PANSS, [63]) was employed to measure psychopathology.”
Method
Digital movement analysis, a new objective method of measuring tardive dyskinesia and drug-induced parkinsonian tremor: acceptability, reliability and validity
Nilsson, F. M., Hansen, B. L., Büchel, C., Gattaz, W. F., & Gerlach, J. (1996) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/bf02274896 · Cited by 7
“The intensity of the psychosis was measured by means of the Positive and Negative Syndrome Scale (PANSS) (Kay et al. 1989; Knorring et al. 1992), which gave the following results: total positive symptoms 19.”
Method
Investigating the Corrective Effect of Forewarning on Memory and Meta-Memory Deficits in Schizophrenia Patients
Peters, M. J. V., Engel, M., Hauschildt, M., Moritz, S., Jelinek, L., & Otgaar, H. (2012) · Journal of Experimental Psychopathology · doi:10.5127/jep.022011 · Cited by 8
Using figure ground perception to examine the unitary and heterogeneity models for psychopathology in schizophrenia
Malaspina, D., Simon, N. M., Corcoran, C. M., Mujica-Parodi, L. R., Goetz, R. R., & Gorman, J. M. (2002) · Schizophrenia Research · doi:10.1016/s0920-9964(01)00380-2 · Cited by 7
Bipolar Affective Disorder and Idiopathic Pulmonary Fibrosis
Bhandari, S., & Samellas, D. (2001) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v62n07e13 · Cited by 7
The Assessment of Mental Health Problems in Adults with Intellectual Disabilities
Hatton, C., & Taylor, J. L. (2012) · doi:10.1002/9781118329252.ch3 · Cited by 7
Stability of psychopathology dimensions in chronic schizophrenia: Response to clozapine treatment
Kay, S. R., & Lindenmayer, J. (1991) · Comprehensive Psychiatry · doi:10.1016/0010-440x(91)90067-m · Cited by 7
Assessment of Negative Symptoms: Instruments and Evaluation Criteria
Stieglitz, R. (1991) · Springer eBooks · doi:10.1007/978-3-642-76841-5_4 · Cited by 7
What are brief, acute and transient psychotic disorders?
Marneros, A., & Pillmann, F. (2004) · Cambridge University Press eBooks · doi:10.1017/cbo9780511544002.013 · Cited by 7
“The more things change…”? Stability of delusional themes across 12 years of presentations to an early intervention service for psychosis
Grunfeld, G., Lemonde, A.-C., Gold, I., Iyer, S. N., Malla, A., Lepage, M., Joober, R., Boksa, P., & Shah, J. L. (2023) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-022-02324-9 · Cited by 6
“Thematic taxonomies differ slightly among assessment tools [4, 5], but have generally made use of familiar forms such as persecutory, grandiose, referential and so on [4].”
Background
Exploring global and local processes underlying alterations in resting-state functional connectivity and dynamics in schizophrenia
Metzner, C., Dimulescu, C., Kamp, F., Fromm, S. P., Uhlhaas, P. J., & Obermayer, K. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1352641 · Cited by 6
Rapid Smoking May Not be Aversive in Schizophrenia
Williams, J. M., Gandhi, K. K., Lu, S., Steinberg, M. L., & Benowitz, N. L. (2012) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntr314 · Cited by 7
Metabolic alterations associated with first and second generation antipsychotics: an twenty-years open study.
Franza, F., & Cervone, A. (2014) · PubMed · Cited by 6
From local to global and back: An exploratory study on cross-scale desynchronization in schizophrenia and its relation to thought disorders
Damiani, S., Scalabrini, A., Ku, H., Lane, T. J., Politi, P., & Northoff, G. (2021) · Schizophrenia Research · doi:10.1016/j.schres.2021.02.021 · Cited by 6
Die Einflüsse des Studiendesigns und der Stichprobenauswahl auf die Berechnung psychiatrischer Versorgungskosten
Kilian, R., Roick, C., & Angermeyer, M. C. (2003) · Der Nervenarzt · doi:10.1007/s00115-003-1553-y · Cited by 6
Validation française d’un questionnaire de qualité de vie des aidants naturels de patients schizophrènes
Richieri, R. M., Boyer, L., Reine, G., Loundou, A., Siméoni, M.-C., Auquier, P., & Lançon, C. (2011) · L Encéphale · doi:10.1016/j.encep.2011.01.005 · Cited by 6
Cognitive behavioural therapy for help‐seeking adolescents and young adults with at‐risk‐mental state: Effects on subclinical positive symptoms
Pozza, A., Domenichetti, S., & Dèttore, D. (2020) · Early Intervention in Psychiatry · doi:10.1111/eip.12974 · Cited by 6
Approaching anger in schizophrenia: What an implicit task tells you that self-report does not
Reddy, L. F., Green, M. F., Wynn, J. K., Rinck, M., & Horan, W. P. (2016) · Schizophrenia Research · doi:10.1016/j.schres.2016.05.018 · Cited by 6
“The psychiatric symptoms of participants with schizophrenia were evaluated using the Positive and Negative Syndrome Scale (PANSS; Kay et al., 1989).”
Method
Efficacy of Asenapine in Schizophrenia Resistant to Clozapine Combined with Electroconvulsive Therapy: A Case Report
Ochi, S., Inoue, S., Yoshino, Y., Shimizu, H., Iga, J., & Ueno, S. (2019) · Clinical Psychopharmacology and Neuroscience · doi:10.9758/cpn.2019.17.4.559 · Cited by 6
“At the time of discharge, her PANSS total score was 62.”
BackgroundInfluential
Negative Symptoms of Schizophrenia Are Improved by Paroxetine Added to Neuroleptics
Jockers-Scherübl, M. C., Godemann, F., & Pietźcker, A. (2001) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v62n07c13 · Cited by 6
Is there a causal link between folate status and schizophrenia? Evidence from genetic association studies
Yoo, S., Montazeri, A., McNulty, H., Kent, M. P., & Little, J. (2024) · Nutritional Neuroscience · doi:10.1080/1028415x.2024.2436822 · Cited by 5
The Effect of Changes in Cannabis Exposure on Psychotic Symptoms in Patients With Comorbid Cannabis Use Disorder
Toftdahl, N. G., Nordentoft, M., & Hjorthøj, C. R. (2016) · Journal of Dual Diagnosis · doi:10.1080/15504263.2016.1176426 · Cited by 5
Neurobiological Signatures of Auditory False Perception and Phantom Perception as a Consequence of Sensory Prediction Errors
Ahn, M.-H., Alsabbagh, N., Lee, H., Kim, H., Jung, M. H., & Hong, S. K. (2022) · Biology · doi:10.3390/biology11101501 · Cited by 6
“In addition, the schizophrenia symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS) [20], which showed an average score of 52.”
MethodInfluential
Antipsychotic Effects of Celecoxib Add-On Haloperidol in Schizophrenia: A Randomized Double-Blind Placebo-Controlled Clinical Trial
Zarghami, M., Dodangi, N., Azari, P., & Khalilian, A. (2024) · Iranian Journal of Psychiatry and Behavioral Sciences · doi:10.5812/ijpbs-138643 · Cited by 5
High-Density Lipoprotein Correlates with Cognitive Functioning in Schizophrenic Women
Staniek, M., Kapelski, P., Zakowicz, P. T., Rajewska‐Rager, A., Wasicka-Przewoźna, K., & Skibińska, M. (2024) · Brain Sciences · doi:10.3390/brainsci14070699 · Cited by 5
“The Positive and Negative Syndrome Scale (PANSS) [31] was used to assess the severity of schizophrenia symptoms at admission (T0) and after eight weeks of treatment (T8).”
Method
Psychometric Evaluation of the Characteristics of Delusions Rating Scale as an Expert Rating Scale
Gentner, N. C., Büche, L., von Bock, A., Rückl, S., Marx, J., Kaiser, S., Barthel, A., Vedder, H., Mundt, C., & Kronmüller, K. (2010) · Psychopathology · doi:10.1159/000321068 · Cited by 5
La experiencia musical como factor curativo en la musicoterapia con pacientes con esquizofrenia crónica
Troice, E. M., & Sosa, J. J. S. (2003) · Salud Mental · Cited by 5
A Placebo-controlled Trial of Folate with B12 in Patients with Schizophrenia with Residual Symptoms in Ethiopia Using a Sequential Parallel Comparison Design
Borba, C. P. C. (2014) · Journal of Advances in Medicine and Medical Research · doi:10.9734/bjmmr/2014/10473 · Cited by 5
“To examine the relationship among response of PANSS total score, negative and positive symptoms and baseline serum and plasma folate, RBC folate, homocysteine and B12 concentrations, tobacco intake, and MTHFR C677T status.”
MethodInfluential
Iminodibenzyl class antipsychotics for schizophrenia: a systematic review and meta-analysis of carpipramine, clocapramine, and mosapramine
Kishi, T., Matsunaga, S., Matsuda, Y., & Iwata, N. (2014) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s73464 · Cited by 5
The long-term outcome
Marneros, A., & Pillmann, F. (2004) · Cambridge University Press eBooks · doi:10.1017/cbo9780511544002.009 · Cited by 5
Comparison of the effect of lithium plus quetiapine with lithium plus risperidone in children and adolescents with bipolar I disorder: a randomized clinical trial
Habibi, N., Dodangi, N., & Nazeri, A. (2017) · Medical Journal of the Islamic Republic of Iran · doi:10.18869/mjiri.31.16 · Cited by 5
“The Positive and Negative Syndrome Scale-Positive subscale (PANSSP)(17) (to assess the severity of psychotic symptoms), the Children’s Depression Inventory (CDI)(18), the Revised Children’s Manifest Anxiety Scale (RCMAS)(19) (to assess depressive and anxiety symptoms, respectively), CGI – Improvement (to assess respon…”
Method
Déficit métacognitif dans la schizophrénie : caractéristiques et liens
Daoud, M., Thabet, J. B., Bouali, M. M., Omri, S., Gassara, I., Feki, R. C., Smaoui, N., Zouari, L., Charfi, N., & Maalej, M. A. (2021) · L Encéphale · doi:10.1016/j.encep.2021.04.004 · Cited by 6
Cortical changes in patients with schizophrenia across two ethnic backgrounds
Langenbach, B. P., Kohl, W., Murai, T., Suslow, T., Ohrmann, P., Bauer, J., Matsukawa, N., Son, S., Pedersen, A., Lichtenstein, T., et al. (2022) · Scientific Reports · doi:10.1038/s41598-022-14914-3 · Cited by 5
Influences of race and clinical variables on psychiatric genetic research participation: Results from a schizophrenia sample
Xavier, R. M., Shanavas, Y., Britt, B. M., & George, W. T. (2023) · PLoS ONE · doi:10.1371/journal.pone.0284356 · Cited by 6
“Our results show that increased severity of psychopathology symptoms assessed by PANSS scores significantly decreased the odds of whether a participant gave a DNA sample (odds ratio [OR] = 0.77, p = 0.001).”
BackgroundMethodInfluential
Acupuncture and schizophrenia - effect and acceptability: preliminary results of the first UK study
Ronan, P., Harbinson, D., MacInnes, D. L., Lewis, W. C., & Robinson, N. (2010) · Cited by 5
Two case studies from a virtual reality intervention for delusions: feasibility and preliminary evidence
Dietrichkeit, M., Flint, K., Krieger, E. C., Grzella, K., Nagel, M., & Moritz, S. (2018) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x18000090 · Cited by 5
“One week before the first intervention date and one week after the second, psychotic symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS; Kay et al., 1989) and the Psychotic Symptom Scale (PSYRATS; Haddock et al.”
Method

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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