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Testing Systems for Assessment of Negative Symptoms in Schizophrenia

Testing Systems for Assessment of Negative Symptoms in Schizophrenia Abstract • To compare methods of measuring negative symptoms, eight rating scales were employed to retrospectively assess and subtype 187 patients with schizophrenia from the Chestnut Lodge Follow-up Study. These included Andreasen's Schedule for Assessment of Negative Symptoms, Carpenter's Criteria for the Deficit Syndrome, Kay and Opler's Positive and Negative Symptom Scale, the scales developed by Krawiecka et al and Crow's modification of them, the Negative Symptom Scale developed by Lewine et al, PogueGeile and Harrow's Negative Symptom Scale, and Abrams and Taylor's Emotional Blunting Scale. The overlap and concordance, temporal stability, and predictive validity of these instruments are described. When rated from detailed medical records, the reliability of all scales was fair to good. Despite their inclusion of different items, there were high positive correlations between the scales when used to rate negative symptoms dimensionally. When used to classify individual patients as having the negative or deficit syndrome, however, concordance among criteria was low. Using the broadest criteria (Pogue-Geile and Harrow), 75 (40%) patients were diagnosed as having negative syndrome; the narrowest criteria (Andreasen and Olsen) yielded 11 (6%) diagnoses of negative syndrome. Narrower definitions tended to be subsets of broader ones. Carpenter's Criteria for the Deficit Syndrome focus on primary enduring negative symptoms and show the greatest temporal stability. Broader criteria, which diagnose the deficit or negative syndrome independent of severity of positive symptoms, had the greatest predictive validity. References 1. Andreasen NC, ed. Modem Problems of Pharmacopsychiatry: Positive and Negative Symptoms and Syndromes . New York, NY: S Karger AG; 1990. 2. Kay SR. Methods of assessing the negative syndrome. In: Proceedings of the 143rd annual meeting of the American Psychiatric Association. Washington, DC: American Psychiatric Association. 1990:88. 3. McGlashan TH, Fenton WS. The positive-negative distinction in schizophrenia: review of natural history validators . Arch Gen Psychiatry . 1992;49:63-72.Crossref 4. Marks RC, Luchins DJ. Relationship between brain imaging findings in schizophrenia and psychopathology: a review of the literature relating to positive and negative symptoms . In: Andreasen NC, ed. Modern Problems of Pharmacopsychiatry: Positive and Negative Symptoms and Syndromes . New York, NY: S Karger AG; 1990:89-123. 5. Pickar D, Litman RE, Konicki PE, Wolkowitz OM, Breier A. Neurochemical and neural mechanisms of positive and negative symptoms in schizophrenia . In: Andreasen NC, ed. Modern Problems of Pharmacopsychiatry: Positive and Negative Symptoms and Syndromes . New York, NY: S Karger AG; 1990:24-151. 6. Buchanan RW, Kirkpatrick B, Heinrichs DW, Carpenter WT. Clinical correlates of the deficit syndrome of schizophrenia . Am J Psychiatry . 1990;147:290-294. 7. Sommers AA. Negative symptoms: conceptual and methodological problems . Schizophr Bull . 1985;11:380-389.Crossref 8. Gur RE, Mozley PD, Resnick SM, Levick S, Erwin R, Saykin AJ, Gur RC. Relations among clinical scales in schizophrenia . Am J Psychiatry . 1991;148:472-478. 9. Fenton WS, McGlashan TH. Natural history of schizophrenia subtypes, I: longitudinal study of paranoid, hebephrenic, and undifferentiated schizophrenia . Arch Gen Psychiatry . 1991;48:969-977.Crossref 10. Fenton WS, McGlashan TH. Natural history of schizophrenia subtypes, II: positive and negative symptoms and long-term course . Arch Gen Psychiatry . 1991;48:978-986.Crossref 11. Andreasen NC, Olsen S. Negative vs positive schizophrenia: definition and validation . Arch Gen Psychiatry . 1982;39:789-794.Crossref 12. Carpenter WT, Heinrichs DW, Wagman AMI. Deficit and non-deficit forms of schizophrenia: the concept . Am J Psychiatry . 1988;145:578-583. 13. Kay SR, Opler LA, Fishbein A. Positive and Negative Syndrome Scale (PANSS) Rating Manual . Toronto, Canada: Multihealth Systems Inc. 1992. 14. Krawiecka M, Goldberg D, Vaughan M. A standardized psychiatric assessment scale for rating chronic psychotic patients . Acta Psychiatr Scand . 1977;55:299-308.Crossref 15. Crow TJ. Molecular pathology of schizophrenia: more than one disease process? BMJ . 1980;280:66-68.Crossref 16. Lewine R, Fogg L, Meltzer H. The development of scales for the assessment of positive and negative symptoms in schizophrenia . Schizophr Bull . 1983;9:368-376.Crossref 17. Pogue-Geile MF, Harrow M. Negative and positive symptoms in schizophrenia and depression: a follow-up . Schizophr Bull . 1985; 10:371-387.Crossref 18. Abrams R, Taylor MA. A rating scale for emotional blunting . Am J Psychiatry . 1978;135:226-229. 19. McGlashan TH. The Chestnut Lodge follow-up study, I: follow-up methodology and study sample . Arch Gen Psychiatry . 1984;41:573-585.Crossref 20. Andreasen NC, Flaum M, Swayze VW, Tyrrell G, Arndt S. Positive and negative symptoms in schizophrenia: a critical reappraisal . Arch Gen Psychiatry . 1990;47:615-621.Crossref 21. Wagman AMI, Heinrichs DW, Carpenter WT. Deficit and nondeficit forms of schizophrenia: neuropsychological evaluation . Psychiatry Res . 1987;22:319-330.Crossref 22. Hsiao JK, Bartko JJ, Potter WZ. Diagnosing diagnoses: receiver operating characteristic methods and psychiatry . Arch Gen Psychiatry . 1989;46:664-667.Crossref 23. McGlashan TH. The Chestnut Lodge follow-up study, II: long-term outcome of schizophrenia and affective disorders . Arch Gen Psychiatry . 1984;41:586-601.Crossref 24. Kraeplin E. Dementia Praecox and Paraphrenia . Edinburgh, Scotland: E & S Livingstone; 1919. 25. Strauss JS, Carpenter WT, Bartko J. The diagnosis and understanding of schizophrenia, III: speculations on the processes that underlie schizophrenic symptoms and signs . Schizophr Bull . 1974;1:61-69.Crossref 26. Carpenter WT, Buchanan RW. Domains of psychopathology relevant to the study of the etiology and treatment of schizophrenia . In: Schultz SC, Tamminga CT, eds. Schizophrenia: A Scientific Focus . New York, NY: Oxford University Press Inc; 1990:13-23. 27. Lenzenweger MF, Dworkin RW, Wethington E. Models of positive and negative symptoms in schizophrenia: an empirical evaluation of latent structures . J Abnorm Psychol . 1989;1:62-70.Crossref 28. Breir A, Wolkowitz OM, Doran AR, Roy A, Boronow J, Hommer DW, Pickar D. Neuroleptic responsivity of negative and positive symptoms in schizophrenia . Am J Psychiatry . 1987;144:1549-1555. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of General Psychiatry American Medical Association

Testing Systems for Assessment of Negative Symptoms in Schizophrenia

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Publisher
American Medical Association
Copyright
Copyright © 1992 American Medical Association. All Rights Reserved.
ISSN
0003-990X
eISSN
1598-3636
DOI
10.1001/archpsyc.1992.01820030011002
Publisher site
See Article on Publisher Site

Abstract

Abstract • To compare methods of measuring negative symptoms, eight rating scales were employed to retrospectively assess and subtype 187 patients with schizophrenia from the Chestnut Lodge Follow-up Study. These included Andreasen's Schedule for Assessment of Negative Symptoms, Carpenter's Criteria for the Deficit Syndrome, Kay and Opler's Positive and Negative Symptom Scale, the scales developed by Krawiecka et al and Crow's modification of them, the Negative Symptom Scale developed by Lewine et al, PogueGeile and Harrow's Negative Symptom Scale, and Abrams and Taylor's Emotional Blunting Scale. The overlap and concordance, temporal stability, and predictive validity of these instruments are described. When rated from detailed medical records, the reliability of all scales was fair to good. Despite their inclusion of different items, there were high positive correlations between the scales when used to rate negative symptoms dimensionally. When used to classify individual patients as having the negative or deficit syndrome, however, concordance among criteria was low. Using the broadest criteria (Pogue-Geile and Harrow), 75 (40%) patients were diagnosed as having negative syndrome; the narrowest criteria (Andreasen and Olsen) yielded 11 (6%) diagnoses of negative syndrome. Narrower definitions tended to be subsets of broader ones. Carpenter's Criteria for the Deficit Syndrome focus on primary enduring negative symptoms and show the greatest temporal stability. Broader criteria, which diagnose the deficit or negative syndrome independent of severity of positive symptoms, had the greatest predictive validity. References 1. Andreasen NC, ed. Modem Problems of Pharmacopsychiatry: Positive and Negative Symptoms and Syndromes . New York, NY: S Karger AG; 1990. 2. Kay SR. Methods of assessing the negative syndrome. In: Proceedings of the 143rd annual meeting of the American Psychiatric Association. Washington, DC: American Psychiatric Association. 1990:88. 3. McGlashan TH, Fenton WS. The positive-negative distinction in schizophrenia: review of natural history validators . Arch Gen Psychiatry . 1992;49:63-72.Crossref 4. Marks RC, Luchins DJ. Relationship between brain imaging findings in schizophrenia and psychopathology: a review of the literature relating to positive and negative symptoms . In: Andreasen NC, ed. Modern Problems of Pharmacopsychiatry: Positive and Negative Symptoms and Syndromes . New York, NY: S Karger AG; 1990:89-123. 5. Pickar D, Litman RE, Konicki PE, Wolkowitz OM, Breier A. Neurochemical and neural mechanisms of positive and negative symptoms in schizophrenia . In: Andreasen NC, ed. Modern Problems of Pharmacopsychiatry: Positive and Negative Symptoms and Syndromes . New York, NY: S Karger AG; 1990:24-151. 6. Buchanan RW, Kirkpatrick B, Heinrichs DW, Carpenter WT. Clinical correlates of the deficit syndrome of schizophrenia . Am J Psychiatry . 1990;147:290-294. 7. Sommers AA. Negative symptoms: conceptual and methodological problems . Schizophr Bull . 1985;11:380-389.Crossref 8. Gur RE, Mozley PD, Resnick SM, Levick S, Erwin R, Saykin AJ, Gur RC. Relations among clinical scales in schizophrenia . Am J Psychiatry . 1991;148:472-478. 9. Fenton WS, McGlashan TH. Natural history of schizophrenia subtypes, I: longitudinal study of paranoid, hebephrenic, and undifferentiated schizophrenia . Arch Gen Psychiatry . 1991;48:969-977.Crossref 10. Fenton WS, McGlashan TH. Natural history of schizophrenia subtypes, II: positive and negative symptoms and long-term course . Arch Gen Psychiatry . 1991;48:978-986.Crossref 11. Andreasen NC, Olsen S. Negative vs positive schizophrenia: definition and validation . Arch Gen Psychiatry . 1982;39:789-794.Crossref 12. Carpenter WT, Heinrichs DW, Wagman AMI. Deficit and non-deficit forms of schizophrenia: the concept . Am J Psychiatry . 1988;145:578-583. 13. Kay SR, Opler LA, Fishbein A. Positive and Negative Syndrome Scale (PANSS) Rating Manual . Toronto, Canada: Multihealth Systems Inc. 1992. 14. Krawiecka M, Goldberg D, Vaughan M. A standardized psychiatric assessment scale for rating chronic psychotic patients . Acta Psychiatr Scand . 1977;55:299-308.Crossref 15. Crow TJ. Molecular pathology of schizophrenia: more than one disease process? BMJ . 1980;280:66-68.Crossref 16. Lewine R, Fogg L, Meltzer H. The development of scales for the assessment of positive and negative symptoms in schizophrenia . Schizophr Bull . 1983;9:368-376.Crossref 17. Pogue-Geile MF, Harrow M. Negative and positive symptoms in schizophrenia and depression: a follow-up . Schizophr Bull . 1985; 10:371-387.Crossref 18. Abrams R, Taylor MA. A rating scale for emotional blunting . Am J Psychiatry . 1978;135:226-229. 19. McGlashan TH. The Chestnut Lodge follow-up study, I: follow-up methodology and study sample . Arch Gen Psychiatry . 1984;41:573-585.Crossref 20. Andreasen NC, Flaum M, Swayze VW, Tyrrell G, Arndt S. Positive and negative symptoms in schizophrenia: a critical reappraisal . Arch Gen Psychiatry . 1990;47:615-621.Crossref 21. Wagman AMI, Heinrichs DW, Carpenter WT. Deficit and nondeficit forms of schizophrenia: neuropsychological evaluation . Psychiatry Res . 1987;22:319-330.Crossref 22. Hsiao JK, Bartko JJ, Potter WZ. Diagnosing diagnoses: receiver operating characteristic methods and psychiatry . Arch Gen Psychiatry . 1989;46:664-667.Crossref 23. McGlashan TH. The Chestnut Lodge follow-up study, II: long-term outcome of schizophrenia and affective disorders . Arch Gen Psychiatry . 1984;41:586-601.Crossref 24. Kraeplin E. Dementia Praecox and Paraphrenia . Edinburgh, Scotland: E & S Livingstone; 1919. 25. Strauss JS, Carpenter WT, Bartko J. The diagnosis and understanding of schizophrenia, III: speculations on the processes that underlie schizophrenic symptoms and signs . Schizophr Bull . 1974;1:61-69.Crossref 26. Carpenter WT, Buchanan RW. Domains of psychopathology relevant to the study of the etiology and treatment of schizophrenia . In: Schultz SC, Tamminga CT, eds. Schizophrenia: A Scientific Focus . New York, NY: Oxford University Press Inc; 1990:13-23. 27. Lenzenweger MF, Dworkin RW, Wethington E. Models of positive and negative symptoms in schizophrenia: an empirical evaluation of latent structures . J Abnorm Psychol . 1989;1:62-70.Crossref 28. Breir A, Wolkowitz OM, Doran AR, Roy A, Boronow J, Hommer DW, Pickar D. Neuroleptic responsivity of negative and positive symptoms in schizophrenia . Am J Psychiatry . 1987;144:1549-1555.

Journal

Archives of General PsychiatryAmerican Medical Association

Published: Mar 1, 1992

References