Table 12.2-5.

Items in the Positive and Negative Syndrome Scale (PANSS)

P1 Delusions
P2 Conceptual disorganization
P3 Hallucinatory behavior
P4 Excitement
P5 Grandiosity
P6 Suspiciousness
P7 Hostility
N1 Blunted affect
N2 Emotional withdrawal
N3 Poor rapport
N4 Passive/apathetic social withdrawal
N5 Difficulty in abstract thinking
N6 Lack of spontaneity and flow of conversation
N7 Stereotyped in thinking
G1 Somatic concern
G2 Anxiety
G3 Guilt feelings
G4 Tension
G5 Mannerisms and posturing
G6 Depression
G7 Motor retardation
G8 Uncooperativeness
G9 Unusual thought content
G10Disorientation
G11Poor attention
G12Lack of judgment and insight
G13Disturbance of volition
G14Poor impulse control
G15Preoccupation
G16Active social avoidance

Positive and Negative Syndrome Scale

The Positive and Negative Syndrome Scale (PANSS) was developed in the late 1980s to remedy
perceived deficits in the BPRS in the assessment of positive and negative symptoms of
schizophrenia and other psychotic disorders by adding additional items and providing careful
anchors for each. The PANSS includes 30 items on three subscales: seven items covering
positive symptoms (e.g., hallucinations and delusions), seven covering negative symptoms (e.g.,
blunted affect), and 16 covering general psychopathology (e.g., guilt or uncooperativeness). In
recent years, these three scales have come to be replaced by a finer division of five subscales
based on factor analysis, but the factor structure of the PANSS and the underlying disorder
remains unclear. Each item is scored on a seven-point, item-specific Likert scale ranging from 1
to 7; thus, the positive and negative subscales each range from 7 to 49, and the general
psychopathology scale ranges from 16 to 112. The PANSS requires a clinician rater because

considerable probing and clinical judgment are required. A semistructured interview guide is
available. The ratings can be completed in 30 to 40 minutes. Reliability for each scale has been
shown to be fairly high, with excellent internal consistency and interrater reliability. Validity also
appears good based on correlation with other symptom severity measures and factor analytic
validation of the subscales. The PANSS has become the standard tool for assessing clinical
outcome in treatment studies of schizophrenia and other psychotic disorders and has been shown
to be easy to administer reliably and sensitive to change with treatment. Its high reliability and
good coverage of both positive and negative symptoms make it excellent for this purpose. It may
also be useful for tracking severity in clinical practice, and its clear anchors make it easy to use
in this setting.