A Brief Review of

What are the elements of reliability?

NAME

DESCRIPTION

Definitions

Each PANSS item has a specific definition, describing the basic construct. This definition should be read carefully in order to determine if it applies to a given patient each time an assessment is made.
Determines relevant information for a specific item. Two sources (1) Data collected during interview (verbal or non-verbal) (2) Data gathered from an informant about symptoms over past week. Rated from 1, Absent to 7, Extreme.

Bases for Rating

Anchoring Points

Definitions, basis for rating, & anchoring points are used in combination to score items. Each element should be interpreted as

literally as possible.

P1. Delusions. Beliefs which are unfounded, unrealistic, and idiosyncratic.

Basis for rating: Thought content

expressed in the interview and its influence on social relations and behavior as reported by primary care workers or family.

1. Absent. Definition does not apply. 2. Minimal. Questionable pathology; may be at the upper extreme of normal limits. 3. Mild. Presence of one or two delusions that are vague, uncrystallized, & not tenaciously held. Delusions do not interfere with thinking, social relations, or behavior.

4.

Moderate. Presence of either

a kaleidoscopic array of poorly formed, unstable delusions or of a few well-formed delusions that occasionally interfere with thinking, social relations or behavior.

5.

Moderate Severe. Presence of

numerous well-formed delusions that are tenaciously held and occasionally interfere with thinking, social relations, or behavior.

6.

Severe. Presence of a stable set of

delusions that are crystallized, possibly systematized, tenaciously held & clearly interfere with thinking, social relations & behavior. Patient at times acts inappropriately and irresponsibly on the basis of unrealistic beliefs.

7.

Extreme. Presence of a stable

set of delusions that are either highly systematized or very numerous and dominate major facets of the patients life. This frequently results in inappropriate and irresponsible actions, which may even jeopardize the safety of the patient or others.

N1. Blunted Affect. Diminished emotional responsiveness as characterized by a reduction in facial expression, modulation of feelings and communicative gestures. Basis for ratings: Observation of physical manifestations of affective tone and emotional responsiveness during the course of the interview.

1. 2.

Absent. Definition does not apply. Minimal. Questionable pathology;

3.

4.

may be at the upper extreme of normal limits. Mild. Changes in facial expression and communicative gestures seem stilted, forced, artificial, or lacking in modulation. Moderate. Reduced range of facial expression and few expressive gestures.

5.

Moderate Severe. Affect generally

6.

appears flat, with few changes in facial expression and a paucity of communicative gestures. Severe. Marked flatness & deficiency of emotions exhibited most of the time. There may be unmodulated extreme affective discharges such as excitement, uncontrolled rage, inappropriate laughter.

7.

Extreme. Changes in facial

expression and evidence of communicative gestures are virtually absent. Patient seems to constantly show a barren or wooden expression.

All required elements must be present to merit a given level of severity:

of facial expression

Reduced range and

few expressive gestures

(1) reduced facial expression

= +

(2) few expressive gestures

Both must be present to rate this level of severity

Give the highest rating that can be justified for each item.
Incorrect: Do not average.
Six days ago patient met criteria for Extreme (7) and now meets criteria for mild (3), do not average to a rating of Moderate Severe (5).

P5

Rating 5
6 Days Ago=7 At Interview=3

Give the highest rating that can be justified for each item.
Correct: Give the highest rating that applies. Six days ago the patient met criteria for Extreme (7) for P5(Grandiosity), so they get a rating of 7, even if They only meet criteria for Mild (3) at interview.

P5

Rating = 7
6 Days Ago=7 At Interview=3

#1: No PANSS items are scored by averaging give the highest rating that applies.

1. how many items are rated solely on the basis of the interview (verbal & nonverbal). 2. how many items are rated solely based upon data gathered from an informant. 3. how many items are rated by combining data from the interview with informant data.

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Important to collect information through a clinically sensitive, free-flowing interview.

Begin by letting the patient talk freely to establish rapport.

Interviews usually takes 30 to 40 minutes. Sometime it may take longer than 40 minutes to complete.

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#2: Always make sure you know when symptoms/events under discussion have occurred.

If the patient does not understand the question as youve asked it, redirect or rephrase questions. Avoid asking leading questions.

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If information has already been given earlier in the interview

phrase questions carefully in order to confirm information.

Example: Patient talks about hearing voices before being asked about them. Instead of later asking: Sometimes people tell me that they can hear noises or voices inside their head that others cant hear. What about you?, you might say: Youve told me you hear voices sometimes. Has that happened in the past week?

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Look for non-verbal responses and symptoms.

Listen to the patient, but always consider informant data for relevant items.

#3: Consider all available information when rating an item, no matter when it occurs, as long as it fits the basis for rating.

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Q:

Whom can informant data be collected from?

Answer: Any person who has been capable of observing the patient over the past week, e.g. parents, family members, etc.

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Q: What can investigators do to ensure that informant data is collected accurately and completely?

Answer: Follow the protocol instructions

carefully, ensure that the informant understands what is being asked of them.

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Contact Information

E-mail: info@panss.org Website: www.panss.org

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