title: Symptom changes in five dimensions of the Positive and Negative Syndrome Scale in refractory psychosis.
abstract: Refractory psychosis units currently have little information regarding which symptoms profiles should be expected to respond to treatment. In the current study, we provide this information using structural equation modeling of Positive and Negative Syndrome Scale (PANSS) ratings at admission and discharge on a sample of 610 patients admitted to a treatment refractory psychosis program at a Canadian tertiary care unit between 1990 and 2011. The hypothesized five-dimensional structure of the PANSS fit the data well at both admission and discharge, and the latent variable scores are reported as a function of symptom dimension and diagnostic category. The results suggest that, overall, positive symptoms (POS) responded to treatment better than all other symptoms dimensions, but for the schizoaffective and bipolar groups, greater response on POS was observed relative to the schizophrenia and major depression groups. The major depression group showed the most improvement on negative symptoms and emotional distress, and the bipolar group showed the most improvement on disorganization. Schizophrenia was distinct from schizoaffective disorder in showing reduced treatment response on all symptom dimensions. These results can assist refractory psychosis units by providing information on how PANSS symptom dimensions respond to treatment and how this depends on diagnostic category.
authors.affiliation: Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada, todd.woodward@ubc.ca.
authors.forename: Todd S
authors.initials: TS
authors.lastname: Woodward
authors.forename: Kwanghee
authors.initials: K
authors.lastname: Jung
authors.forename: Geoffrey N
authors.initials: GN
authors.lastname: Smith
authors.forename: Heungsun
authors.initials: H
authors.lastname: Hwang
authors.forename: Alasdair M
authors.initials: AM
authors.lastname: Barr
authors.forename: Ric M
authors.initials: RM
authors.lastname: Procyshyn
authors.forename: Sean W
authors.initials: SW
authors.lastname: Flynn
authors.forename: Mark
authors.initials: M
authors.lastname: van der Gaag
authors.forename: William G
authors.initials: WG
authors.lastname: Honer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000628:therapy; D002170:Canada; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000628:therapy; D012559:Schizophrenia / Q000175:diagnosis* / Q000628:therapy; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult