title: Could PANSS be a useful tool in the determining of the stages of schizophrenia? A clinically operational approach.
abstract: Staging in schizophrenia might be an important approach for the better treatment and rehabilitation of patients. The purpose of this study was to empirically devise a staging approach in a sample of stabilized patients with schizophrenia. One hundred and seventy patients aged ≥18 years (mean = 40.7, SD = 11.6) diagnosed by DSM-5 criteria were evaluated with the Positive and Negative Syndrome Scale (PANSS). Principal components analysis (PCA) with varimax rotation was used. The model was examined in the total sample and separately across a hypothesized stage of illness based on three age groups and between the two sexes. The PCA revealed a six factor structure for the total sample: 1) Negative, 2) Positive, 3) Depression and anxiety, 4) Excitement and Hostility, 5) Neurocognition and 6) Disorganization. The separate PCAs by stage of illness and sex revealed different patterns and quality of symptomatology. The Negative and Positive factors were stable across all examined groups. The models corresponding to different stages differed mainly in terms of neurocognition and disorganization and their interplay. Catatonic features appear more prominent in males while in females neurocognition takes two forms; one with disorganization and one with stereotype thinking with delusions. This study suggests that the three arbitrary defined stages of illness (on the basis of age) seem to reflect a progress from a preserved insight and more coherent mental functioning to disorganization and eventually neurocognitive impairment. Sexes differ in terms of the relationship of psychotic features with neurocognition. These results might have significant research and clinical implications.
authors.affiliation: Pain and Rehabilitation Centre, and Rehabilitation Medicine, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, SE-581 85, Linköping, Sweden. Electronic address: elena.dragioti@liu.se.
authors.forename: Elena
authors.initials: E
authors.lastname: Dragioti
authors.affiliation: Pain and Rehabilitation Centre, and Rehabilitation Medicine, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, SE-581 85, Linköping, Sweden.
authors.forename: Tobias
authors.initials: T
authors.lastname: Wiklund
authors.affiliation: 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Melina
authors.initials: M
authors.lastname: Siamouli
authors.affiliation: 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Katerina
authors.initials: K
authors.lastname: Moutou
authors.affiliation: 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Konstantinos N
authors.initials: KN
authors.lastname: Fountoulakis
mesh_terms: D000328:Adult; D039721:Diagnostic and Statistical Manual of Mental Disorders; D018450:Disease Progression; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D008960:Models, Psychological; D011569:Psychiatric Status Rating Scales; D012559:Schizophrenia / Q000145:classification* / Q000175:diagnosis*; D012565:Schizophrenic Psychology; D012737:Sex Factors
keywords: Evaluation; PANSS; Pyramidal model; Schizophrenia; Staging; Symptoms