Positive and Negative Syndrome Scale (PANSS)

Aim: To assess the severity of positive, negative, and general psychopathological symptoms
of schizophrenia in a normal individual using the PANSS (Positive and Negative Syndrome
Scale).

Introduction:
Psychotic Features and Disorders
Psychotic Features: Psychotic features are severe mental symptoms that cause abnormal
thinking and perceptions. These symptoms include hallucinations, delusions, disorganized
speech, and disorganized or catatonic behaviour.
According to Karl Jaspers (1913), psychosis involves fundamental changes in the patient's
relation to reality, where the subjective experience overrides objective [Link] is
a mental state characterized by a disconnection from reality, involving hallucinations,
delusions, disorganized thinking, and disturbed perceptions. Psychosis impairs the individual's
ability to distinguish reality from their subjective experiences.
Positive Psychotic Features: Positive symptoms are psychotic behaviors not seen in healthy
individuals and include:
1. Hallucinations: Sensory experiences without external stimuli (e.g., hearing voices).
2. Delusions: Strong beliefs that are inconsistent with reality (e.g., believing one has
special powers).
3. Disorganized Thinking: Incoherent speech and thought processes.
4. Grossly Disorganized or Catatonic Behavior: Inappropriate or bizarre behaviors, or
lack of movement or responsiveness.
Negative Psychotic Features: Negative symptoms reflect a decrease or loss in the ability to
function normally and include:
1. Affective Flattening: Reduced emotional expression.
2. Alogia: Poverty of speech or reduction in verbal output.
3. Anhedonia: Lack of pleasure or interest in previously enjoyed activities.
4. Avolition: Reduced motivation and goal-directed behavior.
5. Social Withdrawal: Reduced ability or desire to engage in social interactions.
Psychotic Disorders (ICD-10 F20–F29):
These disorders are categorized under ICD-10 as psychotic disorders and include:
1. F20: Schizophrenia
2. F21: Schizotypal Disorder
 3. F22: Persistent Delusional Disorder
4. F23: Acute and Transient Psychotic Disorder
5. F24: Induced Delusional Disorder
6. F25: Schizoaffective Disorders
7. F28: Other Nonorganic Psychotic Disorders
8. F29: Unspecified Nonorganic Psychosis
Schneider's First-Rank Symptoms (Schizophrenia):
Schneider's First-Rank Symptoms are a set of key symptoms used to diagnose schizophrenia.
They were introduced by Kurt Schneider in 1959 and remain essential to understanding the
disorder:
1. Auditory Hallucinations: Hearing voices that comment on one’s actions or converse
with one another.
2. Thought Withdrawal/Insertion: Thoughts being removed or inserted into one’s mind
by an external force.
3. Thought Broadcasting: Belief that others can hear one’s thoughts.
4. Delusions of Control: External forces control one’s body and thoughts.
5. Somatic Passivity: Feeling that one’s body or sensations are controlled by external
sources.
Other Disorders with Psychotic Features (not from F20–F29):
1. Bipolar Disorder with Psychotic Features (F31): Mood disturbances combined with
psychotic symptoms.
2. Major Depressive Disorder with Psychotic Features (F32–F33): Severe depression
accompanied by psychotic experiences.
3. Delirium (F05): Confusion, disorientation, and hallucinations due to medical
conditions.
4. Substance-Induced Psychotic Disorder (F10–F19): Psychosis resulting from
substance abuse or withdrawal.
Procedure
Participant Details:
Name- SK
Gender- Female
Age- 25 years
Occupation- Post graduation
Materials Required: PANSS Rating Scale (original 30-item scale), Scoring Sheet and Pencil
for recording scores, Instruction Manual for standard administration of the PANSS.

Test Description:
The PANSS is designed to assess both positive and negative symptoms of schizophrenia,
along with general psychopathology, through clinician observation and structured interviews.
Each item is rated on a 7-point Likert scale ranging from 1 (absent) to 7 (extreme).
The Positive and Negative Syndrome Scale (PANSS) is a widely used tool in clinical practice
and research to measure the severity of schizophrenia symptoms. The scale was developed by
Kay, Fiszbein, and Opler in 1987. It includes 30 items grouped into three scales:
1. Positive Symptoms Scale: Assesses symptoms such as delusions, hallucinations, and
thought disorder.
2. Negative Symptoms Scale: Assesses symptoms related to emotional withdrawal,
blunted affect, and reduced social engagement.
3. General Psychopathology Scale: Evaluates overall mental status, including anxiety,
depression, and cognitive function.
The PANSS is commonly administered to assess baseline severity, track changes over time,
and evaluate the effectiveness of treatment in patients with schizophrenia. However, it is also
used with individuals who do not show clinical signs of schizophrenia to establish a normal
baseline.
Psychometric Properties:
Reliability: The PANSS demonstrates high internal consistency (α = 0.70–0.90) and strong
test-retest reliability.
Validity: The PANSS shows strong construct and concurrent validity, distinguishing symptom
dimensions and correlating with other schizophrenia measures.

Procedure:
Pre-Administration: The participant was briefed about the purpose of the assessment and
informed that there were no right or wrong answers. The participant gave informed consent
and was assured that confidentiality would be maintained.

Rapport formation was initiated by explaining the purpose of the test and its non-invasive
nature. The participant was made comfortable in a quiet environment, ensuring that no external
distractions would interfere with the testing.
Instructions:
Clear and straightforward instructions were provided before each section of the PANSS
assessment.
I. Positive Symptoms Scale: "I will ask you some questions about experiences such as unusual
thoughts, perceptions, or beliefs. Please answer based on what you have noticed over the past
week."

II. Negative Symptoms Scale: "I will ask you about your feelings, emotions, and motivation.
Please respond with how you’ve been feeling over the past week, particularly regarding social
activities or daily tasks."

III. General Psychopathology Scale: "I will ask about your general mental and emotional well-
being, including feelings of anxiety, mood, and concentration. Please answer based on your
experiences over the past week."

Actual Administration: The tests were administered sequentially in a quiet, well-lit room free
from distractions. The examiner ensured that the participant understood each task before
starting.

Behavioral Observation:
The participant remained cooperative throughout the administration. Their behavior appeared
calm, with no signs of distress, confusion, or disorganization in speech or thought.

Introspective Report:
The participant answered all questions clearly and displayed insight into their emotions and
mental state. There were no indications of hallucinations, delusions, or disorganized thought
patterns.

Scoring:
The PANSS is scored by summing the individual ratings on the Positive Symptoms Scale,
Negative Symptoms Scale, and General Psychopathology Scale. Each scale's total score is then
interpreted in terms of symptom severity.
PANSS Score Interpretation
Positive Symptoms Scale:
7 to 15: Mild
16 to 30: Moderate
31 and above: Severe
Negative Symptoms Scale:
7 to 15: Mild
16 to 30: Moderate
31 and above: Severe

General Psychopathology Scale:

Total PANSS Score:

Composite Score:
-42 to -1: Predominance of Negative Symptoms
0: Balance of Symptoms
1 to +42: Predominance of Positive Symptoms

CGI Severity of Illness-Corresponding PANSS Score

Interpretation
Positive Scale:
The participant’s score of 20 on the Positive Scale falls within the mild to moderate range of
psychotic symptoms. This score suggests the presence of some positive psychotic symptoms,
such as mild delusions (e.g., suspicions or beliefs that others might be plotting against them)
or mild hallucinations (e.g., hearing voices). These symptoms may be noticeable but are not
overly disruptive. The participant might occasionally exhibit disorganized thinking (e.g., loose
associations or tangential speech), but they are likely able to maintain relatively consistent day-
to-day functioning with these symptoms present.

Negative Scale:

A score of 15 on the Negative Scale is indicative of mild negative symptoms. This could
manifest as blunted affect (e.g., reduced emotional expression), slight emotional withdrawal
(e.g., decreased interest in social or leisure activities), and mild avolition (e.g., reduced
motivation for activities). While these symptoms may slightly affect social interactions and
motivation, they are not highly impairing, allowing the participant to engage in some social
or occupational activities with a few limitations.

General Psychopathology Scale:

The participant scored a total PANSS score of 84, which aligns with a “Moderately Ill” level
of severity. This suggests that the participant experiences a moderate level of psychiatric
symptoms, including positive symptoms (such as mild hallucinations or delusions), mild
negative symptoms (like emotional withdrawal), and moderate general psychopathology
symptoms (such as anxiety or low mood).

The participant scored a Composite Score of +5. This suggests a slight predominance of
positive symptoms over negative symptoms. This indicates that the participant’s psychotic
features (like delusions or hallucinations) may be more prominent than symptoms of emotional
withdrawal or lack of motivation, although both are present.

Conclusion:
The PANSS assessment indicates that the participant has mild to moderate psychotic and
general psychiatric symptoms.

References
Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The Positive and Negative Syndrome Scale
(PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261–276.
Peralta, V., & Cuesta, M. J. (1994). Psychometric properties of the Positive and Negative
Syndrome Scale (PANSS) in schizophrenia. Psychiatry Research, 53(1), 31–40.