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A Brief Review of

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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.

Bases for Rating 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.

Anchoring Points Rated from 1, Absent to 7, Extreme.

Definitions, basis for rating, & anchoring points are used in combination to score items.

Each element should be interpreted as literally as possible.

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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.

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4. Moderate. Presence of either a kaleidoscopic array of poorly formed, unstable delusions orof 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.

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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 patient’s life. This frequently results in inappropriate and irresponsible actions, which may even jeopardize the safety of the patient or others.

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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. Absent. Definition does not apply.

2. Minimal. Questionable pathology; may be at the upper extreme of normal limits.

3. Mild. Changes in facial expression and communicative gestures seem stilted, forced, artificial, or lacking in modulation.

4. Moderate. Reduced range of facial expression and few expressive gestures.

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5. Moderate Severe. Affect generally appears “flat”, with few changes in facial expression and a paucity of communicative gestures.

6. 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.

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

Both must be present to rate this level of severity

“Reduced range of facial expression

and

few expressive

gestures”

(1) reduced facial expression

(2) few expressive gestures

= +

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).

P56 Days Ago=7 At Interview=3

Rating ≠ 5

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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.

P56 Days Ago=7 At Interview=3

Rating = 7

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

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1. are rated solely on the basis of the interview (verbal & nonverbal).

2. are rated solely based upon data gathered from an

informant.

3. are rated by combining data from the interview with informant data.

how many items

how many items

how many items

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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 understandthe question as you’ve 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 can’t hear. What about you?”, you might say:

“You’ve 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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