Dimensions of Psychosis in Patients with Bipolar Mania as Measured by the Positive and Negative Syndrome Scale

Manhattan Psychiatric Center, New York University of Medicine, New York, NY, USA.
Psychopathology (Impact Factor: 2.08). 02/2008; 41(4):264-70. DOI: 10.1159/000128325
Source: PubMed


Psychosis is present in 50% or more of patients with bipolar mania and is commonly evaluated in clinical research by means of the Positive and Negative Syndrome Scale (PANSS). The aim of the present analysis was to investigate the psychotic dimensions of bipolar disorder and its contributing symptoms based on a factor analysis of baseline PANSS scores and to compare them with those identified in studies of patients with schizophrenia and bipolar disorder.
Baseline data were analyzed from two 3-week, double-blind, placebo-controlled studies of risperidone monotherapy for acute mania associated with bipolar I disorder (n = 535). Inclusion criteria were a DSM-IV diagnosis of bipolar I disorder with manic features, with or without psychotic features, age > or =18 years, and mean baseline Young Mania Rating Scale scores > or =20. A principal component analysis of the 30 PANSS item scores of the 535 patients with a diagnosis of a manic episode at baseline was conducted.
Five factors were extracted by the analysis: anxiety (13.4% of the variance), negative symptoms (12.3%), depression (10.5%), excitement (10.3%), and positive symptoms (8.7%). Similar factors, in particular the negative, excitement, and positive factors, have been identified in patients with schizophrenia. There was an absence of a cognitive factor supporting the notion that bipolar patients may present fewer cognitive symptoms.
The results of the present analysis and those of other studies indicate similarities in psychotic symptom domains, as measured by the PANSS, in patients with bipolar mania and schizophrenia. Future analyses will address the effects of treatment on the identified factors.

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    • "In the present study, the two same factors were shown through confirmatory tests of hypotheses to distinguish subtypes of adults with BPI. Numerous studies have used exploratory factor analysis and CFA to factor analyse symptoms of BP, including the symptoms or signs of mania (Bräunig et al. 1996; Serretti et al. 1999; Perugi et al. 2001; Faraone et al. 2004; Krüger et al. 2010), other mood or psychotic symptoms (Bauer et al. 1991; Dilsaver et al. 1999; Akiskal et al. 2001; Swann et al. 2001, 2008; Daneluzzo et al. 2002; Sato et al. 2002; González-Pinto et al. 2003; Berk et al. 2007; Henry et al. 2007; Adida et al. 2008; Adler et al. 2008; Erkiran et al. 2008; Harvey et al. 2008; Lindenmayer et al. 2008; Cavanagh et al. 2009; Gupta et al. 2009; Thompson et al. 2010; Mitchell et al. 2013), cognitive and energy features (Cassano et al. 2009), temperament (Evans et al. 2005), attention-deficit/hyperactivity disorder (ADHD) features (Joo et al. 2010) or childhood trauma signs (Garno et al. 2005). Resulting factors were shown to be modestly beneficial for genetic mapping in studies of BP, with respect to mood-disturbance factors (Faraone et al. 2004; Savitz et al. 2008) and an ADHD 'inattention' factor (Joo et al. 2010). "

    Psychological Medicine 07/2015; 45:2181-2196. · 5.94 Impact Factor
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    • "The Structured Positive and Negative Syndrome Scale (SCI-PANSS) [33] was used to measure present symptom presentation and severity in this mixed cohort because it measures similar symptom domains in patients with schizophrenia or bipolar disorder [34]. The PANSS was originally assessed as reliable among a group of schizophrenic patients with diverse ethnicities (43% African-American, 33% European-American, 24% Hispanic-American), thus supporting this instrument's cross-ethnic reliability. "
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    ABSTRACT: Immigration status is a significant risk factor for psychotic disorders, and a number of studies have reported more severe positive and affective symptoms among immigrant and ethnic minority groups. We investigated if perceived discrimination was associated with the severity of these symptoms among immigrants in Norway with psychotic disorders. Cross-sectional analyses of 90 immigrant patients (66% first-generation, 68% from Asia/Africa) in treatment for psychotic disorders were assessed for DSM-IV diagnoses with the Structured Clinical Interview for DSM Disorders (SCID-I, sections A-E) and for present symptom severity by The Structured Positive and Negative Syndrome Scale (SCI-PANSS). Perceived discrimination was assessed by a self-report questionnaire developed for the Immigrant Youth in Cultural Transition Study. Perceived discrimination correlated with positive psychotic (r=0.264, p<0.05) and depression/anxiety symptoms (r=0.282, p<0.01), but not negative, cognitive, or excitement symptoms. Perceived discrimination also functioned as a partial mediator for symptom severity in African immigrants. Multiple linear regression analyses controlling for possible confounders revealed that perceived discrimination explained approximately 10% of the variance in positive and depression/anxiety symptoms in the statistical model. Among immigrants with psychotic disorders, visible minority status was associated with perceived discrimination and with more severe positive and depression/anxiety symptoms. These results suggest that context-specific stressful environmental factors influence specific symptom patterns and severity. This has important implications for preventive strategies and treatment of this vulnerable patient group.
    BMC Psychiatry 05/2011; 11(1):77. DOI:10.1186/1471-244X-11-77 · 2.21 Impact Factor
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    • "From the clinician's perspective, the PANSS Excited Component (PANSS-EC) is one of the simplest and most intuitive scales used to assess agitated patients [6]. The PANSS-EC consists of 5 items: excitement, tension, hostility, uncooperativeness, and poor impulse control. "
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    ABSTRACT: Despite the wide use of the Excited Component of the Positive and Negative Syndrome Scale (PANSS-EC) in a clinical setting to assess agitated patients, a validation study to evaluate its psychometric properties was missing. Data from the observational NATURA study were used. This research describes trends in the use of treatments in patients with acute psychotic episodes and agitation seen in emergency departments. Exploratory principal component factor analysis was performed. Spearman's correlation and regression analyses (linear regression model) as well as equipercentile linking of Clinical Global Impression of Severity (CGI-S), Agitation and Calmness Evaluation Scale (ACES) and PANSS-EC items were conducted to examine the scale's diagnostic validity. Furthermore, reliability (Cronbach's alpha) and responsiveness were evaluated. Factor analysis resulted in one factor being retained according to eigenvalue ≥1. At admission, the PANSS-EC and CGI-S were found to be linearly related, with an average increase of 3.4 points (p < 0.001) on the PANSS-EC for each additional CGI-S point. The PANSS-EC and ACES were found to be linearly and inversely related, with an average decrease of 5.5 points (p < 0.001) on the PANSS-EC for each additional point. The equipercentile method shows the poor sensitivity of the ACES scale. Cronbach's alpha was 0.86 and effect size was 1.44. The factorial analyses confirm the unifactorial structure of the PANSS-EC subscale. The PANSS-EC showed a strong linear correlation with rating scales such as CGI-S and ACES. PANSS-EC has also shown an excellent capacity to detect real changes in agitated patients.
    Health and Quality of Life Outcomes 03/2011; 9(1):18. DOI:10.1186/1477-7525-9-18 · 2.12 Impact Factor
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