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Multicenter Study
. 2019 Nov 1;22(11):681-697.
doi: 10.1093/ijnp/pyz053.

Staging of Schizophrenia With the Use of PANSS: An International Multi-Center Study

Konstantinos N Fountoulakis  1 , Elena Dragioti  2   3 , Antonis T Theofilidis  1 , Tobias Wikilund  2   3 , Xenofon Atmatzidis  2   3 , Ioannis Nimatoudis  1 , Erik Thys  4 , Martien Wampers  4 , Luchezar Hranov  5 , Trayana Hristova  5 , Daniil Aptalidis  5 , Roumen Milev  6 , Felicia Iftene  6 , Filip Spaniel  7 , Pavel Knytl  7 , Petra Furstova  7 , Tiina From  8 , Henry Karlsson  8 , Maija Walta  8 , Raimo K R Salokangas  8 , Jean-Michel Azorin  9   10 , Justine Bouniard  9   10 , Julie Montant  9   10 , Georg Juckel  11 , Ida S Haussleiter  11 , Athanasios Douzenis  12 , Ioannis Michopoulos  12 , Panagiotis Ferentinos  12 , Nikolaos Smyrnis  13 , Leonidas Mantonakis  13 , Zsófia Nemes  14 , Xenia Gonda  15 , Dora Vajda  15 , Anita Juhasz  15 , Amresh Shrivastava  16 , John Waddington  17 , Maurizio Pompili  18 , Anna Comparelli  18 , Valentina Corigliano  18 , Elmars Rancans  19 , Alvydas Navickas  20   21 , Jan Hilbig  20   21 , Laurynas Bukelskis  20   21 , Lidija Injac Stevovic  22   23   24 , Sanja Vodopic  22   23   24 , Oluyomi Esan  25 , Oluremi Oladele  25 , Christopher Osunbote  25 , Janusz Κ Rybakowski  26 , Pawel Wojciak  26 , Klaudia Domowicz  26 , Maria Luisa Figueira  27 , Ludgero Linhares  27 , Joana Crawford  27 , Anca-Livia Panfil  28 , Daria Smirnova  29 , Olga Izmailova  29 , Dusica Lecic-Tosevski  30   31 , Henk Temmingh  32 , Fleur Howells  32 , Julio Bobes  33 , Maria Paz Garcia-Portilla  33 , Leticia García-Alvarez  33 , Gamze Erzin  34 , Hasan Karadağ  34 , Avinash De Sousa  35 , Anuja Bendre  35 , Cyril Hoschl  7 , Cristina Bredicean  36 , Ion Papava  36 , Olivera Vukovic  37 , Bojana Pejuskovic  38 , Vincent Russell  38 , Loukas Athanasiadis  39 , Anastasia Konsta  39 , Dan Stein  40 , Michael Berk  41   42 , Olivia Dean  43 , Rajiv Tandon  44 , Siegfried Kasper  45 , Marc De Hert  4
Affiliations
Multicenter Study

Staging of Schizophrenia With the Use of PANSS: An International Multi-Center Study

Konstantinos N Fountoulakis et al. Int J Neuropsychopharmacol. .

Abstract

Introduction: A specific clinically relevant staging model for schizophrenia has not yet been developed. The aim of the current study was to evaluate the factor structure of the PANSS and develop such a staging method.

Methods: Twenty-nine centers from 25 countries contributed 2358 patients aged 37.21 ± 11.87 years with schizophrenia. Analysis of covariance, Exploratory Factor Analysis, Discriminant Function Analysis, and inspection of resultant plots were performed.

Results: Exploratory Factor Analysis returned 5 factors explaining 59% of the variance (positive, negative, excitement/hostility, depression/anxiety, and neurocognition). The staging model included 4 main stages with substages that were predominantly characterized by a single domain of symptoms (stage 1: positive; stages 2a and 2b: excitement/hostility; stage 3a and 3b: depression/anxiety; stage 4a and 4b: neurocognition). There were no differences between sexes. The Discriminant Function Analysis developed an algorithm that correctly classified >85% of patients.

Discussion: This study elaborates a 5-factor solution and a clinical staging method for patients with schizophrenia. It is the largest study to address these issues among patients who are more likely to remain affiliated with mental health services for prolonged periods of time.

Keywords: illness course; outcome; schizophrenia; staging.

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Figures

Figure 1.
Figure 1.
The classic 5-factor model of Stanley Kay and colleagues.
Figure 2.
Figure 2.
Plot of factor scores (y-axis) vs duration of illness (x-axis) and identification of stages
See this image and copyright information in PMC

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