Dataset Information

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

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.

SUBMITTER: Fountoulakis KN

PROVIDER: S-EPMC6872964 | biostudies-literature | 2019 Nov

REPOSITORIES: biostudies-literature

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Publications

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

Fountoulakis Konstantinos N KN Dragioti Elena E Theofilidis Antonis T AT Wikilund Tobias T Atmatzidis Xenofon X Nimatoudis Ioannis I Thys Erik E Wampers Martien M Hranov Luchezar L Hristova Trayana T Aptalidis Daniil D Milev Roumen R Iftene Felicia F Spaniel Filip F Knytl Pavel P Furstova Petra P From Tiina T Karlsson Henry H Walta Maija M Salokangas Raimo K R RKR Azorin Jean-Michel JM Bouniard Justine J Montant Julie J Juckel Georg G Haussleiter Ida S IS Douzenis Athanasios A Michopoulos Ioannis I Ferentinos Panagiotis P Smyrnis Nikolaos N Mantonakis Leonidas L Nemes Zsófia Z Gonda Xenia X Vajda Dora D Juhasz Anita A Shrivastava Amresh A Waddington John J Pompili Maurizio M Comparelli Anna A Corigliano Valentina V Rancans Elmars E Navickas Alvydas A Hilbig Jan J Bukelskis Laurynas L Injac Stevovic Lidija L Vodopic Sanja S Esan Oluyomi O Oladele Oluremi O Osunbote Christopher C Rybakowski Janusz Κ JΚ Wojciak Pawel P Domowicz Klaudia K Figueira Maria Luisa ML Linhares Ludgero L Crawford Joana J Panfil Anca-Livia AL Smirnova Daria D Izmailova Olga O Lecic-Tosevski Dusica D Temmingh Henk H Howells Fleur F Bobes Julio J Garcia-Portilla Maria Paz MP García-Alvarez Leticia L Erzin Gamze G Karadağ Hasan H De Sousa Avinash A Bendre Anuja A Hoschl Cyril C Bredicean Cristina C Papava Ion I Vukovic Olivera O Pejuskovic Bojana B Russell Vincent V Athanasiadis Loukas L Konsta Anastasia A Stein Dan D Berk Michael M Dean Olivia O Tandon Rajiv R Kasper Siegfried S De Hert Marc M

The international journal of neuropsychopharmacology 20191101 11

<h4>Introduction</h4>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.<h4>Methods</h4>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.<h4>Results</h4> ...[more]

PMID: 31563956

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Project description:Abstract Background About 40% of patients with Treatment-Resistant Schizophrenia (TRS) do not respond to an adequate trial with clozapine and are termed Clozapine- Resistant Schizophrenia (CRS). A metanalysis showed that clozapine augmentation with ECT is efficacious for CRS, but no studies with Sham-ECT were reported (1). We published a pilot single-blinded study trial, which, to our knowledge, is the first to evaluate the efficacy of electroconvulsive therapy (ECT) in comparison with Sham–ECT in CRS (2) (NCT02049021) (PS). In this PS, patients with CRS received ECT (n=12) or SHAM-ECT (n=7) and after 12 sessions, but no differences were found between both groups as measured by the total PANSS and subscales at the endpoint. Factors, obtained by factor analytic studies (3), as well as individual items of shorter versions of the PANSS (4), are considered more valid predictors of TRS than subscales. The aim of the present study is a reanalysis of our PS based either PANSS factors obtained through factors analysis as well as on the individual items of the PANSS-30 and the PANSS-6. Methods We used individual participant data (IPD) at the symptom level, based on a statistical approach of a study already published (5). We used PANSS-30 items, traditional subscales, as well as factor scores (Positive, Negative and Cognitive) derived from our factor analysis of patients with TRS (4). Additionally, we analyzed also all the PANSS-6 items and the sum of scores (hallucinatory behavior –P3 and lack of spontaneity and flow of conversation- N6) which identify severe cases. STATA, Comprehensive Metanalysis, and R were used for calculations of effect sizes (fixed effects) and power Results We obtained significant differences between groups with high effect sizes (>0.8) for three symptoms at endpoint: P3 (-0.993, 95% CI= -1.977 to -0.009, p= 0.048), N6 (-1.036, 95% CI= -2.025 to -0.047 p= 0.040), and Disorientation (G10) (-1.445, 95%CI=-2.48—0.40, p=0.006). The between-groups effect-sizes of other symptoms or factors showed no statistically significant differences Discussion The present reanalysis showed that patients with CRS do benefit from ECT treatment, with an improvement of their Hallucinatory Behavior or Lack of Spontaneity and Flow of Conversation, but suffer from some cognitive impairments (Disorientation). These findings are limited due to the small sample. We are conducting a trial with a much larger sample size to test the efficacy and tolerability of ECT vs Sham in CRS.

Project description:Abstract Background: Lurasidone is an atypical antipsychotic agent that has demonstrated efficacy in the treatment of adults with schizophrenia in the dose range of 40–160 mg/d. The objective of this randomized, double-blind, placebo-controlled study was to evaluate the acute efficacy and safety of lurasidone in adolescent patients with schizophrenia. Methods: Adolescents (13–17 years old) diagnosed with schizophrenia were randomly assigned to 6 weeks of double-blind treatment with fixed-dose lurasidone 40 mg/d, 80 mg/d, or placebo. Changes from baseline to Week 6 in PANSS total and subscale (positive, negative, general psychopathology, excitability) scores were evaluated using mixed-model, repeated-measures analysis. Treatment response was defined as ≥20% reduction from baseline in PANSS total score at Week 6 and was analyzed using a logistic regression model with last observation carried forward (LOCF) approach. Results: A total of 326 patients (mean age, 15.4 years) were randomized and received lurasidone 40 mg/d (N = 108), 80 mg/d (N = 106), or placebo (N = 112). The PANSS total score at Week 6 demonstrated a placebo-adjusted, least-squares (LS) mean improvement of −8.0 (P < .001; effect size [ES] = 0.51) for the 40 mg/d group and −7.7 (P < .001; ES = 0.48) for the 80 mg/d group. Placebo-adjusted LS mean change for lurasidone 40 mg/d and 80 mg/d, respectively, was −3.2 (P < .001; ES = 0.62) and −3.2 (P < .001; ES = 0.60) on the PANSS positive subscale, −1.7 (P = .011; ES = 0.41) and −1.6 (P = .022; ES = 0.35) on the PANSS negative subscale, −2.8 (P = .012; ES = 0.38) and −2.8 (P = 0.011; ES = 0.37) on the PANSS general psychopathology subscale, and −1.1 (P = .016; ES = 0.36) and −1.8 (P < .001; ES = 0.53) on the PANSS excitability subscale. The proportion of treatment responders at Week 6 (LOCF) was 42.0% in the placebo group, 63.9% in the lurasidone 40 mg/d group (P < .001; NNT = 5), and 65.1% in the lurasidone 80 mg/d group (P < .001; NNT = 5). The most common adverse events (incidence ≥5% in either lurasidone group and at least twice the rate of placebo) for lurasidone 40 mg/d, 80 mg/d, and placebo, respectively, were nausea (12.7%, 14.4%, and 2.7%), somnolence (9.1%, 11.5%, and 5.4%), akathisia (9.1%, 8.7%, and 1.8%), vomiting (8.2%, 6.7%, and 1.8%), and sedation (5.5%, 1.9%, and 1.8%). The rate of study discontinuation due to adverse events was higher in placebo-treated versus lurasidone-treated patients (8.0% vs. 3.7%, respectively). Conclusion: In this double-blind, placebo-controlled study of adolescent patients with schizophrenia, lurasidone (40 mg/d and 80 mg/d) demonstrated statistically significant efficacy and clinically meaningful improvement across a range of symptoms associated with this disorder. Lurasidone treatment was generally safe and well tolerated in this study. Sponsored by Sunovion Pharmaceuticals Inc. ClinicalTrials.gov identifier: NCT01911429

Dataset Information

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

Introduction

Methods

Results

Discussion

Publications

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

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