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. Author manuscript; available in PMC: 2018 Feb 8.
Published in final edited form as: J Addict Res Ther. 2017 May 11;8(3):324. doi: 10.4172/2155-6105.1000324

Table 1.

Schizophrenia rating scales.

Instrument (Author, Year) Administration Time Type of measure Number of Items Strengths Weakness General Utility
Positive and Negative Syndrome Scale. (PANSS; Kay et al., 1987) [31]. 45-50 mins Option of both PANSS: clinician-completed, SCI-PANSS: interview IQ-PANSS: observer-completed Total of 30 items. (7) Constitute a Positive Scale, (7) negative scale and (16) general psychopathology scale. The fact that it is sensitive to change makes it a “gold standard” in treatment studies. Psycho-pharmacological research supports the PANSS' construct, discriminative, convergent, and predictive validity, as well as its drug sensitivity, when used longitudinally. The PANSS is not designed to rate negative symptoms exclusively, rather, it is a comprehensive scale for the assessment of psychopathology (Kay et al., 1987) [31]. Outdated, lengthy. PANSS and SANS have been criticized (Blanchard et al 2011) because they include items that measure cognitive functioning (attention bias or abstract thinking), which have been now recognized as a distinct category from negative symptoms (Harvey et al 2006). Most commonly used ratings scale. Widely used to assess response to antipsychotic therapy. Commonly used in both academic and pharmaceutical industry trials.
Scale for Assessment of Positive Symptoms. SAPS- (Andreasen, 1984) [32]. 30 Min Clinician rated. Total of 34 items, measures hallucinations, delusions, bizarre behavior and thought disorder. Recognizes positive symptoms. Has good validity and inter-rater reliability for positive symptoms (Andreasen et al., 1984) [32]. Cannot be used alone. Used in conjunction with SANS. Screening scale for assessment of positive symptoms. Scale for rating the severity of positive symptoms (Andreasen, 1984) 33*.
The Scale for Assessment of Negative Symptoms (SANS), (Andreasen, 1983) [33]. Cannot be measured It varies. Clinician rated. The SANS as originally published had 25 items. Currently, SANS consists of 19 items representing 5 scales:

  1. Affective Flattening or Blunting

  2. Alogia

  3. Avoliton-Apathy

  4. Anhedonia-Asociality

  5. Inattention.

(Andreasen, 1983) [34]		 Separates negative symptoms from positive symptoms and depression. Cannot be used alone; need SAPS. Most commonly used ratings scale. SANS helps the clinician track treatment progress. It is widely used in both academic and pharmaceutical industry trials.
Clinical Assessment Interview for Negative Symptoms (CAINS). CAINS-2010 was Developed by CANSAS Group. CAINS and BNSS were developed following a National Institute of Mental Health consensus meeting and addressed some of the shortcomings of earlier instruments. (Kring 2010) [35]. This represents an important and novel addition. CANSAS: (Collaboration to Advance Negative Symptom Assessment in Schizophrenia) Cannot be measured. It varies. Clinician rated. It is comprised of two scales that are scored separately. Motivational and pleasure scale (Nine- items) and Expression Scale (four-items)

  1. 1) Facialexpression

  2. 2) Vocalexpression

  3. 3) Expressivegestures

  4. 4) Quality ofspeech.

 Total of 13 items that assess the presence and severity of negative symptoms. It provides standardized interview probes and descriptive anchor points. All Items are scored on a five-point scale from 0 (no impairment) to 4 (severe deficit) Items in the CAINS construct cover approach motivation, pleasure, social engagement, affective expression, behavioral engagement, and comprehensive assessment of negative symptoms. CAINS is a brief yet comprehensive scale and employable across a broad range of clinical and research contexts. It is a welldeveloped and evaluated scale for measuring negative symptoms. It demonstrates good internal consistency, test-retest stability, and interrater reliability/ agreement. It also demonstrated greater convergent validity than the BPRS and SANS for negative symptoms (Kring, 2010) [35]. CAINS scales are not strongly related to depression, agitation or positive symptoms (Kring, 2010) 35*. CAINS represents a state of the art approach to negative symptoms. Developed for treatment trials, but can be used in other types of negative symptoms. The Clinical Assessment Interview for Negative Symptoms (CAINS) is yielding promising results in the clinical and research setting.
Brief Negative Symptom Scale (BNSS) (Kirkpatrick, 2011) [36]. 15 minutes Clinician rated. Measures negative symptoms in a multicenter clinical trial. In addition to distress, it addresses the same above five negative symptoms domain included in CAINS. (Kirkpatrick, 2011) [36]. 13 items organized into 6 subscales.

  1. Blunted affect

  2. Alogia

  3. Asociality

  4. Anhedonia

  5. Distress

 Its design enables researchers to consider many aspects of negative symptoms. The BNSS scores are highly correlated with SANS and PANSS negative symptoms scores. It has strong interrater, test-retest and internal consistency. (Kirkpatrick, 2011) [36]. Need to know if BNNS is sensitive to change (Its unknown if it could be used in clinical trials) BNSS was developed as a concise instrument suitable for a multicenter clinical trial. (Kirkpatrick, 2011) 36*. Both the BNSS and CAINS represent state of the art approaches to negative symptoms and are yielding promising results in the clinical and research settings. (Kirkpatrick, 2011) 36*
Negative Symptoms Assessment-4 NSA -4 (Alphs, 2010) 40* Rapid testing Includes 4 questions. Clinician rated Requires brief training (Alphs, 2010) [40]. Four items from NSA-16.

  1. Restricted speech quality

  2. Reduced range of motion

  3. Reduced social drive

  4. Reduced intent

 Offers accuracy comparable to the NSA-16 in rating negative symptoms in patients with schizophrenia, Good predictive validity and construct validity, Internal consistency and test--retest reliability, High correlation with other measures of negative symptoms, demonstrating convergent validity. (Alphs, 2011) [41]. Lesser correlations with measures of other forms of psychopathology. (Alphs, 2010) [40]. NSA-4 as a practical clinical tool for assessing the severity of negative symptoms in patients with schizophrenia and tracking their course over time. (Alphs, 2010) 40*
Clinical Global Impression-Schizophrenia (CGI-SCH) Adapted from the Clinical Global Impression (CGI) scale (Guy W, ed.) [42]. CGI-Bipolar Patients (CGI-BP) scale (Spearing MK) [43]. The scale was developed as a European International Project 30 Minutes Clinician rated Two categories:

  1. Severity of illness

  2. Degree of change,

Each category contains five different ratings

  1. Positive

  2. Negative

  3. Depressive

  4. Cognitive

  5. Global evaluated using a seven-point ordinal scale.

 Simple, concise, and quick to administer. Higher reliability than that of the Positive and Negative Symptoms Scale PANSS; (Kay, Fizzbein, & Opler,1987) [45] and General Assessment of Functioning GAF; (Jones et al., 1995) Strong Validity and good psychometric properties, Interrater Reliability, correlation coefficient, sensitivity similar to PANSS (Haro JM, 2003) [44]. The CGI-SCH global score assesses global severity of the disorder, including both symptoms and interference with functioning. (Haro JM, 2003) [44]. Lacks good interrater reliability, sensitivity to change, and has a low correlation coefficient in depression rating. (Haro JM, 2003) [44]. The CGI-SCH scale is a valid reliable instrument for evaluating severity and treatment response in schizophrenia. Its simplicity and quick administration time make it appropriate for use in routine clinical practice and in observational studies. (Haro JM, 2003) 44*.