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Fountoulakis KN, Dragioti E, Theofilidis AT, Wikilund T, Atmatzidis X, Nimatoudis I, Thys E, Wampers M, Hranov L, Hristova T, Aptalidis D, Milev R, Iftene F, Spaniel F, Knytl P, Furstova P, From T, Karlsson H, Walta M, Salokangas RKR, Azorin JM, Bouniard J, Montant J, Juckel G, Haussleiter IS, Douzenis A, Michopoulos I, Ferentinos P, Smyrnis N, Mantonakis L, Nemes Z, Gonda X, Vajda D, Juhasz A, Shrivastava A, Waddington J, Pompili M, Comparelli A, Corigliano V, Rancans E, Navickas A, Hilbig J, Bukelskis L, Injac Stevovic L, Vodopic S, Esan O, Oladele O, Osunbote C, Rybakowski JΚ, Wojciak P, Domowicz K, Figueira ML, Linhares L, Crawford J, Panfil AL, Smirnova D, Izmailova O, Lecic-Tosevski D, Temmingh H, Howells F, Bobes J, Garcia-Portilla MP, García-Alvarez L, Erzin G, Karadağ H, De Sousa A, Bendre A, Hoschl C, Bredicean C, Papava I, Vukovic O, Pejuskovic B, Russell V, Athanasiadis L, Konsta A, Stein D, Berk M, Dean O, Tandon R, Kasper S, De Hert. M. Staging of Schizophrenia With the Use of PANSS: An International Multi-Center Study. Int J Neuropsychopharmacol 2019; 22:681-697. [PMID: 31563956 PMCID: PMC6872964 DOI: 10.1093/ijnp/pyz053] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 07/19/2019] [Accepted: 09/25/2019] [Indexed: 12/30/2022] Open
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.
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Affiliation(s)
- Konstantinos N Fountoulakis
- 3rd Department of Psychiatry, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki,Greece,Correspondence to: Konstantinos N. Fountoulakis, 6, Odysseos str (1 Parodos Ampelonon str.), 55535 Pylaia Thessaloniki, Greece ()
| | - Elena Dragioti
- Department of Medical and Health Sciences (IMH), Faculty of Health Sciences, Linköping University, Linköping, Sweden,Hallunda Psychiatric Outpatient Clinic, Stockholm Psychiatric Southwest Clinic, Karolinska Huddinge University Hospital,Sweden
| | - Antonis T Theofilidis
- 3rd Department of Psychiatry, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki,Greece
| | - Tobias Wikilund
- Department of Medical and Health Sciences (IMH), Faculty of Health Sciences, Linköping University, Linköping, Sweden,Hallunda Psychiatric Outpatient Clinic, Stockholm Psychiatric Southwest Clinic, Karolinska Huddinge University Hospital,Sweden
| | - Xenofon Atmatzidis
- Department of Medical and Health Sciences (IMH), Faculty of Health Sciences, Linköping University, Linköping, Sweden,Hallunda Psychiatric Outpatient Clinic, Stockholm Psychiatric Southwest Clinic, Karolinska Huddinge University Hospital,Sweden
| | - Ioannis Nimatoudis
- 3rd Department of Psychiatry, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki,Greece
| | - Erik Thys
- University Psychiatric Centre KU Leuven, Kortenberg and Department of Neurosciences KU, Leuven, Belgium
| | - Martien Wampers
- University Psychiatric Centre KU Leuven, Kortenberg and Department of Neurosciences KU, Leuven, Belgium
| | - Luchezar Hranov
- University Multiprofile Hospital for Active Treatment in Neurology and Psychiatry “Sveti Naum”, Sofia, Bulgaria
| | - Trayana Hristova
- University Multiprofile Hospital for Active Treatment in Neurology and Psychiatry “Sveti Naum”, Sofia, Bulgaria
| | - Daniil Aptalidis
- University Multiprofile Hospital for Active Treatment in Neurology and Psychiatry “Sveti Naum”, Sofia, Bulgaria
| | - Roumen Milev
- Department of Psychiatry, Queen’s University, Providence Care Hospital, Kingston, Ontario, Canada
| | - Felicia Iftene
- Department of Psychiatry, Queen’s University, Providence Care Hospital, Kingston, Ontario, Canada
| | - Filip Spaniel
- National Institute of Mental Health, Klecany, Czech Republic
| | - Pavel Knytl
- National Institute of Mental Health, Klecany, Czech Republic
| | - Petra Furstova
- National Institute of Mental Health, Klecany, Czech Republic
| | - Tiina From
- Department of Psychiatry, University of Turku, Turku, Finland
| | - Henry Karlsson
- Department of Psychiatry, University of Turku, Turku, Finland
| | - Maija Walta
- Department of Psychiatry, University of Turku, Turku, Finland
| | | | - Jean-Michel Azorin
- Department of Psychiatry, Sainte Marguerite University Hospital, Marseille, France,Timone Institute of Neuroscience, CNRS and Aix-Marseille University, Marseille, France
| | - Justine Bouniard
- Department of Psychiatry, Sainte Marguerite University Hospital, Marseille, France,Timone Institute of Neuroscience, CNRS and Aix-Marseille University, Marseille, France
| | - Julie Montant
- Department of Psychiatry, Sainte Marguerite University Hospital, Marseille, France,Timone Institute of Neuroscience, CNRS and Aix-Marseille University, Marseille, France
| | - Georg Juckel
- Department of Psychiatry, Ruhr University Bochum, LWL-University Hospital, Bochum, Germany
| | - Ida S Haussleiter
- Department of Psychiatry, Ruhr University Bochum, LWL-University Hospital, Bochum, Germany
| | - Athanasios Douzenis
- 2nd Department of Psychiatry, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Michopoulos
- 2nd Department of Psychiatry, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Ferentinos
- 2nd Department of Psychiatry, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Smyrnis
- Department of Psychiatry, National and Kapodistrian University of Athens School of Medicine, Eginition Hospital, Athens, Greece
| | - Leonidas Mantonakis
- Department of Psychiatry, National and Kapodistrian University of Athens School of Medicine, Eginition Hospital, Athens, Greece
| | | | - Xenia Gonda
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Dora Vajda
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Anita Juhasz
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | | | - John Waddington
- Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Anna Comparelli
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Valentina Corigliano
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Elmars Rancans
- Department of Psychiatry and Narcology, Riga Stradins University, Riga, Latvia
| | - Alvydas Navickas
- Clinic of Psychiatric, Faculty of Medicine, Vilnius University, Vilnius, Lithuania,Psychosocial Rehabilitation Department of the Vilnius Mental Health Center, Department for Psychosis Treatment of the Vilnius Mental Health Center, Vilnius, Lithuania
| | - Jan Hilbig
- Clinic of Psychiatric, Faculty of Medicine, Vilnius University, Vilnius, Lithuania,Psychosocial Rehabilitation Department of the Vilnius Mental Health Center, Department for Psychosis Treatment of the Vilnius Mental Health Center, Vilnius, Lithuania
| | - Laurynas Bukelskis
- Clinic of Psychiatric, Faculty of Medicine, Vilnius University, Vilnius, Lithuania,Psychosocial Rehabilitation Department of the Vilnius Mental Health Center, Department for Psychosis Treatment of the Vilnius Mental Health Center, Vilnius, Lithuania
| | - Lidija Injac Stevovic
- Clinical Department of Psychiatry, Clinical Centre of Montenegro, Podgorica, Montenegro,Department of Psychiatry, School of Medicine, University of Montenegro, Dzona Dzeksona bb, Podgorica, Montenegro,Clinical Department of Neurology, Clinical Centre of Montenegro, Dzona Dzeksona bb, Podgorica, Montenegro
| | - Sanja Vodopic
- Clinical Department of Psychiatry, Clinical Centre of Montenegro, Podgorica, Montenegro,Department of Psychiatry, School of Medicine, University of Montenegro, Dzona Dzeksona bb, Podgorica, Montenegro,Clinical Department of Neurology, Clinical Centre of Montenegro, Dzona Dzeksona bb, Podgorica, Montenegro
| | - Oluyomi Esan
- Department of Psychiatry, College of Medicine, University of Ibadan,Nigeria
| | - Oluremi Oladele
- Department of Psychiatry, College of Medicine, University of Ibadan,Nigeria
| | | | - Janusz Κ Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Pawel Wojciak
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Klaudia Domowicz
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Maria Luisa Figueira
- Department of Psychiatry and Mental Health, Santa Maria University Hospital, Lisbon, Portugal
| | - Ludgero Linhares
- Department of Psychiatry and Mental Health, Santa Maria University Hospital, Lisbon, Portugal
| | - Joana Crawford
- Department of Psychiatry and Mental Health, Santa Maria University Hospital, Lisbon, Portugal
| | | | - Daria Smirnova
- Samara State Medical University, Department of Psychiatry, Samara Psychiatric Hospital, Inpatient Unit, Russia
| | - Olga Izmailova
- Samara State Medical University, Department of Psychiatry, Samara Psychiatric Hospital, Inpatient Unit, Russia
| | - Dusica Lecic-Tosevski
- Institute of Mental Health, Belgrade, Serbia,Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | - Henk Temmingh
- Department of Psychiatry and Mental Health, University of Cape Town Cape Town, Western Cape, South Africa
| | - Fleur Howells
- Department of Psychiatry and Mental Health, University of Cape Town Cape Town, Western Cape, South Africa
| | - Julio Bobes
- Department of Psychiatry, University of Oviedo and Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Oviedo, Spain
| | - Maria Paz Garcia-Portilla
- Department of Psychiatry, University of Oviedo and Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Oviedo, Spain
| | - Leticia García-Alvarez
- Department of Psychiatry, University of Oviedo and Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Oviedo, Spain
| | - Gamze Erzin
- Psychiatry Department, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Hasan Karadağ
- Psychiatry Department, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Avinash De Sousa
- Department of Psychiatry Lokmanya Tilak Municipal Medical College Mumbai, India
| | - Anuja Bendre
- Department of Psychiatry Lokmanya Tilak Municipal Medical College Mumbai, India
| | - Cyril Hoschl
- National Institute of Mental Health, Klecany, Czech Republic
| | | | - Ion Papava
- University of Medicine and Pharmacy of Timisoara, Romania
| | - Olivera Vukovic
- Institute of Mental Health, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Bojana Pejuskovic
- Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Vincent Russell
- Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Loukas Athanasiadis
- 1st Department of Psychiatry, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Anastasia Konsta
- 1st Department of Psychiatry, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Dan Stein
- MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Michael Berk
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Australia,Orygen, The National Centre of Excellence in Youth Mental Health and the Centre for Youth Mental Health, the Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, University of Melbourne, Parkville, Australia
| | - Olivia Dean
- Deakin University, School of Medicine, IMPACT Strategic Research Centre, Barwon Health, Geelong, Australia
| | - Rajiv Tandon
- Department of Psychiatry, University of Florida, ***, FL
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Marc De Hert.
- University Psychiatric Centre KU Leuven, Kortenberg and Department of Neurosciences KU, Leuven, Belgium
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