Replicating and Extending the Reliability, Criterion Validity, and Treatment Sensitivity of the PANSS10 and PANSS20 for Pediatric Trials

Document Type

Journal Article

Publication Date

6-1-2025

Journal

JAACAP open

Volume

3

Issue

2

DOI

10.1016/j.jaacop.2024.02.010

Keywords

children and adolescents; psychopharmacology clinical trials; psychosis; rating scale; short form

Abstract

OBJECTIVE: Pediatric studies of schizophrenia have relied on the 30-item Positive and Negative Syndrome Scale (PANSS30) as a primary outcome measure. There have been many efforts to create shorter versions of it to reduce costs and burden. The present aim is to conduct a confirmatory investigation of the reliability and validity of 10- and 20-item abbreviated versions developed in a United States-based National Institute of Mental Health (NIMH) pediatric sample that reflects the 5-factor structure underlying the PANSS, adding more detailed examination of patient-level score reproducibility and extending the examination to a large, placebo-controlled, international pediatric trial. METHOD: We applied the same psychometric and treatment sensitivity analyses as in Findling et al. (2023) to an adolescent schizophrenia paliperidone randomized placebo-controlled trial (RCT), accessed via the Yale Open Data Access (YODA) secure data environment (described in Singh et al., 2011). Analyses included confirmatory factor analyses, graded response models, ω reliability coefficients, tests of convergent criterion validity, sensitivity to change, and Bland-Altman plots to evaluate score reproducibility. RESULTS: Using the paliperidone RCT dataset, with N = 201 participants between the ages of 12 and 17 years (mean age = 15.40, SD = 1.53 years; 59% male), the PANSS 10- or 20-item vs 30-item versions had similar average interitem correlations (0.11-0.15); ω reliabilities of 0.78 to 0.89 with reliability >0.80 across patient presentations from mild residual symptoms to severe pathology; correlations of 0.92 and 0.98 with the 30-item total; partial eta-squared (η) values for time, treatment, and time by treatment; and also correlations with Clinical Global Impression (CGI) severity and Children's Global Assessment Scale (CGAS) ratings. Per-item scores differed by 0.04 points on average on the PANSS10 and by 0.01 points for the PANSS20 vs the PANSS30, all not significant. CONCLUSION: Results replicated reliability and validity findings for the PANSS10 and PANSS20 short forms in an international pediatric randomized placebo-controlled trial. Findings extend prior work by being the first to apply modern reliability models (ω) for multi-factor composites, also using Bland-Altman methods to evaluate patient-level score reproducibility. Scores based on the PANSS10 or PANSS20 reproduce traditional scores with high fidelity and low bias, offering substantial savings in terms of time, cost, and burden, especially when used for tracking progress or outcomes. CLINICAL GUIDANCE: • Consider using the 10-item or 20-item PANSS for regular monitoring and assessment of pediatric schizophrenia patients. These shorter versions maintain high reliability and can streamline the evaluation process, making it more efficient.• Patient and family engagement: Use the abbreviated PANSS versions to engage more effectively with patients and their families. The reduced length of the assessment can alleviate the stress and fatigue associated with longer evaluations, potentially improving patient cooperation and the quality of the data collected.

Department

Psychiatry and Behavioral Sciences

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