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1. Modeling psychological function in patients with schizophrenia with the PANSS: An international multi-center study

Author

Fountoulakis, K.N. Dragioti, E. Theofilidis, A.T. Wiklund, 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, R.K.R. Azorin, J.-M. Bouniard, J. Montant, J. Juckel, G. Haussleiter, I.S. 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. Stevovic, L.I. Vodopic, S. Esan, O. Oladele, O. Osunbote, C. Rybakowski, J.K. Wojciak, P. Domowicz, K. Figueira, M.L. Linhares, L. Crawford, J. Panfil, A.-L. Smirnova, D. Izmailova, O. Lecic-Tosevski, D. Temmingh, H. Howells, F. Bobes, J. Garcia-Portilla, M.P. García-Alvarez, L. Erzin, G. Karadaǧ, 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.

Abstract

Background The aim of the current study was to explore the changing interrelationships among clinical variables through the stages of schizophrenia in order to assemble a comprehensive and meaningful disease model. Methods Twenty-nine centers from 25 countries participated and included 2358 patients aged 37.21 ±Â 11.87 years with schizophrenia. Multiple linear regression analysis and visual inspection of plots were performed. Results The results suggest that with progression stages, there are changing correlations among Positive and Negative Syndrome Scale factors at each stage and each factor correlates with all the others in that particular stage, in which this factor is dominant. This internal structure further supports the validity of an already proposed four stages model, with positive symptoms dominating the first stage, excitement/hostility the second, depression the third, and neurocognitive decline the last stage. Conclusions The current study investigated the mental organization and functioning in patients with schizophrenia in relation to different stages of illness progression. It revealed two distinct cores of schizophrenia, the Positive and the Negative, while neurocognitive decline escalates during the later stages. Future research should focus on the therapeutic implications of such a model. Stopping the progress of the illness could demand to stop the succession of stages. This could be achieved not only by both halting the triggering effect of positive and negative symptoms, but also by stopping the sensitization effect on the neural pathways responsible for the development of hostility, excitement, anxiety, and depression as well as the deleterious effect on neural networks responsible for neurocognition. © 2021 Cambridge University Press. All rights reserved.

Published
2021

2. Gender, age at onset, and duration of being ill as predictors for the long-term course and outcome of schizophrenia: an international multicenter study

Author

Fountoulakis, KN, Dragioti, E, Theofilidis, AT, Wiklund, 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, J-M, 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, Stevovic, LI, Vodopic, S, Esan, O, Oladele, O, Osunbote, C, Rybakowski, JK, Wojciak, P, Domowicz, K, Figueira, ML, Linhares, L, Crawford, J, Panfil, A-L, Smirnova, D, Izmailova, O, Lecic-Tosevski, D, Temmingh, H, Howells, F, Bobes, J, Garcia-Portilla, MP, Garcia-Alvarez, L, Erzin, G, Karadag, H, De Sousa, A, Bendre, A, Hoschl, C, Bredicean, C, Papava, I, Vukovic, O, Pejuskovic, B, Russell, V, Athanasiadis, L, Konsta, A, Fountoulakis, NK, Stein, D, Berk, M, Dean, O, Tandon, R, Kasper, S, De Hert, M, Fountoulakis, KN, Dragioti, E, Theofilidis, AT, Wiklund, 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, J-M, 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, Stevovic, LI, Vodopic, S, Esan, O, Oladele, O, Osunbote, C, Rybakowski, JK, Wojciak, P, Domowicz, K, Figueira, ML, Linhares, L, Crawford, J, Panfil, A-L, Smirnova, D, Izmailova, O, Lecic-Tosevski, D, Temmingh, H, Howells, F, Bobes, J, Garcia-Portilla, MP, Garcia-Alvarez, L, Erzin, G, Karadag, H, De Sousa, A, Bendre, A, Hoschl, C, Bredicean, C, Papava, I, Vukovic, O, Pejuskovic, B, Russell, V, Athanasiadis, L, Konsta, A, Fountoulakis, NK, Stein, D, Berk, M, Dean, O, Tandon, R, Kasper, S, and De Hert, M

Abstract

BACKGROUND: The aim of the current study was to explore the effect of gender, age at onset, and duration on the long-term course of schizophrenia. METHODS: Twenty-nine centers from 25 countries representing all continents participated in the study that included 2358 patients aged 37.21 ± 11.87 years with a DSM-IV or DSM-5 diagnosis of schizophrenia; the Positive and Negative Syndrome Scale as well as relevant clinicodemographic data were gathered. Analysis of variance and analysis of covariance were used, and the methodology corrected for the presence of potentially confounding effects. RESULTS: There was a 3-year later age at onset for females (P < .001) and lower rates of negative symptoms (P < .01) and higher depression/anxiety measures (P < .05) at some stages. The age at onset manifested a distribution with a single peak for both genders with a tendency of patients with younger onset having slower advancement through illness stages (P = .001). No significant effects were found concerning duration of illness. DISCUSSION: Our results confirmed a later onset and a possibly more benign course and outcome in females. Age at onset manifested a single peak in both genders, and surprisingly, earlier onset was related to a slower progression of the illness. No effect of duration has been detected. These results are partially in accord with the literature, but they also differ as a consequence of the different starting point of our methodology (a novel staging model), which in our opinion precluded the impact of confounding effects. Future research should focus on the therapeutic policy and implications of these results in more representative samples.

Published
2021

3. Modeling psychological function in patients with schizophrenia with the PANSS : An international multi-center study

Author

Fountoulakis, K.N., Dragioti, Elena, Theofilidis, A.T., Wiklund, Tobias, Atmatzidis, Xenofon, 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, R.K.R., Azorin, J.-M., Bouniard, J., Montant, J., Juckel, G., Haussleiter, I.S., 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., Stevovic, L.I., Vodopic, S., Esan, O., Oladele, O., Osunbote, C., Rybakowski, J.K., Wojciak, P., Domowicz, K., Figueira, M.L., Linhares, L., Crawford, J., Panfil, A.-L., Smirnova, D., Izmailova, O., Lecic-Tosevski, D., Temmingh, H., Howells, F., Bobes, J., Garcia-Portilla, M.P., Garciá-Alvarez, L., Erzin, G., Karada, 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., Fountoulakis, K.N., Dragioti, Elena, Theofilidis, A.T., Wiklund, Tobias, Atmatzidis, Xenofon, 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, R.K.R., Azorin, J.-M., Bouniard, J., Montant, J., Juckel, G., Haussleiter, I.S., 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., Stevovic, L.I., Vodopic, S., Esan, O., Oladele, O., Osunbote, C., Rybakowski, J.K., Wojciak, P., Domowicz, K., Figueira, M.L., Linhares, L., Crawford, J., Panfil, A.-L., Smirnova, D., Izmailova, O., Lecic-Tosevski, D., Temmingh, H., Howells, F., Bobes, J., Garcia-Portilla, M.P., Garciá-Alvarez, L., Erzin, G., Karada, 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., and De, Hert M.

Abstract

Background. The aim of the current study was to explore the changing interrelationships among clinical variables through the stages of schizophrenia in order to assemble a comprehensive and meaningful disease model. Methods. Twenty-nine centers from 25 countries participated and included 2358 patients aged 37.21 ± 11.87 years with schizophrenia. Multiple linear regression analysis and visual inspection of plots were performed. Results. The results suggest that with progression stages, there are changing correlations among Positive and Negative Syndrome Scale factors at each stage and each factor correlates with all the others in that particular stage, in which this factor is dominant. This internal structure further supports the validity of an already proposed four stages model, with positive symptoms dominating the first stage, excitement/hostility the second, depression the third, and neurocognitive decline the last stage. Conclusions. The current study investigated the mental organization and functioning in patients with schizophrenia in relation to different stages of illness progression. It revealed two distinct “cores” of schizophrenia, the “Positive” and the “Negative,” while neurocognitive decline escalates during the later stages. Future research should focus on the therapeutic implications of such a model. Stopping the progress of the illness could demand to stop the succession of stages. This could be achieved not only by both halting the triggering effect of positive and negative symptoms, but also by stopping the sensitization effect on the neural pathways responsible for the development of hostility, excitement, anxiety, and depression as well as the deleterious effect on neural networks responsible for neurocognition.

Published
2021
Full Text
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4. Staging of Schizophrenia With the Use of PANSS: An International Multi-Center Study

Author

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, J-M, 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, Stevovic, LI, Vodopic, S, Esan, O, Oladele, O, Osunbote, C, Rybakowski, JK, Wojciak, P, Domowicz, K, Figueira, ML, Linhares, L, Crawford, J, Panfil, A-L, Smirnova, D, Izmailova, O, Lecic-Tosevski, D, Temmingh, H, Howells, F, Bobes, J, Garcia-Portilla, MP, Garcia-Alvarez, L, Erzin, G, Karadag, 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, 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, J-M, 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, Stevovic, LI, Vodopic, S, Esan, O, Oladele, O, Osunbote, C, Rybakowski, JK, Wojciak, P, Domowicz, K, Figueira, ML, Linhares, L, Crawford, J, Panfil, A-L, Smirnova, D, Izmailova, O, Lecic-Tosevski, D, Temmingh, H, Howells, F, Bobes, J, Garcia-Portilla, MP, Garcia-Alvarez, L, Erzin, G, Karadag, 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, and De Hert, M

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.

Published
2019

5. Gender, age at onset, and duration of being ill as predictors for the long-term course and outcome of schizophrenia: an international multicenter study.

Author

Fountoulakis KN, Dragioti E, Theofilidis AT, Wiklund 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, Stevovic LI, Vodopic S, Esan O, Oladele O, Osunbote C, Rybakowski JK, 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, Fountoulakis NK, Stein D, Berk M, Dean O, Tandon R, Kasper S, and De Hert M

Subjects
Humans, Female, Male, Age of Onset, Diagnostic and Statistical Manual of Mental Disorders, Schizophrenia diagnosis, Schizophrenia epidemiology
Abstract

Background: The aim of the current study was to explore the effect of gender, age at onset, and duration on the long-term course of schizophrenia., Methods: Twenty-nine centers from 25 countries representing all continents participated in the study that included 2358 patients aged 37.21 ± 11.87 years with a DSM-IV or DSM-5 diagnosis of schizophrenia; the Positive and Negative Syndrome Scale as well as relevant clinicodemographic data were gathered. Analysis of variance and analysis of covariance were used, and the methodology corrected for the presence of potentially confounding effects., Results: There was a 3-year later age at onset for females ( P  < .001) and lower rates of negative symptoms ( P  < .01) and higher depression/anxiety measures ( P  < .05) at some stages. The age at onset manifested a distribution with a single peak for both genders with a tendency of patients with younger onset having slower advancement through illness stages ( P  = .001). No significant effects were found concerning duration of illness., Discussion: Our results confirmed a later onset and a possibly more benign course and outcome in females. Age at onset manifested a single peak in both genders, and surprisingly, earlier onset was related to a slower progression of the illness. No effect of duration has been detected. These results are partially in accord with the literature, but they also differ as a consequence of the different starting point of our methodology (a novel staging model), which in our opinion precluded the impact of confounding effects. Future research should focus on the therapeutic policy and implications of these results in more representative samples.

Published
2022
Full Text
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6. Modeling psychological function in patients with schizophrenia with the PANSS: an international multi-center study.

Author

Fountoulakis KN, Dragioti E, Theofilidis AT, Wiklund 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, Stevovic LI, Vodopic S, Esan O, Oladele O, Osunbote C, Rybakowski JK, 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, and De Hert M

Subjects
Adolescent, Adult, Aged, Aged, 80 and over, Disease Progression, Female, Humans, Male, Middle Aged, Schizophrenia diagnosis, Schizophrenic Psychology
Abstract

Background: The aim of the current study was to explore the changing interrelationships among clinical variables through the stages of schizophrenia in order to assemble a comprehensive and meaningful disease model., Methods: Twenty-nine centers from 25 countries participated and included 2358 patients aged 37.21 ± 11.87 years with schizophrenia. Multiple linear regression analysis and visual inspection of plots were performed., Results: The results suggest that with progression stages, there are changing correlations among Positive and Negative Syndrome Scale factors at each stage and each factor correlates with all the others in that particular stage, in which this factor is dominant. This internal structure further supports the validity of an already proposed four stages model, with positive symptoms dominating the first stage, excitement/hostility the second, depression the third, and neurocognitive decline the last stage., Conclusions: The current study investigated the mental organization and functioning in patients with schizophrenia in relation to different stages of illness progression. It revealed two distinct "cores" of schizophrenia, the "Positive" and the "Negative," while neurocognitive decline escalates during the later stages. Future research should focus on the therapeutic implications of such a model. Stopping the progress of the illness could demand to stop the succession of stages. This could be achieved not only by both halting the triggering effect of positive and negative symptoms, but also by stopping the sensitization effect on the neural pathways responsible for the development of hostility, excitement, anxiety, and depression as well as the deleterious effect on neural networks responsible for neurocognition.

Published
2021
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7. Prevalence and clinical picture of premenstrual syndrome in females from Bulgaria.

Author

Chumpalova P, Iakimova R, Stoimenova-Popova M, Aptalidis D, Pandova M, Stoyanova M, and Fountoulakis KN

Abstract

Background: Premenstrual syndrome (PMS) and its more severe form premenstrual dysphoric disorder (PMDD) are highly prevalent conditions, but there seems to be ethnic and cultural variances in their distribution., Aims: To explore the prevalence of PMS/PMDD and their typical clinical features in a Bulgarian population., Materials and Methods: This investigation was designed and executed as a cross-sectional descriptive study. Three hundred and five conveniently recruited females with no psychiatric history filled in a self-evaluation questionnaire based on DSM-IV tapping on different symptoms of PMS. The prevalence of the conditions was calculated., Results: 32.1% ( N  = 98) of the tested females (mean age 31.04 ± 6.31) suffered from PMS and 3.3% ( N  = 10) were diagnosed with PMDD. The leading symptoms in the sample were irritability, fatigue and changes in appetite, depressed mood, mood swings, and anxiety, and abdominal bloating, breast tension and tenderness. Most of the symptoms were moderately severe. Mild and moderate cases of PMS were near equally distributed and more frequent than severe ones., Conclusion: PMS is a common condition which is usually mildly expressed, but severe cases are not an exception. The clinical picture is dominated by almost equally distributed psychological and somatic symptoms., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s) 2020.)

Published
2020
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8. Staging of Schizophrenia With the Use of PANSS: An International Multi-Center Study.

Author

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, and De Hert M

Subjects
Adult, Europe, Factor Analysis, Statistical, Female, Humans, Male, Middle Aged, Nigeria, Schizophrenia classification, Schizophrenia physiopathology, Sotos Syndrome, Young Adult, Disease Progression, Psychiatric Status Rating Scales statistics & numerical data, Schizophrenia diagnosis
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., (© The Author(s) 2019. Published by Oxford University Press on behalf of CINP.)

Published
2019
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