Modeling psychological function in patients with schizophrenia with the PANSS: an international multi-center study
Authors: Fountoulakis Konstantinos N. , Dragioti Elena , Theofilidis Antonis T. , Wiklund Tobias , Atmatzidis Xenofon , Nimatoudis Ioannis , Thys Erik , Wampers Martien , Hranov Luchezar , Hristova Trayana , Aptalidis Daniil , Milev Roumen , Iftene Felicia , Spaniel Filip , Knytl Pavel , Furstova Petra , From Tiina , Karlsson Henry , Walta Maija , Salokangas Raimo K.R. , Azorin Jean-Michel , Bouniard Justine , Montant Julie , Juckel Georg , Haussleiter Ida S. , Douzenis Athanasios , Michopoulos Ioannis , Ferentinos Panagiotis , Smyrnis Nikolaos , Mantonakis Leonidas , Nemes Zsófia , Gonda Xenia , Vajda Dora , Juhasz Anita , Shrivastava Amresh , Waddington John , Pompili Maurizio , Comparelli Anna , Corigliano Valentina , Rancans Elmars , Navickas Alvydas , Hilbig Jan , Bukelskis Laurynas , Stevovic Lidija I. , Vodopic Sanja , Esan Oluyomi , Oladele Oluremi , Osunbote Christopher , Rybakowski Janusz K. , Wojciak Pawel , Domowicz Klaudia , Figueira Maria L. , Linhares Ludgero , Crawford Joana , Panfil Anca-Livia , Smirnova Daria , Izmailova Olga , Lecic-Tosevski Dusica , Temmingh Henk , Howells Fleur , Bobes Julio , Garcia-Portilla Maria P. , García-Alvarez Leticia , Erzin Gamze , Karadağ Hasan , De Sousa Avinash , Bendre Anuja , Hoschl Cyril , Bredicean Cristina , Papava Ion , Vukovic Olivera , Pejuskovic Bojana , Russell Vincent , Athanasiadis Loukas , Konsta Anastasia , Stein Dan , Berk Michael , Dean Olivia , Tandon Rajiv , Kasper Siegfried , De Hert Marc 
Published: April 2020

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.