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PSY71 - PANSS - JUL-BB-EBB‘I I33:26 PM Positive Scale(P i...

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Unformatted text preview: JUL-BB-EBB‘I- I33 :26 PM Positive Scale (P) i . Patient Initials: Patient Number Study Number: __ Positive and Negative Symptom Scale Worksheet r PANSS Rating Criteria APPROVED Date Rated: Time Ratcdru—m MAY 2 8 2004 Eater’s Initials:‘_ a_. PARTNERS HUMAN RESEARCH COMM Delusions - nation which are unfounded.'unrealistic and idiosyncratic. Mm: ' Thought content expressed in the interview and its influence on social relations and behavior. 1 Absent - Definition does not apply ' 2 Minimal — Questionable pathology: may be at the upper extreme of normal limits 3 Mild - Presence-of one or two-delusions which are vague, uncrystallized, and not tenaciously held. Delusions do not interfere with thinking, social relations or behavior ‘ 4 Moderate-— Presence of either a kaleidoscopic array of poorly formed, unstable delusions or of a ‘ few wellnt'onned delusions that occasionally interfere with thinking, social relations or behavior. 5 Moderate Severe— Presence of hummus well formed delusions that are tenaciously held and occasionally interfere with thinking, Social relations or'behavior . 6 Severe - Presence of a stable set of delusions which are crystallized, possibly systematiZed, tenaciously held and clearly interfere with thinking, social relations or behavior; 7 Extreme — Presence of a stable set of‘delusions which are either highly systematized or very numerous, and which dominate major facets of the patients life. This frequently results in inappropriate and irresponsible action. which may even jeopardize the safety of the patient or othm ' ConcePtual Disorgaulnatlon Disorganized process of thinking characterized by disruption of goal directed sequencing, e.g., ciretunstantiality, tangentiaiity, loose associations, non sequinns, gross illogicality, or thought block. 3W: Cognitive verbal processes observed timing the course ofthe interview. 1 2 3 4 Absent — Definition does not apply. . . Minimal - Questionable pathology; may be at the upper extreme of normal limits. Mild - 'Ihinlring is circumstantial, tangential or paralogical. There is some difficulty inddirecting thoughts toward a goal. and some loosening ofassociations may be evidenced under pressure. Moderate - Able to focus thoughts when communication are brief and structured, but becomes loose or irrelevant when dealing with more complex communications or when under minimal pressure. - Moderate Severe —- Generally has difficulty in organizing thought, as evidenced by frequent irrelevaneies, disconnectedness or loosening of associations even when not under pressure. JUL—BE—EBBd- I33 :26 PM Study Number: Patient Initials: Patient Number: m Positive and Negative Symptom Scale . PANSS Rating Criteria Positive $cale (P) 3. Hallucinatory Behavior .. Verbal report or behavior indicating perceptions, which are not generated by external stimuli. These may occur in the auditory, visual, olfactOry, or somatic realms. l ' : Verbal report and physical manifestations during the course of interview as well as reports of behavior by primary care workers or family. 1 2 3 . d Absent - Definition does not apply. Minimal - Questionable pathology; may be at the upper extreme of normal limits. Mild — One or two clearly formed but infrequent hallucinations, or else a number of Vague abnormal perceptions, which do not result in distortions. of thinking or behavior. Moderate —— Hallucinations occur fiequently but‘not continuously, and the patient's thinking and behavior are affected only to a minor extent Moderate severe - Hallucinations occur fiequent, may involve more than one sensory modality, and tend to distort thinking andfor disrupt behavior. Patient may have delusional interpretation of these experiences and respond to them emotionally and, on occasion; verbally as cell. Severe — Hallucinations'are present almost continuously causing ‘majOr disruption of thinking and behavior. Patient heats these as real perceptions, and functioning is impeded by frequent emotional and verbal responses to them. - ‘ Extreme — Patient is almost totally preoccupied with hallucination, which virtually dominate thinking and behavior. Hallucinations are provided a rigid delusional interpretation and provoke verbal and behavioral responses, including obedience to command hallucinations. . Excitement -— Hyperactivity as reflected in accelerated motor behavior, heightened responsively to stimuli, hyper vigilance, or excessive mood labilltjf. .32 13mm Behavioral manifestations during the course of interview as well as reports of behavior by primary care workers or family. 1 Absent .. Definition does not apply. ‘ ' - 2 Minimal .. Questionable pathology: may he at the upper extreme of normal limits. 3 Mild — Tends to be slightly agitated, hyper vigilant, or mildly over aroused throughout the interview, but without distinct episodes of excitement or marked mood lability. Speech may be slightly pressured. 4 Moderate — Agitation or over arousal is clearly evident throughout the interview, affecting speech and general mobility, or episodic outbursts occur sporadically. , 5 Moderate Severe - Significant hyper activity or frequent outbursts of motor activity or observed, making it difficult for the patient to sit still for longer than several minutes at any given time. 6 Severe - Marked exciton-rent dominates the interview, delimits attendee, and to some extent affirms personal limctions suchaseatingandslecping. . . , c . - ,. . 7 Extreme - Marlcod excitement seriously interferes in eating and sleeping and makes interpersonal interactions virtually inmossible. Acceleration of speech and motor activity may result in incoherence and exhaustion. ‘ ' JUL—BB—EBBd- 33:27 PM P.93 Patient initials: Patient Number; m—_ smdy Number: Positive and Negative Symptom Scale ‘ PANSS Rating Criteria Positive Scale (P) 5. Grandloslty Exaggerated self~opinion and unrealistic convictions of superiority, including delusiOns of extraordinary abilities, wealth, knowledge, fame, pcwar, and moral righteousness. flags tor rating: Thought content expressed in the interview and its influence on behavior. 1 Absent — Definition does not apply ‘ 1 Minimal - Questionable pathology; may be at the upper extreme of normal limits. 3 Mild .. Some expansiveness or boastfulness is evident, but withoat clear-cut grandiose delusions. ‘ ' 4 Moderate — Feels distinctly and unrealistically superior to others. Some poorly formed delusions about special atoms or abilities may be present but are not acted upon. -* 5 Moderate Severe w Clear-out delusions concerning remarkable abilities, status, or power are . . expressed and influence attiurde but not behavior. - i‘ 6 Severe - Clear out delusions of remarkable superiority involving more than one parameter (wealth, knowledge, fame, etc.) are expressed, notably influence interactions, and may be acted upon. 7 Extreme ~— Thinking, interactions, and behavior are dominated by multiple delusions of amazing ability, wealth, ltnowledge, fame, power, and/or moral stature, which may take on a bizarre quality. 6. Suspicion:mess/Persecution Uruealistic or exaggerated ideas of persecution as reflected in guardedness, a distrustful attitude, suspicious hyper vigilance, or frank delusions that others mean one harm. Basis for rating; Thought content expressed in the interview and its influence on behavior. 1 Absent — Definition does not apply. ' . 2 Minimal — Questionable pathology; may be at the upper extreme of normal limits 3 Mild w Presents a guarded or oven openly dish‘ustful attimde, but thoughts, interactions, and behavior are minimally affected 4 Moderate - Distrustl’ulness is clearly evident and intruders on the interview and or ' behavior, but there is no evidence of persecutory delusions. Alternatively. there may be indication of loosely formed persecutory delusions, but these do not seem to afi'ect the patient's attitude or interpersonal relations. 5 Moderate Severe —- Patient shows marked distrusmrlness, leading to major disruption of interpersonal relations, or else there are clear-cut persecutory delusions that have limited impact on interpersonal relations and behavior. ' p 6 Severe - Clear-mt pervasive delusions of persecution which may be systematizetl and significantly interfere in interpersonal relations. ‘ 7 Extreme - .A network of systematiaed perseeutory delusions dominates the patient's thinking, social relations, and behavior. JUL—BE—EBBd- 33:28 PM F".B4 Study Number: Positive Scale (P) 7. Patient Initials: Patient Number: Positive and Negative Symptom Scale PANSS Rating Criteria Hostility Verbal and nonverbal expressions of anger and resentment, including sarcasm, peasive- aggressive behavior, verbal abuse and assaultiveness. Wing; Interpersonal behavior observed during the interview and reports by primary care workers or fondly. 1 2 . 3 4 Absent - Definition does not apply Minimal ~7 Questionable pathology; may be at upper extreme of normal limits. Mild -— Indirect or restrained communication of anger, such as sarcasm, disrespect. hostile expressions, and occasional irritability. Moderate .. Presents an overtly hostile attlmde, showing frequent irritability and direct expression of anger or resentment. Moderate Severe- Pstient is highly irritable and occasionally verbally abusive or threatening. Severe -- ,Uncooperativenus and verbal abuse or tln‘eats notably influence the interview and seriously impact upon social relations. Patient may be violent and destructive but is not physically aseeultive towards others. Extreme — Marked anger results in extreme uncooperativenoss precluding other interactions or in episode(s) or physical assault toward others JUL—BB—EBBd- I33 :23 PM Study Number: Patient Initials: Patient Number: M m Positive and Negative Symptom Scale PANSS Rating Criteria I Negative Scale (N) 1. Blunted Affect Diminished emotional responsiveness as characterized by a reduction in facial expression, modulation of feelings, and conununicative gesture. 2. 'n - Observation of physical manifestatious of affective tone and emotional l'eEptmsivanegg during the course of interview. 1 2 3 4 Absent w Definition does not apply. Minimal — Questionable pathology; may be at the upper extreme of normal limits. Mild — Changes in facial expressicn and communicative gestures seem to be edited, forced, artificial, or lacking in modulation. ' Moderate — Reduced range. of facial expression and few expressitte gestures result in a dull appearance. l Moderate Severe — Affect is generally “flat" with only Occasional changes in facial expressionand a paucity of communicative gestures. Severe - Marked flatness and deficiency of emotions exhibited most of the time. There may be unmodulated extreme affective discharges, such as excitement, rage, or inappropriate uncontrolled laughter. Extreme — Changes in facial expression and evidence of communicative gestures are virtually absent. Patient seems constantly to show a barren or ‘fivooden" expression. Emotional Withdrawal Lack ofintercat in, involvement with, and affectiVe commitment to life’s events. flfilfi for rating, Repetts of fiutotioning flom primary cane workers of family and observation of interpersonal behavior during the course of interview. output- UI Absent .. Definition doesnot apply. Mlnlmal —- Questionable pathology; may he at the upper extreme ofnonnal limits. Mild - Usually lacks initiative and occasionally may show deficient interest in surrounding events. Moderate — Patient is generally distanced emotionally from the milieu and its challenges but, with summon can be engaged Moderate'Severc - Patient is clearly detached emotionally frorn persons and events in the milieu, resisting all efforts at engagement. Patient appears distant, docile, and purposeless but can be involved in communication at least briefly and tends to personal needs, sometimes with assistance. Severe - Mat-load deficiency of interest and emotional commitment results in limited conversation with others and frequent neglect efpersonal functions, for which the patient requires supervision. Extreme - Patient is almost totally withdrawn, tmconununicative, and neglectful of personal needs as a result of profomtd lack of interest and emotional commitment. . JUL—BB—EBBd- I33 :29 PM Patient Initials: Patient Number: Study Number: -—...._. Positive and Negative Symptom Scale PANSS Rating Criteria \ Negative Scale (N) 3. Poor Rapport Lack of interpersonal empathy, openness in conversation and sense of closeness, interest, 4'. or involvement with the interviewer. This is evidenced by interpersonal distancing and reduced verbal and nonverbal commimication. mm Interpersonal behavior during the course of interview. 1 Absent — Defu‘titlon does not apply. 2 Minimal - Questionable pathology; maybe at the upper esherne of normal limits. 3 Mild ... Convolution Iis character'm by a stilted, strained, or artificial tone. It may lack emotional 4 Moderate - Patient typically is aloof, with interpersonal distance quite evident. Patient may answer questions mechanically, act bored, or «press disinterest. 5 Moderate Severe — Disinvolvement is obvious and clearly impedes the moductivity of the interview. Patient may tend to avoid eye or face contact. 6 Severe — Patient is highly indifferent, with marked interpersonal diatoms. Answers are perfilnctoty, andthere is little nonverbal evidence of involvement. Eye and face contact are fioquently avoided. . 7 Extreme — Patient is totally uninvolved with the intendewer. Patient appears to be completely indifferent and consistently avoids verbal and nonverbal interactions during the interview. FasslvelApatiietlc Social Withdrawal Diminished interest and initiative in social interactions due to passivity, apathy, energy, or avoiition. Tiiia lead to reduced interpersonal hivclvenicnts and neglect of activities of daily living. Bfiifl for rating: Reports on social behavior from primary care workers or family. 1 Absent — Definition deer not apply. ‘ 2 Minimal — Questionable pathology; may be at the upper «home of normal limits. 3 Mild — Shows occasional interest in social activities but poor initiative. Usually engages with others-only when approached first by them. _ _ 4 Moderate a. Passively goes along with most social activities but in a disinterested or mechanical way. Tends to recede into the background. ' 5 Moderate Severe - Passively participates in only a minority of activities and shows virtually no interest or initiative. Generally spends little time with others. 6 Severe -— Tends to be apathetic and isolated, participating very rarely in social activities and occasionally neglecting personal needs. Has very few spontaneous social contacts. . 7 Extreme .. Profoundly apathetic, socially isolated, and personally neglectfiil. JUL—BB—EBEHI- 63:36 PM F".El_r' Study Number: I Patient Initials: Patient Number: Hon—m Positive and Negative Symptom Scale , - PAN SS Rating Criteria Negative Scale (N) 5. Difficulty ln Abstract Thinking Impairment in the use of the abstract symbolic mode of thinking, as evidenced by difficulty in classification, forming generalizations, and proceeding beyond concrete or egocentric thinking in problem solving tasks. , Basis f9; raring: Responses to questions on similarities and proverb interpretation, and use of concrete vs. abstract mode during the course of the interview. 1 2 3 4 Absent ... Definition does not apply. Minimal _‘- Questionable pathology; may be at the upper extreme of normal limits. Mild — Tends to give literal or personalised interpretations to the more difficult proverbs and may have some problems with concepts that are fairly abstract or remotely related. Moderate - Often utilized a concrete mode. Has difliculty with roost proverbs and some catngories. Tends to be distracted by fiinctienal aspects and salient features. Moderate Severe * Deals primarily in a concrete mode, exhibiting difiiculty with most proverbs and many categories. . Severe .. Unable to grasp the abstract meaning of any proverbs or figurative expressions and can formulate classifications for only the most simple of similarities. Thinking is either vacuous or locked into functional aspects, salient features, and idiosyncratic interpretations, Extreme — Can use only concrete modes of thinking. Shows no comprehension of proverbs, common metaphors or similes, and simple categories. Eyen salicnt‘and functional attributes do not serve as a basis for classification. This rating may apply to those who cannot interact even minimally with the examiner due to marked cognitive impairment. 6. Lack, of Spontaneity and Flow oi" Conversation Reduction in the normal flow of communication associated with apathy, defensiveness, or cognitive deficit. This is manifested by diminished fluidity and productivity of the verbal interactions] process. atom Cognitive verbal processes observed during the course of interview. 1 Absent — Definition does not apply. 2 Minimal 7 Questionable pathology; may be at the upper extreme of normal lindts. 3 Mild - Conversation shows little initiative. patient‘s answers tend to be brief and unembcllished, requiring direct and loading quesiions by the interviewer. - 4 Moderate - Conversation lacks free flow and appears uneven or halting. Leading questions are fiequently needed to elicit adequate romance and proceed with conversation. 5 Moderate Severe —'patient shows a marked lack of spontaneity and openness, replying to the interviewer's questions with only one or two brief sentences. .' 6 Severe — Patient’s responses are limited mainly to a few words or short phrases intended to avoid or ‘ctntail communication. (e.g., “I don't know," “I’m not at liberty to say") Conversation is. seconds more. easiest“. and the WWW is hishlr “11 "reruns. .. 7 Extreme — Verbal output is ' restricted to, at “tribes and Occasionalu" Wiemakmg . conversation not possible. .I JUL—BB—EBBd- 33:39 PM F".BS 7. Patient Initials: Patient Number: nun—HM Study Number: Positive and negative Symptom Scale PANSS Rating Criteria Negative Scale (N) Stereotyped Thinking Decreased fluidity, spontaneity, and flexibility of thinking, as evidence in rigid, repetitious, or barren thought content. Wag; Cognitive verbal processes observed during the interview. I. 2 3 4 Absent — Definition does not apply. Minimal - Questionable pathology; may be at the upper extreme of normal limits. Mild — Some rigidity shown in attitudes or beliefs. Patient may refuse to consider alternative positions or have difficulty in shifting fiom one idea to another. Moderate — Conversation revolves around a recurrent theme, resulting in difficulty in shifting to a new topic Moderate Severe - Thinlring is rigid and repetitious to the point that despite the interviewer's efi'orts, conversation is limited to only two or three dominating topics. Severe - Uncontrolled repetition of demands, statements, ideas, or questions which severely impairs conversation. ' Extreme — Thinking, behavior, and conversation are dominated by constant repetition of fixed ideas or limited phrases, leading to gross rigidity, inappropriatencss, and restrictive ness of patient‘s communication. JUL—BE—EBB‘I- 33:31 PM F" [*4 Patient Initials: Patient Number: Study Number: Positive and Negative Symptom Scale PAN SS Rating Criteria \ General Psychopathology Scale (G) Somatic Concern Physical complaints or beliefs about bodily illness or malfunctions. This may range from a vague sense of ill being to clear cut delusions of catastrophic physical disease. W Thought content expressed' til the' interview 2 3 4 Absent Definition does not apply. Minimal- -Questionahle pathology; may he at the upper extreme of normal limits. Mild — Distinctly concerned about health or somatic issues, as evidenced by occasional questions and desire for reassurance. Moderate -- Complains about poor health or bodily malfimction, but there is no delusional conviction, and over concern can be alloyed by reassurance. Moderate Severe— Patient expresses ntnnerous or ficquont cornpiai...
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