The five-factor model of the Positive and Negative Syndrome Scale I: Confirmatory factor analysis fails to confirm 25 published five-factor solutions

OBJECTIVE The aim of this study was to test the goodness-of-fit of all previously published five-factor models of the Positive and Negative Syndrome Scale (PANSS). METHODS We used confirmatory factor analysis (CFA) with a large data set (N = 5769). RESULTS The different subsamples were tested for heterogeneity and were found to be homogeneous. This indicates that despite variability in age, sex, duration of illness, admission status, etc., in the different subsamples, the structure of symptoms is the same for all patients with schizophrenia. Although previous research has shown that a five-factor model fits the data better than models with three or four factors, no satisfactory fit for any of the 25 published five-factor models was found with CFA. CONCLUSIONS Variability in age, sex, admission status and duration of illness has no substantial effect on the structure of symptoms in schizophrenia. The lack of fit can be caused by ill-defined items that aim to measure several properties in a single rating. Another explanation is that well-defined symptoms can have two or more causes. Then a double or triple loading item should not be discarded, but included because the complexity of symptoms in schizophrenia is represented by these multiple loadings. Such a complex model not only needs confirmation by CFA, but also has to be proven stable. A 10-fold cross-validation is suggested to develop a complex and stable model.

[1]  P. Bentler,et al.  Cutoff criteria for fit indexes in covariance structure analysis : Conventional criteria versus new alternatives , 1999 .

[2]  W. Honer,et al.  31 Panss symptom factors in schizophrenia , 1997, Schizophrenia Research.

[3]  J. Lindenmayer,et al.  A new five factor model of schizophrenia , 2006, Psychiatric Quarterly.

[4]  P. Fitzgerald,et al.  A confirmatory factor analytic evaluation of the pentagonal PANSS model , 2003, Schizophrenia Research.

[5]  C. Lançon,et al.  An Exploration of the Psychometric Properties of the French Version of the Positive and Negative Syndrome Scale , 1999, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[6]  R. Emsley,et al.  The factor structure for the Positive and Negative Syndrome Scale (PANSS) in recent-onset psychosis , 2003, Schizophrenia Research.

[7]  P. Bentler,et al.  Fit indices in covariance structure modeling : Sensitivity to underparameterized model misspecification , 1998 .

[8]  M. Bell,et al.  Five-component model of schizophrenia: Assessing the factorial invariance of the positive and negative syndrome scale , 1994, Psychiatry Research.

[9]  E. Lindström,et al.  Principal component analysis of the Swedish version of the Positive and Negative Syndrome Scale for schizophrenia , 1993 .

[10]  M Davies,et al.  The Structured Clinical Interview for DSM-III-R (SCID). II. Multisite test-retest reliability. , 1992 .

[11]  William D. Schafer,et al.  The Robustness of the Likelihood Ratio Chi-Square Test for Structural Equation Models: A Meta-Analysis , 2001 .

[12]  P M Bentler,et al.  Normal theory based test statistics in structural equation modelling. , 1998, The British journal of mathematical and statistical psychology.

[13]  B. Everitt,et al.  Modelling Covariances and Latent Variables Using EQS , 1993 .

[14]  N. Tarrier,et al.  The evolution of symptoms in the early course of non-affective psychosis , 2003, Schizophrenia Research.

[15]  Philip D. Harvey,et al.  Empirical assessment of the factorial structure of clinical symptoms in schizophrenic patients: Symptom structure in geriatric and nongeriatric samples , 1994 .

[16]  J. K. Wing,et al.  Diagnosis and clinical measurement in psychiatry , 2013 .

[17]  C. Lançon,et al.  Stability of the five-factor structure of the Positive and Negative Syndrome Scale (PANSS) , 2000, Schizophrenia Research.

[18]  D. Rubin,et al.  Statistical Analysis with Missing Data. , 1989 .

[19]  R. Hoyle.  Structural equation modeling: concepts, issues, and applications , 1997 .

[20]  Peter M. Bentler,et al.  EQS : structural equations program manual , 1989 .

[21]  M. First,et al.  The Structured Clinical Interview for DSM-III-R (SCID). I: History, rationale, and description. , 1992, Archives of general psychiatry.

[22]  M. Nakaya,et al.  Latent structures underlying schizophrenic symptoms: a five-dimensional model , 1999, Schizophrenia Research.

[23]  D. Linszen,et al.  Dimensions and Subtypes of Recent-Onset Schizophrenia: A Longitudinal Analysis , 1995, The Journal of nervous and mental disease.

[24]  S. Dollfus,et al.  Principal-component analysis of PANSS and SANS - SAPS global ratings in schizophrenic patients , 1991, European Psychiatry.

[25]  J. Graham,et al.  A latent structure analysis of the positive and negative symptoms in schizophrenia. , 1994, Comprehensive psychiatry.

[26]  N C Andreasen,et al.  The Comprehensive Assessment of Symptoms and History (CASH). An instrument for assessing diagnosis and psychopathology. , 1992, Archives of general psychiatry.

[27]  J. Lindenmayer,et al.  Psychopathology of Schizophrenia: initial validation of a 5-factor model. , 1995, Psychopathology.

[28]  S. Marder,et al.  The effects of risperidone on the five dimensions of schizophrenia derived by factor analysis: combined results of the North American trials. , 1997, The Journal of clinical psychiatry.

[29]  Joseph L Schafer,et al.  Multiple Imputation for incomplete multivariate data under a latent-class selection model , 2006 .

[30]  Philip D. Harvey,et al.  Empirical assessment of the factorial structure of clinical symptoms in schizophrenia. A multisite, multimodel evaluation of the factorial structure of the Positive and Negative Syndrome Scale. The PANSS Study Group. , 1997, Psychopathology.

[31]  Kenneth A. Bollen,et al.  Structural Equations with Latent Variables , 1989 .

[32]  D. Sommers,et al.  A longitudinal analysis , 1992 .

[33]  C. Lançon,et al.  Factorial structure of the Positive and Negative Syndrome Scale (PANSS): a forced five‐dimensional factor analysis , 1998, Acta psychiatrica Scandinavica.

[34]  Y. Kawasaki,et al.  Evaluation and interpretation of symptom structures in patients with schizophrenia , 1994, Acta psychiatrica Scandinavica.

[35]  Mark van der Gaag,et al.  The five-factor model of the Positive and Negative Syndrome Scale II: A ten-fold cross-validation of a revised model , 2006, Schizophrenia Research.

[36]  P. Liddle,et al.  Syndromes of Chronic Schizophrenia , 1990, British Journal of Psychiatry.

[37]  J. Lindenmayer,et al.  Five factor model of schizophrenia: Replication across samples , 1993, Schizophrenia Research.

[38]  R. Lomax,et al.  The Effect of Varying Degrees of Nonnormality in Structural Equation Modeling , 2005 .

[39]  H. Marsh,et al.  In Search of Golden Rules: Comment on Hypothesis-Testing Approaches to Setting Cutoff Values for Fit Indexes and Dangers in Overgeneralizing Hu and Bentler's (1999) Findings , 2004 .

[40]  M. Nakaya,et al.  Is Schizophrenic Symptomatology Independent of the Phase of the Illness? , 1999, Psychopathology.

[41]  N. Hayashi,et al.  Is There a Gender Difference in a Factorial Structure of the Positive and Negative Syndrome Scale? , 2002, Psychopathology.

[42]  Philip D. Harvey,et al.  Empirical evaluation of the factorial structure of clinical symptoms in schizophrenia: Effects of typical neuroleptics on the brief psychiatric rating scale , 1996, Biological Psychiatry.

[43]  S. Dollfus,et al.  Stability of positive and negative symptoms in schizophrenic patients: a 3-year follow-up study , 1995, European Psychiatry.

[44]  W. Cahn,et al.  Component structure of the Positive And Negative Syndrome Scale (PANSS) in patients with recent-onset schizophrenia and spectrum disorders , 2000, Psychopharmacology.

[45]  R. Mass,et al.  Psychopathological syndromes of schizophrenia: evaluation of the dimensional structure of the positive and negative syndrome scale. , 2000, Schizophrenia bulletin.

[46]  S. Dollfus,et al.  Principal-component analyses of PANSS and SANS-SAPS in schizophrenia: their stability in an acute phase , 1995, European Psychiatry.

[47]  S. Kay,et al.  The positive and negative syndrome scale (PANSS) for schizophrenia. , 1987, Schizophrenia bulletin.

[48]  V. Peralta,et al.  Psychometric properties of the Positive and Negative Syndrome Scale (PANSS) in schizophrenia , 1994, Psychiatry Research.

[49]  V. Peralta,et al.  Are There More Than Two Syndromes in Schizophrenia? , 1992, British Journal of Psychiatry.

[50]  C. Stefanis,et al.  Five-factor model of schizophrenic psychopathology: how valid is it? , 2000, European Archives of Psychiatry and Clinical Neuroscience.

[51]  L. Williams,et al.  The Five Symptom Dimensions and Depression in Schizophrenia , 2003, Psychopathology.

[52]  N C Andreasen,et al.  The Distinction of Positive and Negative Symptoms , 1991, British Journal of Psychiatry.

[53]  V. Peralta,et al.  Cognitive disorders in the positive, negative, and disorganization syndromes of schizophrenia , 1995, Psychiatry Research.

[54]  S. Sevy,et al.  Pyramidical model of schizophrenia. , 1990, Schizophrenia bulletin.

[55]  Yasuhiro Kawasaki,et al.  P300 and the thought disorder factor extracted by factor-analytic procedures in schizophrenia , 1998, Biological Psychiatry.