Positive Symptom Rating Scale

Clinicians should use standardized psychiatric rating scales to rate response objectively. The four-item Positive Symptom Rating Scale and the Brief Negative Symptom Assessment are scales that are brief enough to be useful in the outpatient setting. 

FIGURE 66-2. Brief clinical assessments for monitoring antipsychotic response in schizophrenia. To enhance consistency in ratings, the structured probes in the administration manual should be used each time the scales are used. (Data from Miller et aP and Miller et al. The complete administration manual for the Positive Symptom Rating Scale and the Brief Negative Symptom Assessment can be accessed from the appendices in the TIMA Procedure Manual Schizophrenia Module at http-//www.dshs.state.tx.us/ mhprograms/timasczman.pdf. This rating scale is in the public domain and may be reproduced with appropriate citation of the authors and source.)... 

Item Positive Symptom Rating Scale (PSRS)... 

Positive and Negative Syndrome Scale for Children and Adolescents (K-PANSS) (Fields et al., 1994) Rating scale for positive and negative symptoms and other symptoms Interviewer rating Parent/Child 6-16... 

Patient selection based on symptom severity. This can be defined directly by a minimal acceptable severity score as measured by a rating instrument (e.g. the Hamilton Rating Scale for Depression, the Positive and Negative Symptom Scale or other established assessment instruments see Section 5.6). An indirect definition of symptom severity may be a consequence of the status of a patient population a clinical trial designed for inpatients generally implies a more severe symptom profile than a study with... 

Abbrevations CGI, Clinical Global Impressions scale SCZ, schizophrenia GAS, Global SczAD (schizoaffective disorder) PANNS, Positive and Negative Syndrome Scale BPRS, Brief Psychiatric Rating Scale SANS, Scale for the Assessment of Negative Symptoms. 

One final common inclusion in many studies of occupational behavioral toxicology and in some test batteries is assessments of symptoms experienced by those exposed to chemicals. While this might be perceived as an ostensibly simple procedure, it entails numerous potential confounds. These evaluations are typically administered via questionnaires. Items for the questionnaire must be carefully constructed with respect to not only the choices of items but also the wording of the text and the manner in which the response is recorded. Clearly, the motivation of the subject in answering the questions must be considered. One problem can arise when the list of symptoms includes only those that are associated with the toxicant of concern. It is necessary to include symptoms that are not associated with the particular toxicant under evaluation so that some assessment of the tendency of the subject to respond positively to all symptoms can be evaluated. Several such evaluations of subjective and mood states are available. The most widely used is the Profile of Mood States (POMS), which consists of 65 adjectives of various moods that the subject answers according to a 5-point rating scale. The POMS has been used extensively in the evaluation of the acute effects of CNS drugs and toxicants. 

Clinical trials invariably employ self-reporting of symptoms, using standardized questionnaires, the tool most often used being the 17-or 21-item Hamilton Rating Scale for Depression (HAM-D). A positive response to... 

In an initial confirmation of the preclinical findings, a phase II clinical trial using 10-40 mg of MDL 100907 per day for 6 weeks showed improved Parkinson rating scale (BPRS) scores relative to placebo and no EPS liability (665). A larger phase III trial showed some minor improvement in positive symptoms at the 10-mg/day dose, but this effect disappeared at the 20-mg/day dose, compared with placebo. Functional PET scans of selected patients in the trial showed minor metabolic changes in the frontal cortex at the 10 but not 20 mg dose. Clinical trials of MDL100907 have been halted, presumably because of limited efficacy (666). Between the findings with ritan-... 

In a recent report, the mean CY-BOCS score at initial assessment (23 6.5) did not differ between child and adolescent OCD subjects. It should be noted that although the CY-BOCS is an anchored ordinal scale, it is not linear and lacks sensitivity to change when symptoms are severely impairing. For example, time occupied is scored as 4 when more than 8 hours/day are spent in either obsessions or compulsions, while 4 hours/day would rate a score of 3—i.e., a 50% decrease in time lowers this item score by one point (out of 5 ordinal scores). It is for this reason that a decrease in CY-BOCS score of more than 25% is considered clinically significant improvement and a number of controlled studies have used a 25% reduction to define a positive response. The CY-BOCS remains the gold standard for both baseline evaluation as well as for monitoring effects of treatment. 

All these studies essentially use the same definition for responder (i.e., 20% improvement on a standard rating instrument, usually the Positive and Negative Symptoms Scale [PANSS]). Because this criterion is the standard and was decided beforehand, there is no statistical problem of a post hoc choice of optimal cutoff points for dichotomization. 

Phytotoxicity assay. Compounds were tested for phytotoxic activity in a 24-well microtiter plate, using atrazine as a positive control. Lettuce seeds were incubated in the wells on filter paper impregnated with test compounds. Seeds were grown in growth chamber at 25°C with a 16-hr photoperiod at 400 pmol/m2/sec photosynthetically active radiation for 4 days. Treatments were in duplicates. Compounds were dissolved in acetone and tested at final concentrations of 0.1 - 3 mM in a final volume of 200 pL (10% acetone in H2O) in the wells. Seedlings were rated on a scale of 0 (no symptoms) to 5 (seedling death). 

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