RELIABILITY OF CORE SCHIZOPHRENIA SYMPTOMS RATINGS USING THE SIX-ITEM POSITIVE AND NEGATIVE SYNDROME SCALE (PANSS-6) PERFORMED BY MEDICAL STUDENTS

Abstract Background Assessing and monitoring the severity of illness is an essential component of the measurement-based treatment of schizophrenia. The six-item Positive And Negative Syndrome Scale (PANSS-6) is a psychometrically valid scale, which allows for a brief and valid assessment of the severity of core symptoms of schizophrenia via the Simplified positive And Negative Symptoms interview (SNAPSI). The use of the PANSS-6 in a clinical setting requires raters to obtain reliable and valid ratings. The aim of the study was to determine the amount of training needed for raters with no or very little clinical experience to perform reliable PANSS-6 ratings. Methods A total of 89 5th year medical students, divided in 4 groups, which were enrolled in a 4-week mandatory internship in the psychiatric unit of Aarhus University Hospital were invited to participate in the training program. Out of 89 students 58% (n=52) participated. The training program contained 9 hours of standardized training. All participants performed a baseline rating of a SNAPSI patient interview before the display of a theoretical introduction video to SNAPSI and the principles of PANSS-6 rating. Following the theoretical introduction, the students individually rated another 5 SNAPSI patient videos. After each SNAPSI video, an expert consensus-video was displayed. The order of the SNAPSI and corresponding consensus videos was randomized between the 4 different groups of students. The PANSS-6 ratings performed by the students were compared to gold standard ratings performed by a certified PANSS-rater and psychiatrist at different time-points during the training. Agreements were calculated by using percent agreement. Results The percent agreement between the students and the gold standard on the PANSS-6 total score improved from time 1 (baseline) to time 4 (after the theoretical introduction video and 3 SNAPSIs) from 88% to 100%. Discussion In conclusion, medical students with very limited clinical experience were able to perform reliable PANSS-6 ratings of SNAPSI patient interviews after participating in a brief standardized training program. Future studies should assess whether raters with very limited clinical experience are able to conduct the SNAPSI and extract sufficient information for PANSS-6 rating. This would render the possibility of using medical students as PANSS-6 raters in clinical practice to remedy the shortage of psychiatrists and to allow for measurement-based care, which requires systematic administration of symptom rating scales to drive clinical decision making.