Mapping PANSS factor dynamics: a novel framework for tracking therapeutic response in schizophrenia

To study the factor structure of PANSS score dynamics in patients with schizophrenia spectrum disorders (SSD) and its relationship to individual patient characteristics.

A single-center retrospective observational study was conducted. We analyzed medical records of patients with SSD from Russian Mental Health Research Center (Moscow, Russia), in whom neuroinflammation biomarkers had been monitored and item-level PANSS scores were available. Dynamics of individual PANSS items after therapy adjustment were examined via exploratory factor analysis (FA; n=182). The relationship between derived factor scores and potential predictors (clinical characteristics, therapy, sex, neuroinflammation markers) was assessed using multivariate regression (n=148).

We developed an algorithm for conducting and interpreting exploratory FA for ordinal psychometric test scores. A factor structure of PANSS dynamics has been developed that divides the regression of psychopathological features into three dimensions (directions): positive, negative, and affective symptoms. The initial PANSS scores, summed separately according to three dimensions of the factor structure, were found to have an effect on reducing negative symptoms. The positive influence of the female sex on the therapeutic response in negative and depressive dimensions was revealed. The use of antidepressants or anticonvulsants worsens the regression of positive symptoms, while the use of antidepressants reduces the regression of the depressive component. Cholinolytics as part of therapy are associated with regression of positive symptoms, and higher baseline values of blood leukocyte elastase activity in blood reduced the regression.

The need to explore individual psychometric scale items via exploratory FA, along with the utility of factor scores as therapeutic response variables in psychiatry, is underscored. Identified patterns hold significance for personalized SSD treatment and warrant further investigation.