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Scale for the Assessment of Negative Symptoms (SANS)

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Andreasen NC. Negative symptoms in schizophrenia. Arch Gen Psychiatry. 1982;39:784-788.

Appropriate for: Patients with schizophrenia
Administered by: Clinicians or trained rater
Time to complete: 15-20 minutes

Summary of Scale for the Assessment of Negative Symptoms:
SANS assesses five symptom complexes to obtain clinical ratings of negative symptoms in patients with schizophrenia. They are: affective blunting; alogia (impoverished thinking); avolition/apathy; anhedonia/asociality; and disturbance of attention. The final symptom complexes seems to have less obvious relevance to negative symptoms than the other four complexes. Assessments are conducted on a six-point scale (0=not at all to 5=severe).

Ratings are made on each negative symptom cluster, after consideration has been given to each of the items contained within the various complex scores. Item descriptions are not given, but anchor point descriptions are given for each score.

Benefits of the SANS:

  • Broad negative symptomatology - SANS assesses a wide variety of different negative symptomatology, specifically in individual group measures. This helps ensure a more reliable conclusion
  • Good concurrent validity - SANS is a well-respected and commonly used instrument, and has been shown to provide consistent and valid results as assessed by the concurrent administration of other assessment tools
  • Commonly used with BPRS
  • Cross-cultural - SANS has been shown to retain validity in a variety of different cultural settings

Challenges of the SANS:

  • Subjectivity - SANS assesses behaviour based on rater observation and patient interview. However, it also draws on the subjective observations by hospital staff and members of the patient's family
  • Symptomatology - while SANS aims to assess specific negative symptoms/symptom clusters associated with schizophrenia, it must be noted that many symptoms covered by SANS are also associated with affective disorders, particularly depression. As depression is a frequent finding among patients with schizophrenia, high severity scores on SANS for affective symptomatology merit further investigation
  • Blind to secondary negative symptoms
  • Rates over time, rather than the moment - this can lead to issues of unreliability


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