Identifying clinically meaningful symptom response cut-off values on the SANS in predominant negative symptoms

Schizophr Res. 2013 Apr;145(1-3):125-7. doi: 10.1016/j.schres.2012.12.032. Epub 2013 Feb 8.


Background: The treatment and measurement of negative symptoms are currently at issue in schizophrenia, but the clinical meaning of symptom severity and change is unclear.

Aim: To offer a clinically meaningful interpretation of severity and change scores on the Scale for the Assessment of Negative Symptoms (SANS).

Method: Patients were intention-to-treat participants (n=383) in two double-blind randomized placebo-controlled clinical trials that compared amisulpride with placebo for the treatment of predominant negative symptoms. Equipercentile linking was used to examine extrapolation from (a) CGI-S to SANS severity ratings, and (b) CGI-I to SANS percentage change (n=383). Linking was conducted at baseline, 8-14 days, 28-30 days, and 56-60 days of the trials.

Results: Across visits, CGI-S ratings of 'not ill' linked to SANS scores of 0-13, and ranged to 'extreme' ratings that linked to SANS scores of 102-105. The relationship between the CGI-S and the SANS severity scores assumed a linear trend (1=0-13, 2=15-56, 3=37-61, 4=49-66, 5=63-75, 6=79-89, 7=102-105). Similarly the relationship between CGI-I ratings and SANS percentage change followed a linear trend. For instance, CGI-I ratings of 'very much improved' were linked to SANS percent changes of -90 to -67, 'much improved' to -50 to -42, and 'minimally improved' to -21 to -13.

Conclusions: The current results uniquely contribute to the debate surrounding negative symptoms by providing clinical meaning to SANS severity and change scores and so offer direction regarding clinically meaningful response cut-off scores to guide treatment targets of predominant negative symptoms.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Amisulpride
  • Antipsychotic Agents / therapeutic use
  • Double-Blind Method
  • Female
  • Humans
  • Intention
  • Male
  • Psychiatric Status Rating Scales
  • Schizophrenia / diagnosis*
  • Schizophrenia / drug therapy
  • Schizophrenic Psychology*
  • Severity of Illness Index*
  • Sulpiride / analogs & derivatives
  • Sulpiride / therapeutic use
  • Treatment Outcome*


  • Antipsychotic Agents
  • Sulpiride
  • Amisulpride