The Clinical Assessment Interview for Negative Symptoms (CAINS): Final Development and Validation

doi:10.1176/APPI.AJP.2012.12010109

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The Clinical Assessment Interview for Negative Symptoms (CAINS): Final Development and Validation

Journal Article•DOI•

The Clinical Assessment Interview for Negative Symptoms (CAINS): Final Development and Validation

Ann M. Kring¹, Raquel E. Gur, Jack J. Blanchard, William P. Horan, Steven P. Reise - Show less +1 more•Institutions (1)

University of California, Berkeley¹

01 Feb 2013-American Journal of Psychiatry (NIH Public Access)-Vol. 170, Iss: 2, pp 165-172

TL;DR: The CAINS is an empirically developed and evaluated measure of negative symptoms that is brief yet comprehensive and employable across a wide range of research and clinical contexts.

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Abstract: ObjectiveA major barrier to developing treatments for negative symptoms has been measurement concerns with existing assessment tools. Fulfilling the top recommendation of the National Institute of Mental Health’s Consensus Development Conference on Negative Symptoms, the Clinical Assessment Interview for Negative Symptoms (CAINS) was developed using an iterative, empirical approach, and includes items assessing motivation, pleasure, and emotion expression. The authors employed multiple analytic techniques to develop the CAINS and here provide final development and validation results.MethodThe CAINS structure, interrater agreement, test-retest reliability, and convergent and discriminant validity were assessed in a large and diverse sample of 162 outpatients with schizophrenia or schizoaffective disorder recruited from four sites.ResultsThree items with poor psychometric properties were removed, resulting in a 13-item CAINS. The CAINS factor structure was replicated, demonstrating two modestly correlated s...

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Journal Article•DOI•

The Hierarchical Taxonomy of Psychopathology (HiTOP): A Dimensional Alternative to Traditional Nosologies

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Roman Kotov¹, Robert F. Krueger², David Watson³, Thomas M. Achenbach⁴, Robert R. Althoff⁴, R. Michael Bagby⁵, Timothy A. Brown⁶, William T. Carpenter⁷, Avshalom Caspi⁸, Lee Anna Clark³, Nicholas R. Eaton¹, Miriam K. Forbes², Kelsie T. Forbush⁹, David Goldberg¹⁰, Deborah S. Hasin¹¹, Steven E. Hyman¹², Masha Y. Ivanova⁴, Donald R. Lynam¹³, Kristian E. Markon¹⁴, Joshua D. Miller¹⁵, Terrie E. Moffitt⁸, Leslie C. Morey¹⁶, Stephanie N. Mullins-Sweatt¹⁷, Johan Ormel¹⁸, Christopher J. Patrick¹⁹, Darrel A. Regier²⁰, Leslie Rescorla²¹, Camilo J. Ruggero²², Douglas B. Samuel¹³, Martin Sellbom²³, Leonard J. Simms²⁴, Andrew E. Skodol²⁵, Tim Slade²⁶, Susan C. South¹³, Jennifer L. Tackett²⁷, Irwin D. Waldman²⁸, Monika A. Waszczuk¹, Thomas A. Widiger²⁹, Aidan G. C. Wright³⁰, Mark Zimmerman³¹ - Show less +36 more•Institutions (31)

Stony Brook University¹, University of Minnesota², University of Notre Dame³, University of Vermont⁴, University of Toronto⁵, Boston University⁶, University of Maryland, Baltimore⁷, Duke University⁸, University of Kansas⁹, King's College London¹⁰, Columbia University¹¹, Broad Institute¹², Purdue University¹³, University of Iowa¹⁴, University of Georgia¹⁵, Texas A&M University¹⁶, Oklahoma State University–Stillwater¹⁷, University of Groningen¹⁸, Florida State University¹⁹, Uniformed Services University of the Health Sciences²⁰, Bryn Mawr College²¹, University of North Texas²², University of Otago²³, University at Buffalo²⁴, University of Arizona²⁵, University of New South Wales²⁶, Northwestern University²⁷, Emory University²⁸, University of Kentucky²⁹, University of Pittsburgh³⁰, Brown University³¹

23 Mar 2017-Journal of Abnormal Psychology

TL;DR: The HiTOP promises to improve research and clinical practice by addressing the aforementioned shortcomings of traditional nosologies and provides an effective way to summarize and convey information on risk factors, etiology, pathophysiology, phenomenology, illness course, and treatment response.

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Abstract: The reliability and validity of traditional taxonomies are limited by arbitrary boundaries between psychopathology and normality, often unclear boundaries between disorders, frequent disorder co-occurrence, heterogeneity within disorders, and diagnostic instability. These taxonomies went beyond evidence available on the structure of psychopathology and were shaped by a variety of other considerations, which may explain the aforementioned shortcomings. The Hierarchical Taxonomy Of Psychopathology (HiTOP) model has emerged as a research effort to address these problems. It constructs psychopathological syndromes and their components/subtypes based on the observed covariation of symptoms, grouping related symptoms together and thus reducing heterogeneity. It also combines co-occurring syndromes into spectra, thereby mapping out comorbidity. Moreover, it characterizes these phenomena dimensionally, which addresses boundary problems and diagnostic instability. Here, we review the development of the HiTOP and the relevant evidence. The new classification already covers most forms of psychopathology. Dimensional measures have been developed to assess many of the identified components, syndromes, and spectra. Several domains of this model are ready for clinical and research applications. The HiTOP promises to improve research and clinical practice by addressing the aforementioned shortcomings of traditional nosologies. It also provides an effective way to summarize and convey information on risk factors, etiology, pathophysiology, phenomenology, illness course, and treatment response. This can greatly improve the utility of the diagnosis of mental disorders. The new classification remains a work in progress. However, it is developing rapidly and is poised to advance mental health research and care significantly as the relevant science matures. (PsycINFO Database Record

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1,635 citations

Cites methods from "The Clinical Assessment Interview f..."

...Novel measures, such as the Clinical Assessment Interview for Negative Symptoms (CAINS; Kring et al., 2013) and the Brief Negative Symptom Scale (BNSS; Kirkpatrick et al., 2011), have been developed to provide reliable assessment of the two dimensions of negative symptoms, but are more narrow in…...
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Journal Article•DOI•

The influence of illness-related variables, personal resources and context-related factors on real-life functioning of people with schizophrenia

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Silvana Galderisi¹, Alessandro Rossi², Paola Rocca³, Alessandro Bertolino⁴, Armida Mucci¹, Paola Bucci¹, Paola Rucci⁵, Dino Gibertoni⁵, Eugenio Aguglia⁶, Mario Amore⁷, Antonello Bellomo⁸, Massimo Biondi⁹, Roberto Brugnoli⁹, Liliana Dell'Osso¹⁰, Diana De Ronchi⁵, Gabriella Di Emidio², Massimo Di Giannantonio¹¹, Andrea Fagiolini¹², Carlo Marchesi¹³, Palmiero Monteleone¹⁴, Lucio Oldani¹⁵, Federica Pinna¹⁶, Rita Roncone², Emilio Sacchetti¹⁷, Paolo Santonastaso¹⁸, Alberto Siracusano¹⁹, Antonio Vita¹⁷, Patrizia Zeppegno²⁰, Mario Maj¹ - Show less +25 more•Institutions (20)

University of Naples Federico II¹, University of L'Aquila², University of Turin³, University of Bari⁴, University of Bologna⁵, University of Catania⁶, University of Genoa⁷, University of Foggia⁸, Sapienza University of Rome⁹, University of Pisa¹⁰, University of Chieti-Pescara¹¹, University of Siena¹², University of Parma¹³, University of Salerno¹⁴, University of Milan¹⁵, University of Cagliari¹⁶, University of Brescia¹⁷, University of Padua¹⁸, University of Rome Tor Vergata¹⁹, University of Eastern Piedmont²⁰

01 Oct 2014-World Psychiatry

TL;DR: The observed complex associations among investigated predictors, mediators and real‐life functioning strongly suggest that integrated and personalized programs should be provided as standard treatment to people with schizophrenia.

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344 citations

Cites background from "The Clinical Assessment Interview f..."

...Moreover, largely used scales for the assessment of negative symptoms have been criticized for the inclusion of items assessing neurocognition and the focus on behavioral aspects, as opposed to internal experience, which may lead to artefactual associations with functional outcome measures (28,29)....
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Journal Article•DOI•

Deconstructing negative symptoms of schizophrenia: avolition-apathy and diminished expression clusters predict clinical presentation and functional outcome.

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Gregory P. Strauss¹, William P. Horan², Brian Kirkpatrick³, Bernard A. Fischer⁴, Bernard A. Fischer¹, William R. Keller¹, Pinar Miski¹, Robert W. Buchanan¹, Robert W. Buchanan⁴, Michael F. Green², William T. Carpenter¹, William T. Carpenter⁴ - Show less +8 more•Institutions (4)

University of Maryland, Baltimore¹, University of California, Los Angeles², Scott & White Hospital³, Veterans Health Administration⁴

01 Jun 2013-Journal of Psychiatric Research

TL;DR: It is suggested that distinct subgroups of patients with elevated AA or DE can be identified within the broader diagnosis of schizophrenia and that these subgroups show clinically meaningful differences in presentation.

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343 citations

Journal Article•DOI•

The current conceptualization of negative symptoms in schizophrenia.

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Stephen R. Marder¹, Silvana Galderisi²•Institutions (2)

Semel Institute for Neuroscience and Human Behavior¹, University of Naples Federico II²

01 Feb 2017-World Psychiatry

TL;DR: The assessment of the negative symptom dimension has recently improved, but even current expert consensus‐based instruments diverge on several aspects and the use of objective measures might contribute to overcome uncertainties about the reliability of rating scales, but these measures require further investigation and validation.

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314 citations

Journal Article•DOI•

Negative symptoms of schizophrenia: new developments and unanswered research questions

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Silvana Galderisi¹, Armida Mucci¹, Robert W. Buchanan², Celso Arango³, Celso Arango⁴ - Show less +1 more•Institutions (4)

Seconda Università degli Studi di Napoli¹, University of Maryland, Baltimore², Complutense University of Madrid³, Hospital General Universitario Gregorio Marañón⁴

01 Aug 2018-The Lancet Psychiatry

TL;DR: If substantial progress is to be made in the understanding and treatment of negative symptoms, then advances in concepts and assessment should be integrated into the design of future studies of these symptoms.

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275 citations

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References

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Journal Article•DOI•

Intraclass correlations: uses in assessing rater reliability.

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Patrick E. Shrout¹, Joseph L. Fleiss•Institutions (1)

Columbia University¹

01 Mar 1979-Psychological Bulletin

TL;DR: In this article, the authors present guidelines for choosing among six different forms of the intraclass correlation for reliability studies in which n target are rated by k judges, and the confidence intervals for each of the forms are reviewed.

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Abstract: Reliability coefficients often take the form of intraclass correlation coefficients. In this article, guidelines are given for choosing among six different forms of the intraclass correlation for reliability studies in which n target are rated by k judges. Relevant to the choice of the coefficient are the appropriate statistical model for the reliability and the application to be made of the reliability results. Confidence intervals for each of the forms are reviewed.

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21,185 citations

"The Clinical Assessment Interview f..." refers methods in this paper

...ICCs ranging from 0.31 to 0.70 have been reported for the individual SANS items (28); ICCs for CAINS items range from 0.67 to 0.94 (see supplementary table 1 in the online data supplement)....
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...Average ICCs between the four sites for the motivation/ pleasure and expression scales were 0.93 and 0.77, respectively, indicating good rater agreement by raters from different sites....
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...After we confirmed the CAINS structure, additional analyses assessed between-site interrater agreement with intraclass correlation (ICC) (27); testretest reliability; convergent validity (i....
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...After we confirmed the CAINS structure, additional analyses assessed between-site interrater agreement with intraclass correlation (ICC) (27); testretest reliability; convergent validity (i.e., whether the CAINS significantly correlated with negative symptoms assessed with the BPRS, the SANS, FACES coded facial expressions, and selfreport measures); discriminant validity (i.e., whether the CAINS was not strongly correlated with positive symptoms, depression, agitation, medication side effects, and cognitive functioning); and the relationship between the CAINS and functioning....
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Journal Article•DOI•

The Positive and Negative Syndrome Scale (PANSS) for Schizophrenia

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Stanley R. Kay¹, Abraham Fiszbein¹, Lewis A. Opler¹•Institutions (1)

Albert Einstein College of Medicine¹

01 Jan 1987-Schizophrenia Bulletin

TL;DR: Review of five studies involving the PANSS provided evidence of its criterion-related validity with antecedent, genealogical, and concurrent measures, its predictive validity, its drug sensitivity, and its utility for both typological and dimensional assessment.

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Abstract: The variable results of positive-negative research with schizophrenics underscore the importance of well-characterized, standardized measurement techniques. We report on the development and initial standardization of the Positive and Negative Syndrome Scale (PANSS) for typological and dimensional assessment. Based on two established psychiatric rating systems, the 30-item PANSS was conceived as an operationalized, drug-sensitive instrument that provides balanced representation of positive and negative symptoms and gauges their relationship to one another and to global psychopathology. It thus constitutes four scales measuring positive and negative syndromes, their differential, and general severity of illness. Study of 101 schizophrenics found the four scales to be normally distributed and supported their reliability and stability. Positive and negative scores were inversely correlated once their common association with general psychopathology was extracted, suggesting that they represent mutually exclusive constructs. Review of five studies involving the PANSS provided evidence of its criterion-related validity with antecedent, genealogical, and concurrent measures, its predictive validity, its drug sensitivity, and its utility for both typological and dimensional assessment.

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18,358 citations

"The Clinical Assessment Interview f..." refers background or result in this paper

...Test-retest reliability in other studies ranges from 0.37 to 0.54 for the SANS (28) and 0.68 for the negative symptom subscale of the Positive and Negative Syndrome Scale (PANSS) (29)....
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...that interrater agreement for the CAINS is higher than that reported for the SANS (28), and the test-retest reliability is comparable to those of the SANS and the PANSS (28, 29)....
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...Our results demonstrate that interrater agreement for the CAINS is higher than that reported for the SANS (28), and the test-retest reliability is comparable to those of the SANS and the PANSS (28, 29)....
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...These scales are consistent with the domains identified in reviews of the negative symptomon older negativemeasures, such as the SANS and the PANSS (34, 35)....
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...68 for the negative symptom subscale of the Positive and Negative Syndrome Scale (PANSS) (29)....
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Journal Article•DOI•

The Brief Psychiatric Rating Scale

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John E. Overall¹, Donald R. Gorham•Institutions (1)

Kansas State University¹

01 Jun 1962-Psychological Reports

TL;DR: The Brief Psychiatric Rating Scale (BRS) as mentioned in this paper was developed to provide a rapid assessment technique particularly suited to the evaluation of patient change, and it is recommended for use where efficiency, speed, and economy are important considerations.

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Abstract: The Brief Psychiatric Rating Scale was developed to provide a rapid assessment technique particularly suited to the evaluation of patient change. Sixteen symptom constructs which have resulted from factor analyses of several larger sets of items, principally Lorr's Multidimensional Scale for Rating Psychiatric Patients (MSRPP) (1953) and Inpatient Multidimensional Psychiatric Scale (IMPS) (1960), have been included for rating on 7-point ordered category rating scales. The attempt has been to include a single scale to record degree of symptomacology in each of the relatively independent symptom areas which have been identified. Some of the preliminary work which has led to the identification of primary symptom constructs has been published (Gorham & Overall, 1960, 1961, Overall, Gorharn, & Shawver, 1961). While other reports are in preparation, applications of the Brief Scale in both pure and applied research suggest the importance of presenting the basic instrument to the wider scientific audience at this time, together with recommendations for its standard use. The primary purpose in developing the Brief Scale has been the development of a highly efficient, rapid evaluation procedure for use in assessing treatment change in psychiatric patients while at the same time yielding a rather comprehensive description of major symptom characteristics. It is recommended for use where efficiency, speed, and economy are important considerations, while more detailed evaluation procedures, such as those developed by Lorr (1953, 1961) should perhaps be wed in other cases. In order to achieve the maximum effectiveness in use of the Brief Scale, a standard interview procedure and more detailed description of rating concepts are included in this report. In addition, each symptom concept is defined briefly in the rating scale statements themselves. Raters using the scale should become thoroughly familiar with the scale definitions presented herein, after which the rating scale statements should be sufficient to provide recall of the nature and delineation of each symptom area. , To increase the reliability of ratings, it is recommended that patients be interviewed jointly by a team of two clinicians, with the two raters making independent ratings at the completion of the interview. An alternative procedure which has been recommended by some is to have raters discuss and arrive at a

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10,457 citations

"The Clinical Assessment Interview f..." refers methods in this paper

...Additional clinical characteristics were assessed with the 24-item BPRS (12), assessing positive, negative, depressionanxiety, and agitation domains (13); the Calgary Depression Scale for Schizophrenia (14); the modified Simpson-Angus Rating Scale for medication side effects (15); and the Scale for the Assessment of Negative Symptoms (SANS) (16)....
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Journal Article•DOI•

Behavioral inhibition, behavioral activation, and affective responses to impending reward and punishment: The BIS/BAS Scales

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Charles S. Carver¹, Teri L. White²•Institutions (2)

University of Miami¹, University of California, Los Angeles²

01 Aug 1994-Journal of Personality and Social Psychology

TL;DR: In this paper, self-report scales to assess dispositional BIS and behavioral activation system (BAS) sensitivities were created, and a situation in which Ss anticipated a punishment was created.

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Abstract: J. A. Gray (1981, 1982) holds that 2 general motivational systems underlie behavior and affect: a behavioral inhibition system (BIS) and a behavioral activation system (BAS). Self-report scales to assess dispositional BIS and BAS sensitivities were created. Scale development (Study 1) and convergent and discriminant validity in the form of correlations with alternative measures are reported (Study 2). In Study 3, a situation in which Ss anticipated a punishment was created. Controlling for initial nervousness, Ss high in BIS sensitivity (assessed earlier) were more nervous than those low in BIS sensitivity. In Study 4, a situation in which Ss anticipated a reward was created. Controlling for initial happiness, Ss high in BAS sensitivity (Reward Responsiveness and Drive scales) were happier than those low in BAS sensitivity. In each case the new scales predicted better than an alternative measure. Discussion is focused on conceptual implications.

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6,345 citations

"The Clinical Assessment Interview f..." refers methods in this paper

...Self-report measures included the Temporal Experience of Pleasure Scale (22), assessing anticipatory and consummatory pleasure; the Behavioral Inhibition/Behavioral Activation Scales (23), assessing sensitivity of approach and avoidance motivation systems; the Social Anhedonia Scale (24), assessing decreased social pleasure; and the Social Closeness Scale (25), assessing social engagement and desire for close relationships....
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Journal Article•DOI•

Research domain criteria (RDoC): toward a new classification framework for research on mental disorders

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Thomas R. Insel¹, Bruce N. Cuthbert¹, Marjorie A. Garvey¹, Robert K. Heinssen¹, Daniel S. Pine¹, Kevin J. Quinn¹, Charles A. Sanislow¹, Philip S. Wang¹ - Show less +4 more•Institutions (1)

National Institutes of Health¹

01 Jul 2010-American Journal of Psychiatry

5,173 citations

"The Clinical Assessment Interview f..." refers background in this paper

...Thus, items in the CAINS tap constructs covering approach motivation, pleasure, social engagement, and affective expression, which are also part of the NIMHResearch Domain Criteria (5, 6)....
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...Research that seeks to delineate the neurobiological and behavioral processes that undergird these symptoms, processes that are also a current focus of the Research Domain Criteria (5, 6, 39), will further help to focus the development of treatments for the motivation/pleasure and expression domains....
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