Predictive Validity of the 5-Factor PANSS Model in Acute Schizophrenia: Early Response to Aripiprazole and Brexpiprazole.

BACKGROUND

Predicting early treatment response in acute schizophrenia is critical yet challenging. This observational study aimed to determine whether improvements in specific symptom domains after 2 weeks predict overall response at 6 weeks in patients treated with aripiprazole (ARI) or brexpiprazole (BRE).

METHODS

We included 65 patients (34 antipsychotic-naïve and 31 antipsychotic-free recurrent) treated with flexible doses of ARI or BRE. Benzodiazepines were used in 41 patients (64.1%), and their use did not significantly impact prediction. The Positive and Negative Syndrome Scale (PANSS) and Clinical Global Impression-Improvement were used to assess responses.

RESULTS

Receiver operating characteristic analysis revealed area under the curve values for PANSS total (PANSS-T), negative, excitement, cognitive, positive, and depressive/anxiety components of 0.788, 0.783, 0.603, 0.746, 0.738, and 0.735, respectively. Kendall's tau correlation and Cramer's V revealed significant predictive relationships for PANSS-T (0.413, P <0.001), negative (0.411, P <0.001), and therapeutic response dichotomized by this score (0.573, P <0.001), cognitive (0.364, P <0.001), positive (0.344, P <0.001), and depression/anxiety (0.344, P =0.001), but not for excitement (0.15, P =0.151). Benzodiazepine use did not significantly impact these predictive associations.

CONCLUSIONS

This study is the first to evaluate the predictive validity of the PANSS 5-factor model in patients with acute schizophrenia treated with ARI/BRE. Early symptom improvements, particularly in negative domains, are stronger predictors of overall response, while excitement symptom improvements showed a weaker relationship. These findings underscore the importance of early, symptom-specific assessments to optimize treatment strategies for acute schizophrenia. Further studies with larger samples are necessary to validate these results.