Measures the prevalence of positive and negative syndromes in schizophrenia.

Positive Scale


1. Beliefs which are unfounded, unrealistic, and idiosyncratic

Conceptual disorganization

2. Disorganized process of thinking characterized by disruption of goal-directed sequencing

Hallucinatory behavior

3. Verbal report or behavior indicating perceptions which are not generated by external stimuli


4. Hyperactivity as reflected in accelerated motor behavior, heightened responsivity to stimuli, hypervigilance, or excessive mood lability


5. Exaggerated self-opinion and unrealistic convictions of superiority, including delusions of extraordinary abilities, wealth, knowledge, fame, power, and moral righteousness


6. Unrealistic or exaggerated ideas of persecution, as reflected in guardedness, distrustful attitude, suspicious hypervigilance, or frank delusions that others mean harm


7. Verbal and nonverbal expressions of anger and resentment, including sarcasm, passive-aggressive behavior, verbal abuse, and assaultiveness

Negative Scale

Blunted affect

8. Diminished emotional responsiveness as characterized by a reduction in facial expression, modulation of feelings, and communicative gestures

Emotional withdrawal

9. Lack of interest in, involvement with, and affective commitment to life’s events

Poor rapport

10. Lack of interpersonal empathy, openness in conversation, and sense of closeness, interest, or involvement with the interviewer

Passive-apathetic social withdrawal

11. Diminished interest and initiative in social interactions due to passivity, apathy, anergy, or avolition

Difficulty in abstract thinking

12. Impairment in the use of the abstract-symbolic mode of thinking, as evidenced by difficulty in classification, forming generalizations, and proceeding beyond concrete or egocentric thinking in problem-solving tasks

Lack of spontaneity and flow of conversation

13. Reduction in the normal flow of communication associated with apathy, avolition, defensiveness, or cognitive deficit

Stereotyped thinking

14. Decreased fluidity, spontaneity, and flexibility of thinking, as evidenced in rigid, repetitious, or barren thought content

General Psychopathology Scale

Somatic concern

15. Physical complaints or beliefs about bodily illness or malfunctions


16. Subjective experience of nervousness, worry, apprehension, or restlessness, ranging from excessive concern to feelings of panic about the present or future

Guilt feelings

17. Sense of remorse or self-blame for real or imagined misdeeds in the past


18. Overt physical manifestations of fear, anxiety, and agitation, such as stiffness, tremor, profuse sweating, and restlessness

Mannerisms and posturing

19. Unnatural movements or posture as characterized be an awkward, stilted, disorganized, or bizarre appearance


20. Feelings of sadness, discouragement, helplessness, and pessimism

Motor retardation

21. Reduction in motor activity as reflected in slowing or lessening of movements and speech, diminished responsiveness of stimuli, and reduced body tone


22. Active refusal to comply with the will of significant others, including the interviewer, hospital staff or family, which may be associated with distrust, defensiveness, stubbornness, negativism, rejection of authority, hostility, or belligerence

Unusual thought content

23. Thinking characterized by strange, fantastic, or bizarre ideas, ranging from those which are remote or atypical to those which are distorted, illogical, and patently absurd


24. Lack of awareness of one’s relationship to the milieu, including persons, place, and time, which may be due to confusion or withdrawal

Poor attention

25. Failure in focused alertness manifested by poor concentration, distractibility from internal and external stimuli, and difficulty in harnessing, sustaining, or shifting focus to new stimuli

Lack of judgement and insight

26. Impaired awareness or understanding of one’s own psychiatric condition and life situation

Disturbance of volition

27. Disturbance in the willful initiation, sustenance, and control of one’s thoughts, behavior, movements, and speech

Poor impulse control

28. Disordered regulation and control of action on inner urges, resulting in sudden, unmodulated, arbitrary, or misdirected discharge of tension and emotions without concern about consequences


29. Absorption with internally generated thoughts and feelings and with autistic experiences to the detriment of reality orientation and adaptive behavior

Active social avoidance

30. Diminished social involvement associated with unwarranted fear, hostility, or distrust


Total Points


Points (Positive Scale)


Points (Negative Scale)


Points (General Psychopathology Scale)

Scale Reading

Schizophrenia severity


Final diagnosis should be made with clinical interview and mental status examination including assessment of patient’s level of distress and functional impairment.


PHQ-9 Management Summary
Score Depression severity Comments
0-4 Minimal or none Monitor; may not require treatment
5-9 Mild Use clinical judgment (symptom duration, functional impairment) to determine necessity of treatment
10-14 Moderate
15-19 Moderately severe Warrants active treatment with psychotherapy, medications, or combination
20-27 Severe


  • Perform suicide risk assessment in patients who respond positively to item 9 “Thoughts that you would be better off dead or of hurting yourself in some way.”
  • Rule out bipolar disorder, normal bereavement, and medical disorders causing depression.


Addition of the selected points.


The PHQ-9 is a validated, 9-question tool to assess for the degree of depression present in an individual; the last question is not scored, but is useful functionally to help the clinician assess the impact of the patient's symptoms on his or her life.


The PHQ-9 was initially developed by Kroenke et al (2001), as a subset of 9 questions from the full PHQ, which had previously been derived and studied in a cohort of 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics (Spitzer 1999). PHQ-9 scores ≥10 were found to be 88% sensitive and also 88% specific for detecting MDD. Criterion validity was also assessed in a sample of 580 patients.

The PHQ-9 has also been validated in several additional subpopulations, including in psychiatric patients (Beard 2016), patients with medical comorbidities such as multiple sclerosis (Ferrando 2007) and Parkinson’s disease (Chagas 2013), pregnant patients (Sidebottom 2012), and in an occupational health setting (Volker 2016).

A meta-analysis of 29 studies including 6,725 patients found similar sensitivity (88%, 95% CI 83-92%) and specificity (85%, 95% CI 82-88%) for a cutoff of ≥10 as did the previous studies, both overall and for subgroups. Notably, they found that when used in the primary care setting, only approximately 50% of patients screening positive on the PHQ-9 in fact had major depression (Levis 2019).