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SANS

1. Little change in facial expressions: Expressionless face, mechanical, indifferent, emotional response does not change or changes very little during conversation.
Please choose
1. Little change in facial expressions: Expressionless face, mechanical, indifferent, emotional response does not change or changes very little during conversation.
None
Suspicious
Mild
Moderate
Severe
Very severe
2. Reduced spontaneous movements: Sits still throughout the conversation, with few or no spontaneous movements, rarely changes position, posture, or moves hands or feet.
Please choose
2. Reduced spontaneous movements: Sits still throughout the conversation, with few or no spontaneous movements, rarely changes position, posture, or moves hands or feet.
None
Suspicious
Mild
Moderate
Severe
Very severe
3. Poor use of posture and gestures: When expressing ideas, does not use hands or body movement, for example, not leaning forward when talking about a major topic or not reclining when relaxing.
Please choose
3. Poor use of posture and gestures: When expressing ideas, does not use hands or body movement, for example, not leaning forward when talking about a major topic or not reclining when relaxing.
None
Suspicious
Mild
Moderate
Severe
Very severe
4. Poor eye contact: Avoids eye contact with others, does not use eyes to aid expression, eyes stare blankly ahead even when speaking.
Please choose
4. Poor eye contact: Avoids eye contact with others, does not use eyes to aid expression, eyes stare blankly ahead even when speaking.
None
Suspicious
Mild
Moderate
Severe
Very severe
5. No emotional reaction: Unable to smile or laugh even when hearing jokes or playful remarks.
Please choose
5. No emotional reaction: Unable to smile or laugh even when hearing jokes or playful remarks.
None
Suspicious
Mild
Moderate
Severe
Very severe
6. Lack of vocal inflection: The voice is often very monotonous, lacking normal modulation, not using tone or volume changes to emphasize important words. Even when discussing personal matters, the tone remains constant.
Please select
6. Lack of vocal inflection: The voice is often very monotonous, lacking normal modulation, not using tone or volume changes to emphasize important words. Even when discussing personal matters, the tone remains constant.
None
Suspicious
Mild
Moderate
Severe
Very Severe
7. General emotional flatness: A comprehensive assessment of the severity of symptoms, with emphasis on unresponsiveness, inadequacy, and overall reduction in emotional intensity.
Please select
7. General emotional flatness: A comprehensive assessment of the severity of symptoms, with emphasis on unresponsiveness, inadequacy, and overall reduction in emotional intensity.
None
Suspicious
Mild
Moderate
Severe
Very Severe
8. Lack of speech volume: There is limited spontaneous speech. Responses to questions are often brief, shallow, with little elaboration or additional explanations. Responses may consist of single words, or the patient may not answer at all. The examiner may feel the need to constantly prompt or encourage the patient to answer more thoroughly.
Please select
8. Lack of speech volume: There is limited spontaneous speech. Responses to questions are often brief, shallow, with little elaboration or additional explanations. Responses may consist of single words, or the patient may not answer at all. The examiner may feel the need to constantly prompt or encourage the patient to answer more thoroughly.
None
Suspicious
Mild
Moderate
Severe
Very Severe
9. Lack of speech content: Although the responses to questions may contain enough words, they provide insufficient information. The content may be vague, overly abstract, overly concrete, repetitive, or rigid. The examiner may find that the patient speaks a lot but doesn’t actually answer the question.
Please select
9. Lack of speech content: Although the responses to questions may contain enough words, they provide insufficient information. The content may be vague, overly abstract, overly concrete, repetitive, or rigid. The examiner may find that the patient speaks a lot but doesn’t actually answer the question.
None
Suspicious
Mild
Moderate
Severe
Very Severe
10. Speech interruptions: The speech flow is interrupted before a thought or concept is completed. After a silent pause lasting from seconds to minutes, the patient states that they cannot recall what they were saying or planning to say. If the patient voluntarily describes the pause as such, or when asked by the examiner, states that this was the reason for the pause, it can be considered a speech interruption.
Please select
10. Speech interruptions: The speech flow is interrupted before a thought or concept is completed. After a silent pause lasting from seconds to minutes, the patient states that they cannot recall what they were saying or planning to say. If the patient voluntarily describes the pause as such, or when asked by the examiner, states that this was the reason for the pause, it can be considered a speech interruption.
None
Suspicious
Mild
Moderate
Severe
Very Severe
11. Delayed responses: The patient takes significantly longer to answer questions than normal. They may appear “indifferent.” The examiner may question whether the patient heard the question, but will find that the patient knows what was asked and is merely struggling to form an appropriate response.
Please select
11. Delayed responses: The patient takes significantly longer to answer questions than normal. They may appear “indifferent.” The examiner may question whether the patient heard the question, but will find that the patient knows what was asked and is merely struggling to form an appropriate response.
None
Suspicious
Mild
Moderate
Severe
Very Severe
6. Lack of tonal fluctuation: The tone is often monotonous, lacking normal intonation, and does not use changes in pitch or volume to emphasize important words. Even when talking about personal matters, the tone does not soften. Almost all speech is in a single tone.
Please choose
6. Lack of tonal fluctuation: The tone is often monotonous, lacking normal intonation, and does not use changes in pitch or volume to emphasize important words. Even when talking about personal matters, the tone does not soften. Almost all speech is in a single tone.
None
Suspicious
Mild
Moderate
Severe
Very Severe
7. Overall emotional flatness: Comprehensive assessment of the severity of the symptoms, with a focus on unresponsiveness, inappropriateness, and a general reduction in emotional intensity.
Please choose
7. Overall emotional flatness: Comprehensive assessment of the severity of the symptoms, with a focus on unresponsiveness, inappropriateness, and a general reduction in emotional intensity.
None
Suspicious
Mild
Moderate
Severe
Very Severe
8. Poverty of speech: The amount of spontaneous speech is limited, resulting in simple, superficial answers that are not elaborated upon. There is little self-initiated supplementary explanation. Answers may consist of single words, or there may be no answer at all. The examiner often feels the need to constantly encourage the patient to provide more detailed answers.
Please choose
8. Poverty of speech: The amount of spontaneous speech is limited, resulting in simple, superficial answers that are not elaborated upon. There is little self-initiated supplementary explanation. Answers may consist of single words, or there may be no answer at all. The examiner often feels the need to constantly encourage the patient to provide more detailed answers.
None
Suspicious
Mild
Moderate
Severe
Very Severe
9. Poverty of speech content: Although the speech volume is sufficient, it does not provide adequate information. The content may be vague, too abstract or too concrete, repetitive, or stereotypical. The examiner may find that the patient says a lot but does not answer the question.
Please choose
9. Poverty of speech content: Although the speech volume is sufficient, it does not provide adequate information. The content may be vague, too abstract or too concrete, repetitive, or stereotypical. The examiner may find that the patient says a lot but does not answer the question.
None
Suspicious
Mild
Moderate
Severe
Very Severe
10. Speech interruption: Speech is interrupted before a thought or concept is completed. After several seconds to minutes of silence, the patient states that they cannot remember what they were talking about or what they intended to say. If the patient voluntarily describes their thinking or responds to an examiner’s inquiry, indicating that this is the reason for the pause, it is considered speech interruption.
Please choose
10. Speech interruption: Speech is interrupted before a thought or concept is completed. After several seconds to minutes of silence, the patient states that they cannot remember what they were talking about or what they intended to say. If the patient voluntarily describes their thinking or responds to an examiner’s inquiry, indicating that this is the reason for the pause, it is considered speech interruption.
None
Suspicious
Mild
Moderate
Severe
Very Severe
11. Slow response: The patient takes more time than usual to answer questions. They appear “indifferent.” The examiner may wonder if the patient heard the question, but it becomes clear that the patient understood the question and simply has difficulty forming their thoughts to provide an appropriate answer.
Please choose
11. Slow response: The patient takes more time than usual to answer questions. They appear “indifferent.” The examiner may wonder if the patient heard the question, but it becomes clear that the patient understood the question and simply has difficulty forming their thoughts to provide an appropriate answer.
None
Suspicious
Mild
Moderate
Severe
Very Severe
17. Decreased interest and activities in entertainment: The patient shows little or no interest or hobbies. Although this symptom may occur insidiously or gradually, there is a noticeable decline compared to the previous level of interest and activity. Patients with mild loss of interest often appear passive or indifferent, for example, only occasionally showing interest in watching TV. The most severe manifestation is complete non-participation or refusal to engage in activities. Both the quality and quantity of interest in entertainment should be considered during evaluation.
Please select
17. Decreased interest and activities in entertainment: The patient shows little or no interest or hobbies. Although this symptom may occur insidiously or gradually, there is a noticeable decline compared to the previous level of interest and activity. Patients with mild loss of interest often appear passive or indifferent, for example, only occasionally showing interest in watching TV. The most severe manifestation is complete non-participation or refusal to engage in activities. Both the quality and quantity of interest in entertainment should be considered during evaluation.
None
Suspicious
Mild
Moderate
Severe
Extreme
18. Decreased sexual activity: Given the patient’s age and marital status, sexual interest and activity have decreased. Married patients may show a lack of interest in sexual life or engage in sex only passively. In severe cases, the patient may not participate in any sexual activity at all. Single individuals may not be involved in sexual activities for a long period and have no desire to fulfill these needs. Whether married or single, the patient may feel little sexual desire and derive little pleasure from sex or masturbation.
Please select
18. Decreased sexual activity: Given the patient’s age and marital status, sexual interest and activity have decreased. Married patients may show a lack of interest in sexual life or engage in sex only passively. In severe cases, the patient may not participate in any sexual activity at all. Single individuals may not be involved in sexual activities for a long period and have no desire to fulfill these needs. Whether married or single, the patient may feel little sexual desire and derive little pleasure from sex or masturbation.
None
Suspicious
Mild
Moderate
Severe
Extreme
19. Lack of intimacy: The patient finds it difficult to establish intimate feelings with others.
Please select
19. Lack of intimacy: The patient finds it difficult to establish intimate feelings with others.
None
Suspicious
Mild
Moderate
Severe
Extreme
20. Decreased interest in making friends: The patient has a limited range of interactions with friends and peers. Regardless of gender, they have few or no friends and do not try to develop relationships, spending most of their time alone.
Please select
20. Decreased interest in making friends: The patient has a limited range of interactions with friends and peers. Regardless of gender, they have few or no friends and do not try to develop relationships, spending most of their time alone.
None
Suspicious
Mild
Moderate
Severe
Extreme
21. Lack of interest/social activities overall assessment: A comprehensive assessment of the severity of lack of interest or social activities should be conducted. Age, gender, and family situation should be taken into account.
Please select
21. Lack of interest/social activities overall assessment: A comprehensive assessment of the severity of lack of interest or social activities should be conducted. Age, gender, and family situation should be taken into account.
None
Suspicious
Mild
Moderate
Severe
Extreme
22. Lack of attention to social interaction: The patient shows a lack of attention to social work or activities, looking elsewhere during conversations, not engaging in discussions, or displaying a lack of involvement or participation. They may abruptly stop discussions for no apparent reason. They seem to have a sense of "alienation" or "being an outsider." Their attention also cannot be concentrated during games, reading, or watching television.
Please select
22. Lack of attention to social interaction: The patient shows a lack of attention to social work or activities, looking elsewhere during conversations, not engaging in discussions, or displaying a lack of involvement or participation. They may abruptly stop discussions for no apparent reason. They seem to have a sense of "alienation" or "being an outsider." Their attention also cannot be concentrated during games, reading, or watching television.
None
Suspicious
Mild
Moderate
Severe
Extreme
23. Lack of concentration during psychological testing: Although the patient has a considerable level of education and intelligence, their performance on simple intelligence tests is poor. This can be assessed by subtracting 7 from 100 (for those with at least a middle school education) or subtracting 3 from 100 (for those with at least a primary school education), with five consecutive subtractions, scoring 10 points for getting all incorrect.
Please select
23. Lack of concentration during psychological testing: Although the patient has a considerable level of education and intelligence, their performance on simple intelligence tests is poor. This can be assessed by subtracting 7 from 100 (for those with at least a middle school education) or subtracting 3 from 100 (for those with at least a primary school education), with five consecutive subtractions, scoring 10 points for getting all incorrect.
None
Suspicious
Mild
Moderate
Severe
Extreme
24. Overall assessment of attention disorder: This score should assess the patient's overall attention in clinical and testing settings.
Please select
24. Overall assessment of attention disorder: This score should assess the patient's overall attention in clinical and testing settings.
None
Suspicious
Mild
Moderate
Severe
Extreme
Score:

Result Interpretation

Total score of the scale: the sum of the scores from the 24 individual items (ranging from 0 - 120)

Total score of the subscale comprehensive evaluation: the total score of the 5 subscales (items 7, 12, 16, 21, and 24) (ranging from 0 - 25)

Subscale comprehensive evaluation: the individual scores from the 5 subscales (5 scores)

Result types: According to the author's recommendations, the schizophrenia can be further classified according to the results of SANS and SAPS. If the total evaluation score of the subscales ≥ 3, it is called the "prominent symptom group," and then based on the relevant positive and negative "prominent symptom groups" and their combinations, it is classified into 3 types:

① Positive symptom predominant type. There is one or more prominent positive symptom groups, with no prominent negative symptom groups.

② Negative symptom predominant type. There are two or more prominent negative symptom groups, with no prominent positive symptom groups.

③ Mixed type: does not meet the criteria of either ① or ②.

In 1982, N. Andreasen in the USA developed the Scale for the Assessment of Negative Symptoms (SANS) and the Scale for the Assessment of Positive Symptoms (SAPS) due to the need to study schizophrenia with predominant negative and positive symptoms. SANS addresses the previous shortcomings in psychiatric assessment scales concerning negative symptoms.

The 24 items of SANS are divided into 5 subscales: 1. Flat or blunted affect; 2. Poverty of thought; 3. Lack of volition; 4. Lack of interest or social engagement; 5. Attention disorder.

The scoring is based on a 6-point scale: (0) None, normal or increased; (1) Suspicious; (2) Mild, exists but is mild; (3) Moderate; (4) Significant; (5) Severe. Each item has specific assessment criteria. SANS is assessed over the past month. For pharmacological research, it can be shortened to one week.

Generally, a natural clinical psychiatric examination method is used for communication. Initially, based on previous materials and clinical experience, determine a topic that the patient is most likely to engage in to introduce the examination.

References

Research Paper Andreasen NC. The Scale for the Assessment of Negative Symptoms (SANS): conceptual and theoretical foundations. Br J Psychiatry Suppl. 1989;(7):49-58.
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