Original Paper
Psychopathology
DOI: 10.1159/000472154
Validation of the Five-Factor Model of the Arabic
Version of the Positive and Negative Syndrome
Scale in Schizophrenia
Arij Yehya a Suhaila Ghuloum d Ziyad Mahfoud b Mark Opler e Anzalee Khan f, g
Samer Hammoudeh a Yahya Hani d Hassen Al-Amin c
Departments of a Research, b Health Policy and Research and c Psychiatry, Weill Cornell Medicine – Qatar, and
d
Department of Psychiatry, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar; e CSO-Prophase LLC,
New York, NY, f NeuroCog Trials, Durham, NC, and g Nathan S. Kline Institute for Psychiatric Research,
Orangeburg, NY, USA
Keywords
Schizophrenia · Arabic Positive and Negative Syndrome
Scale · Cultural psychiatry · Principal components analysis
Abstract
Background: The Positive and Negative Syndrome Scale
(PANSS) is a widely used assessment for patients with schizo-
phrenia across clinical and research settings. This scale al-
lows the classification of the psychotic symptoms to better
understand the psychopathology in patients with schizo-
phrenia. There are no available data on the different compo-
nents of psychopathology in Arab patients with schizophre-
nia. Objectives: This study examined the factor structure of
the validated Arabic version of the PANSS in a sample of Arab
patients with schizophrenia. Methods: The Arabic version of
the PANSS was administered to 101 patients with schizo-
phrenia, and principal component analysis (PCA) was carried
out after the cross-cultural adaptation and validation of this
version. Results: This sample had more males (66.3%) than
females (33.7%) with a mean age of 35.03 years (SD = 9.99).
PCA showed that 28 items loaded on 5 components: cogni-
tive, negative, excited, depressed and positive. These factors
explained 63.19% of variance. The 2 remaining items, gran-
diosity and somatic concerns, did not load well on any of
© 2017 S. Karger AG, Basel
E-Mail karger@karger.com
www.karger.com/psp
Received: November 8, 2016
Accepted after revision: March 24, 2017
Published online: May 18, 2017
these components. Conclusion: Our results support the
common 5-dimension PANSS model shown in other cultures
with different languages. Nevertheless, there were minor
differences, which could reflect cultural or semantic differ-
ences. © 2017 S. Karger AG, Basel
Introduction
Schizophrenia is a chronic mental disorder that affects
multiple domains of human emotions, thinking and be-
havior. A systematic review has shown that the lifetime
prevalence of schizophrenia worldwide is 4 per 1,000 per-
sons [1]. Schizophrenia is known to affect the patients’
daily functioning and social activities, which in turn re-
sult in an increased burden on the patients’ family and
society [2]. Kay et al. [3] developed the Positive and Neg-
ative Syndrome Scale (PANSS) to capture the symptoms
observed in patients with schizophrenia. This scale has
been translated into Arabic and validated in the Arab
population [4]. The PANSS is made up of 30 items that
use a Likert-type scale ranging from 1 “absent” to 7 “ex-
treme.” The authors of the scale originally grouped the
items into 3 subscales: positive symptoms, negative symp-
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Univ. of California San Diego
Hassen Al-Amin, MD
Weill Cornell Medicine – Qatar, Education City
PO Box 24144
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Doha (Qatar)
E-Mail haa2019 @ qatar-med.cornell.edu
toms and general psychopathology [3]. The former 2 sub-
scales are made up of 7 items each, while the third com-
prises 16 items that cover symptoms such as depression,
anxiety, guilt feelings, and impulse control. White et al.
[5] derived a model by performing exploratory factor
analysis (EFA) that resulted in 5 factors from a pentago-
nal model. These factors were labeled: positive, negative,
dysphoric mood, activation, and autistic preoccupation.
It is this 5-factor model that is presently proposed in the
manual for the PANSS (Multi-Health Systems Inc.,
PANSS). The PANSS has good reliability and validity [3]
and is currently the most used tool in clinical and research
settings. Although schizophrenia has been viewed as hav-
ing the same manifestations worldwide especially in se-
vere cases [6], other studies have shown that developed
countries have dominantly delusions and thought disor-
der while in many developing countries the predominant
symptoms are hallucinations [7, 8].
Studies across cultures characterized the different di-
mensionality of the PANSS using principal component
analysis (PCA). Different models of factor structure were
proposed and supported by diverse samples. For instance,
Kay and Sevy [9] proposed a 4-factor model. Bell et al.
[10] showed a 5-factor model of the PANSS that best fit
the published data. Van den Oord et al. [11] supported a
6-factor model while Emsley et al. [12] showed the stabil-
ity of a 7-factor model. Levine and Rabinowitz [13] used
the parallel analysis and PCA and confirmed the 5 dimen-
sions of the PANSS using a large sample from 2 clinical
trials. These new models changed the assessed outcomes
of the treatments given in clinical settings [14] and helped
to create specialized treatments based on the patients’
scores on different factors [15, 16]. The 5-factor model
was found to be the most stable across the studies done
on different cultures and in many countries [17]. These
countries included France [18], Germany [19], Greece
[20], the USA [21], Brazil [21], and China [21, 22]. The
factors are commonly referred to as positive, negative,
cognitive (or disorganized), excited (or hostility) and de-
pressive/anxiety. The items loaded on each factor are very
similar to the ones reported by White et al. [5]; the posi-
tive and negative ones still carry the same labels but the
dysphoric mood corresponds to the item now known as
depressive/anxiety, the activation one refers to the excited
factor and the autistic preoccupation fits the cognition (or
disorganized) factor.
Schizophrenia is prevalent in the Arab region as well
[23]. Ghuloum et al. [24] reported that the prevalence of
schizophrenia in patients visiting primary care settings in
Qatar was 3.6%. However, to our knowledge, there is no
2 Psychopathology
DOI: 10.1159/000472154
published study that analyzed the factor model in the
Arab population. The aim of this study is to explore the
factor structure of the Arabic version of the PANSS in
Arab patients with schizophrenia. This will help in under-
standing the specific domains of the symptomatology of
schizophrenia in this population.
Methods
This cross-sectional study is part of a larger project done in
Qatar to validate several Arabic rating scales that are used in the
assessment and treatment of patients with schizophrenia. It is
noteworthy that the EFA was done on the same sample in which
the version was validated. The Institutional Review Boards at Ha-
mad Medical Corporation and Weill Cornell Medicine in Qatar
both approved this study. All participants signed a consent form
after the procedures involved and their duration had been ex-
plained. The study was conducted between February 2013 and No-
vember 2014.
There has been a debate about the sample size needed for a
proper recovery of population factors. Comrey and Lee [25] pro-
posed a sample less than 300 to be fair. However, in circumstances
when the most communalities are good (generally >0.60) and fac-
tor structure is robust, a sample size of 100 is considered sufficient
for PCA [26, 27]. We opted to recruit 100 patients in this study to
ensure generalizability of the results to the Arab population in
Qatar.
Subjects
Participants were recruited from the Psychiatry Department at
Rumailah Hospital in Doha, Qatar. This psychiatric facility is the
only available one in Doha, and it has 70 inpatient beds (95% oc-
cupancy) and 10 daily outpatient clinics that receive about 120
patients per day. Most of the inpatients are admitted with acute
psychosis, and about 25% of outpatients have schizophrenia. Pa-
tients recruited had to be between 18 and 65 years of age and know
Arabic as their native language. Patients with a history of drug or
alcohol abuse or who were at risk of harming themselves or others
were excluded from this study. The diagnosis of schizophrenia
among these eligible patients was confirmed by the Arabic version
of the Mini International Neuropsychiatric Interview for Schizo-
phrenia and Other Psychotic Disorders (MINI-6) [28]. MINI-6
uses a semistructured interview and follows the DSM-IV-TR
(American Psychiatric Association, 2000) criteria to establish the
diagnosis.
Procedure
Trained raters administered the Arabic version of the Struc-
tured Clinical Interview for the PANSS to 101 patients (see Yehya
et al. [4] for details). This interview was developed by Kay et al. [29]
to assist in PANSS rating and took 30–45 min to complete. Infor-
mation about the sociodemographics of the patients was collected
(such as gender, nationality, marital status, education). In addi-
tion, patients’ clinical features were recorded including duration
of illness, duration of treatment, current treatment type and anti-
psychotic dosage.
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 Statistical Analysis Table 1. Sociodemographics of the sample
The data collected were analyzed using the Statistical Package
for Social Sciences version 23 (SPSS v23.0, Chicago, IL, USA). For Frequency Percentage
summarizing the data (sociodemographic and clinical), mean and
standard deviation were calculated for the continuous measures Gender
while the discrete data were expressed as a percentage. The dose Males 67 66.3
equivalences were calculated based on chlorpromazine 100 mg as Females 34 33.7
reported in Andreasen et al. [30]. To determine the number of com- Nationality
ponents that lie behind the 30 items of the PANSS we followed the Egypt 5 5.0
approach by Levine and Rabinowitz [13]. We performed parallel Qatar 61 60.4
analysis using the SPSS syntax available online (https://people. Sudan 13 12.9
ok.ubc.ca/brioconn/nfactors/rawpar.sps) [31]. This program was Other 22 21.7
run on all data sets using the principal axis/common factor analysis Education
for 20 simulations of normally distributed random data generation No schooling 2 2
with the percentile of 90. EFA was also carried out using principal Elementary/intermediate 36 35.6
component extraction analysis (PCA) with varimax rotation. This Secondary/high school 39 38.6
analysis is robust to normality, multicollinearity and singularity, Vocational/diploma 2 2.0
and it has limited assumptions [32]. The factor structure of the College/postgraduate degree 22 21.8
PANSS was fitted, with eigenvalues higher than 1 being retained for Employment
factor extraction. Factor loadings of 0.5 or higher were considered Employed 31 30.7
in the interpretation of the factors. The scree plot was inspected to Unemployed 55 54.5
determine the number of factors with an eigenvalue greater than 1 Student 10 9.9
as cutoff [33]. Items that factored less than 0.30 were dropped from Retired 3 2.97
the EFA. Anti-imaging correlation tables were inspected as well as Not reported 2 1.98
the Kaiser-Mayer-Olkin and Bartlett tests. The internal consistency Marital status
of each factor was determined by Cronbach’s α. Married 27 26.7
Single 62 61.4
Other (divorced/widowed) 12 11.9

Results

Sociodemographic Measures Table 2. Clinical features of the sample

Patients in this study were 18–62 years old, with a
mean age of 35.03 years (SD = 9.99). Table 1 shows the Range Mean SD
sociodemographic information of the sample. The latter
Duration of illness, years 0 – 40 11.69 8.98
had more males than females. Many of the participants Duration of treatment,
were Qatari but not all Arab countries were equally rep- years 0 – 39 11.02 8.74
resented in this sample; however, the sample included Ar- AP dose equivalence, mg 43.84 – 4,848.81 1,067.11 1,424.61
abs from various countries (i.e. Egypt, Sudan, Algeria, PANSS total score 30 – 128 73.22 23.18
Bahrain, Jordan, Lebanon, Libya, Saudi Arabia, Syria, and PANSS positive 7 – 37 19.88 7.07
PANSS negative 7 – 39 18.76 8.71
Yemen). In general, patients were educated with at least
PANSS general
an elementary degree, and 21.8% had a college degree. psychopathology 16 – 65 34.57 11.53
More than half of the patients were unemployed and sin-
gle. AP (antipsychotics) dose equivalence was based on chlorprom-
azine 100 mg [29].
Clinical Features
The clinical and treatment profile of the patients in this
study is presented in Table 2. The duration of illness of
these schizophrenia patients ranged from less than 1 to 40 were on a combination of first- and second-generation
years. Similarly, the duration of treatment showed high antipsychotics, while only 9 (8.9%) were on first-genera-
variability with a mean of 11.02 years and a standard de- tion antipsychotics only. The rest were not currently on
viation of 8.74. As for the treatment profiles, the number any antipsychotics (30 patients, 29.7%). Those who were
of hospitalizations for patients ranged between 1 and 18 under antipsychotic treatment had a mean equivalent
with a median of 3. When recruited, 44 patients (43.6%) dose of 1,067.1 mg (SD = 1,424.61). Patients scored a
were on second-generation antipsychotics, 18 (17.8%) mean of 73.22 (SD = 23.18; range 30–128) on the PANSS
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Factor Structure of Arabic PANSS Psychopathology 3

DOI: 10.1159/000472154
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Table 3. PCA of the Arabic version of the PANSS

h2 Cognitive Negative Excited Depressed Positive Sixth Seventh

factor factor factor factor factor factor factor

P2 conceptual disorganization 0.74 0.729

N5 difficulty in abstract thinking 0.66 0.771
N7 stereotyped thinking 0.69 0.715
G10 disorientation 0.70 0.725
G11 poor attention 0.62 0.687
G13 disturbance of volition 0.69 0.628
G15 preoccupation 0.71 0.531
N1 blunted affect 0.78 0.707
N2 emotional withdrawal 0.79 0.771
N3 poor rapport 0.77 0.695
N4 passive apathetic social withdrawal 0.75 0.815
N6 lack of spontaneity and flow of conversation 0.82 0.647
G12 lack of judgment and insight 0.66 0.486
G16 active social avoidance 0.75 0.747
P4 excitement 0.70 0.689
P7 hostility 0.70 0.710
G4 tension 0.64 0.453
G5 mannerisms and posturing 0.68 0.495
G7 motor retardation 0.69 –0.496
G8 uncooperativeness 0.47 0.602
G14 poor impulse control 0.74 0.548
G2 anxiety 0.65 0.743
G3 guilt feelings 0.64 0.770
G6 depression 0.72 0.786
P1 delusions 0.71 0.510
P3 hallucinatory behavior 0.84 0.872
P6 suspiciousness persecution 0.67 0.481
G9 unusual thought content 0.77 0.570
P5 grandiosity 0.77 0.838
G1 somatic concerns psychopathology 0.69 0.691
Percentage variance explained 32.77% 12.92% 8.09% 4.98% 4.42%

total composite score, suggesting that this group is “mod-
erately ill” [34]. The score ranges on PANSS positive and
negative subscales were almost equal (Table 2).
Exploratory Factor Analysis
Using PCA, the items loaded on 7 factors. Bartlett’s
test of sphericity indicates that the correlation matrix is
significantly different from an identity matrix, with
χ2(435) = 1,871.57, p < 0.001. The sample adequacy for
the EFA was verified using the approach of Field [35]
where the Kaiser-Mayer-Olkin test result (0.763 in this
sample) should be >0.60. The results showed that the
original 30 items of the PANSS were empirically summa-
rized by 7 components that accounted for 70.59% of vari-
ance. Communality values tended to be high with a cutoff
of 0.45, and hence all were included in the interpretation
of the factors (Table 3). Items on grandiosity (P5) and so-
matic concerns psychopathology (G1) factored alone and
hence were excluded from further analysis since they only
explained a small percentage of the variance (less than
4%). Thus, the total variance explained by the 5 compo-
nents (28 items) was 63.19%. The 5-dimension model was
also confirmed by the results of the parallel analysis (with
20 simulations) where only the eigenvalues of the first 5
components from the raw data were greater than the
means and the simulated eigenvalues of the 90th percen-
tile of randomly generated data [31].
Table  3 presents the factor loadings of the different
items. Table  4 provides the eigenvalues, percentage of
variances and mean with standard deviation of each fac-
tor. The factor that explained the highest percentage of
variance was the cognitive factor, 32.77%. This factor had
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7 items: conceptual disorganization, difficulty in abstract
thinking, disorientation, poor attention, disturbance of
volition and preoccupation. The negative factor explained
less variance, and it included the rest of the negative items
(blunt affect, emotional withdrawal, poor rapport, social
withdrawal, lack of spontaneity), in addition to lack of
judgment and insight and active social avoidance. The
excited factor explained 8.09% of variance and factored 7
items: poor impulse control, excitement, tension, hostil-
ity, mannerisms and posturing, uncooperativeness, and
motor retardation. The latter item negatively factored
with this excited component. Only 3 items factored on the
depression factor (anxiety, guilt feelings, depression), and
they explained 4.98% of the variance. The last was the
positive factor, and it explained the least of the variance
(4.42%). Items that loaded on this factor were delusions,
hallucinatory behavior, suspiciousness, persecution and
unusual thought content.
The cognitive and negative factors had the highest
number of items with the highest PANSS mean scores.
The positive factor had also a high mean when consider-
ing that it had only 4 items (Table 4). Finally, the item
loadings of the 5 factors from our study and another 6
different studies in other countries are summarized in Ta-
ble 5. The similarities and differences in these different
cultures will be discussed below.
Discussion
The aim of this project was to study the factor structure
of the Arabic version of the PANSS in patients with
schizophrenia. Our results showed that there are 5 fac-
tors: cognition, negative, excited, depressed, and positive.
A review of the component analyses done on the PANSS
on other diverse samples showed that the 5-dimension
model was the most common [17]. Our factor structure
provides a good model as it accounts for 63.19% of the
total variance, which is very similar to that reported in
several other studies as shown in Table 5. This is the first
study to administer the validated Arabic version of the
PANSS in the Arab region and to validate the component
loading in Arab patients with schizophrenia.
The factor that explained the most variance in our
study was cognition (32.77%). The factor that had the
highest percentage of variance explained differs from
study to study. For instance, in the Chinese population
[36] the positive factor had the highest percentage of
variance explained. This positive factor explained the
least of the variance in our study. Lykouras et al. [20]
Factor Structure of Arabic PANSS
Table 4. Scores on the different factors of the Arabic PANSS
Factors Items, n Mean (SD) Eigen- Total Cumulative
value variance, % variance, %
Cognitive 7 17.76 (7.88) 9.832 32.77 32.77
Negative 7 17.98 (8.21) 3.875 12.92 45.69
Excitement 7 11.19 (4.61) 2.427 8.09 53.78
Depression 3 7.21 (3.26) 1.495 4.98 58.76
Positive 4 15.28 (5.43) 1.327 4.42 63.19
found that the negative factor had this highest percentage
in Greece. In our study, however, the negative factor had
the second highest percentage of variance explained, and
the excited factor explained more than the depressed
one. This was also found when factoring the scores on the
PANSS from patients in France [18]. The clinical factors
in each sample like the duration of illness and treatment
could play a major role in the differences between the
variances of each factor; for example, the majority of our
patients have been taking relatively high doses of medi-
cations for several years (Table 2), which might had con-
tributed to the lower scores on the positive factor. How-
ever, other studies suggested that variations in the psy-
chotic symptoms could reflect unique cultural aspects
[37]. In this regard, studies from the developing coun-
tries reported a higher frequency of hallucinations while
those from western developed ones showed more de-
pressive symptoms, delusions and thought insertion/
broadcasting [7, 8].
Our loadings were compared to other cultures as pre-
sented in Table 5. In this sample of Arab patients, some
items loaded on the cognitive factor similarly to other
studies [9, 18, 20]. In addition, items on volition and pre-
occupation loaded on this factor too. Similar results were
found in the Chinese population [22]. However, in other
studies, volition usually loaded on the negative factor [9,
20]. Preoccupation loaded on depression/anxiety in Kay
and Sevy’s [9] components analysis. For the negative fac-
tor, the items that loaded on it were similar to those in
other studies as shown in Table 5, except for the item on
lack of judgment and insight. This item was similarly fac-
tored with the negative items in China [22] but loaded on
the positive factor in other studies [9, 18]. It is generally
possible that items from the cognitive factor (also known
as disorganized/concrete in other studies) might overlap
with the negative factor as many negative features might
reflect cognitive deficits that are attributed to neurodevel-
opmental deficits regardless of cultural attributes. The
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Psychopathology 5
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Table 5. Comparison of the factor loadings of the Qatar population with other published studies

Present Kay and Sevy Lancon et al. Mass et al. Lykouras et al. Stefanovics et al. Wu et al.
study [9], 1990 [18], 2000 [19], 2000 [20], 2000 [21], 2014 [22], 2015

Population Qatar USA France Germany Greece USA, China, China

Brazil
Sample size 101 240 205 253 258 1,460, 1,020, 252 813
P2 conceptual disorganization cognitive disorganized cognitive disorganized disorganized disorganized cognitive
N5 difficulty in abstract thinking cognitive disorganized cognitive disorganized disorganized disorganized negative
N7 stereotyped thinking cognitive – – – disorganized – cognitive
G10 disorientation cognitive disorganized cognitive – disorganized/ – negative
negative
G11 poor attention cognitive negative cognitive disorganized disorganized disorganized cognitive
G13 disturbance of volition cognitive negative – – negative – cognitive
G15 preoccupation cognitive depressive/ – – negative – cognitive
anxiety
N1 blunted affect negative negative negative negative negative negative negative
N2 emotional withdrawal negative negative negative negative negative negative negative
N3 poor rapport negative negative negative negative negative negative negative
N4 passive apathetic social withdrawal negative negative negative negative negative negative negative
N6 lack of spontaneity and flow of
conversation negative negative negative negative negative negative negative
G12 lack of judgment and insight negative positive positive – positive/ – negative
depressive
G16 active social avoidance negative negative negative negative excited – negative
P4 excitement excited excited excitation excited excited excited excitement
P7 hostility excited excited excitation excited excited excited excitement
G4 tension excited depressive/ excitation excited depressive/ – excitement
anxiety anxiety
G5 mannerisms and posturing excited negative – excited negative/ – excitement
cognitive
G7 motor retardation excited negative negative – negative negative cognitive
G8 uncooperativeness excited excited – excited excited excited
G14 poor impulse control excited excited excitation excited excited excited excitement
G2 anxiety depressed depressive/ depression depressive/ depressive/ depressed depression
anxiety anxiety anxiety
G3 guilt feelings depressed depressive/ depression depressive/ depressive/ depressed depression
anxiety anxiety anxiety
G6 depression depressed depressive/ depression depressive/ depressive/ depressed depression
anxiety anxiety anxiety
P1 delusions positive positive positive positive positive positive positive
P3 hallucinatory behavior positive positive positive positive positive positive positive
P6 suspiciousness persecution positive – positive – positive – positive
G9 unusual thought content positive positive positive positive positive positive positive
P5 grandiosity – positive positive excited positive positive positive
G1 somatic concerns psychopathology – depressive/ – – excited – depression
anxiety
Percentage of variance explained 63.19% 64.7% 64.3% 68.9% 59.85% not reported 64.2%

items in the excited factor were similar to those reported
in the studies presented in Table 5, except for motor re-
tardation. This item is expected to load on the negative
instead of excited factor. It is worth noting here that mo-
tor retardation had a negative loading (–0.46; Table  3)
and thus ended with the excited factor in the Arab pa-
tients. This could be related to the lack of significant mo-
tor retardation in this sample to correlate well with the
other negative features. It seems that the depressed and
positive factors are somewhat universal as they had the
same loading items as all the 6 studies reviewed in other
countries (Table 5).
The 30 items were included into 5 factors with large
loading (>0.40). The items on grandiosity and somatic
concern that loaded each on a separate factor had low
contribution to the variance explained (less than 4%). In
addition they did not cross-load on any other factor. The
grandiosity item generally loaded on the positive factor in
several other studies (Table 5). In the model presented by
van der Gaag et al. [38, 39], somatic concerns was includ-
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ed into the positive factor. However, in the model of Wall-
work et al. [40] this item did not load on any factor. It is
possible that the somatic concerns of Arab patients with
schizophrenia do not reach the delusional levels and the
latter are not commonly associated with grandiose
themes. However, it is also plausible that the translation
of these items into Arabic did not capture the same con-
struct provided in English versions or the raters showed
variability on some of these items. In a study on cross-
cultural validity of the PANSS [41] among different coun-
tries, the authors suggested that differences in scoring, in
addition to culture and translation, could also contribute
to the differences in factor structures among cultures.
Schizophrenia has been viewed initially to be very similar
across cultures where the degree of the overlap in the ill-
ness definition and symptoms in many countries increas-
es with the illness severity [6]. On the other hand, mea-
surements of psychiatric symptoms leading to a diagnosis
like schizophrenia have been criticized for their interna-
tional use without paying attention to the validation
across cultures [42]. There is evidence that improper
translation and adaptation of an instrument can affect the
scale reliability compared with that of the same original
version [43]. For example, although several cultures be-
lieve in sorcery, religious and spiritual causes for the psy-
chosis, it had been reported that a large number of Arab
people commonly relate mental illness to possession by a
supernatural force, such as demons, Jinn, the evil eye (Al-
Ein), or magic (Sihr) [44]. The strength and spread of
such beliefs can have a differential cultural impact on how
patients from different cultures would present such be-
liefs and how the raters would score the corresponding
items from the PANSS.
Limitations
Our study has much strength due to the proper train-
ing of raters, the proper design and validation, and the
heterogeneity of the sample in terms of symptomatology
and duration of illness. However, our results have a few
limitations that are worth controlling for in future stud-
ies. First, males and females were not equally represented
in the sample. Hence, since the sample had more males,
this might prevent a generalizable conclusion of the factor
structure across gender. Nevertheless, other studies sug-
gested that there are no such differences across gender
[45]. Second, not all the Arab countries were well repre-
sented in this study, and the number of Qataris was high-
er than those of other Arab nationalities; thus, more com-
ponent analyses should be carried out in different coun-
tries in the Arab region to check whether our findings are
Factor Structure of Arabic PANSS
generalizable to other Arabic countries. Third, our com-
parisons with other cultures have some limitations as not
all studies used the same kinds of rotations or even PCA,
so more studies are needed to confirm these comparisons.
Conclusions
In conclusion, the factor structure in this sample of
Arab patients with schizophrenia was similar to that
found in the literature with minor differences. Items on
grandiosity and somatic concerns were different as they
did not add to any of the main factor clusters: positive,
negative, cognition, excited and depression/anxiety. Fur-
ther evaluation of these items should provide either a spe-
cific cultural domain or a difference in the language of the
scale itself.
Acknowledgment
The Qatar National Research Fund (QNRF) thankfully sup-
ported this study (NPRP 4-268-3-086).
Disclosure Statement
All authors declare no commercial or financial conflicts of in-
terest with regard to the submitted article. The QNRF did not have
any additional role in the study design, data collection and analy-
sis, decision to publish, or preparation of the manuscript.
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