Predictive validity of the personal and social performance scale for PANSS outcomes in schizophrenia: a severity-stratified study

The Positive and Negative Syndrome Scale (PANSS) is a widely used instrument for assessing symptom severity in schizophrenia, whereas the Personal and Social Performance Scale (PSP) provides a practical measure of functional outcomes. This study aimed to evaluate the predictive validity of the PSP for PANSS outcomes in patients with schizophrenia receiving antipsychotic treatment in a real-world clinical setting. A total of 763 patients with schizophrenia receiving paliperidone treatment were recruited in a 12 week multicenter prospective study. Among patients with baseline PANSS scores greater than 90, those with PSP scores ≥60 at week 12 were more likely to achieve a reduction of more than 20% in PANSS scores, whereas those with PSP scores <60 showed less improvement. Structural equation modeling indicated that symptom reduction was associated with better functional outcomes. However, improvements in symptom severity were not necessarily associated with better subjective quality of life. These findings support the PSP as a practical tool that may assist clinicians in monitoring treatment response and functional outcomes in routine care settings. Trial registration ClinicalTrials.gov, NCT07445217. Registered February 28, 2026. Retrospectively registered.