Department of Psychiatry

Penn Behavioral Health


Brain-Behavior and Genetic Studies of the 22q11DS

The CANSAS project was a National Institute of Mental Health-funded multisite study that has constructed a next-generation negative symptom scale. This research program involved 4 research sites including the University of Maryland (Jack Blanchard), University of Pennsylvania (Raquel E. Gur), UCLA (William Horan), and UC Berkeley (Ann Kring). A two-study scale development design was conducted at the four sites with nearly 500 people with schizophrenia or schizoaffective disorder. From this effort, we have developed the Clinical Assessment Interview for Negative Symptoms (CAINS).

In Study 1 of the NIMH-funded CANSAS, the CAINS was administered to 300 outpatients with diagnoses of schizophrenia and schizoaffective disorder. Participants were assessed for general symptoms as well as for depression to allow for an assessment of the discriminant validity of the scale, specifically its hypothesized independence from positive symptoms and depression. Scale psychometrics were assessed with Item Response Theory analyses to fully examine item and scale performance. Interrater agreement was evaluated both within- and across sites.

Study 2 tested the revised CAINS in 160 outpatients to examine convergent validity as well as discriminant validity. Relations with social functioning and short-term temporal stability were evaluated.

Final revisions were made to the CAINS following Study 2, resulting in a 13-item scale. The completed instrument has been made available for dissemination with a users manual, interview guide and training videos. (Click here to request access)


  • Forbes, C., Blanchard J.J., Bennett, M., Horan, W.P., Kring, A.M., Gur, R.E. (2010). Initial Development and Preliminary Validation of a New Negative Symptom Measure: The Clinical Assessment Inventory for Negative Symptoms. Schizophrenia Research, 124, 36-42.
  • Blanchard, J.J., Kring, A.M., Horan, W.P., Gur, R.E. (2011). Toward the Next Generation of Negative Symptom Assessments: The Collaboration for the Advancement of Negative Symptom Assessment in Schizophrenia. Schizophrenia Bulletin, 37, 291-299.
  • Horan, W.P., Kring, A.M., Gur, R.E., Reise, S.P., Blanchard, J.J. (2011). Development and Psychometric Validation of the Clinical Assessment Interview for Negative Symptoms (CAINS). Schizophrenia Research, 132, 140-145.
  • Kring, A. M., Gur, R. E., Blanchard, J. J., Horan, W. P., Reise, S. P., & (2013). The Clinical Assessment Interview for Negative Symptoms (CAINS): Final development and validation. American Journal of Psychiatry, 170, 165-172.

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