Brief Negative Symptom Scale, BNSS Test - the question form

0. Normal: able to experience full pleasure during a range of activities; fully within the normal range.

1. Questionable: pleasure is experienced during activities, but less than many other people; still within the normal range.

2. Mild: a slight reduction in the intensity of pleasure experienced during activities.

3. Moderate: a slight reduction in the intensity of pleasure experienced in most activities, or a moderate reduction in the intensity of pleasure experienced in some activities.

4. Moderately severe: at least a moderate reduction in the intensity of pleasure experienced in most activities; a substantial reduction may be present in one activity.

5. Marked: a substantial reduction in the intensity of pleasure experienced in most activities; some capacity for pleasure remains; only moderate pleasure may be experienced even when a high level of pleasure would be expected.

6. Severe: no pleasure is experienced under any circumstances.

0. Normal: the patient frequently engages in pleasurable activities; no impairment in the frequency of experiencing pleasure.

1. Questionable: the patient engages in pleasurable activities less often than many people, but this may be within normal limits.

2. Mild: slight reduction in the frequency of pleasurable activities, outside normal limits.

3. Moderate: slight reduction in the frequency of pleasure for most activities, or a moderate reduction in the frequency of pleasure for some activities.

4. Marked: at least a moderate reduction in the frequency of pleasure for most activities; may include a profound reduction in intensity for one activity.

5. Severe: profound reduction in the frequency of pleasure for most activities; some ability to experience pleasure remains, but it occurs rarely even when the level of pleasure would be expected to be high.

6. Extreme: absence of pleasure throughout the entire previous week.

0. Normal: Able to enjoy thinking about doing various activities in the future; fully within normal limits.

1. Questionable: Enjoys thinking about doing various activities in the future, but less than many other people; still within normal limits.

2. Mild: Enjoys thinking about doing various activities in the future, but to a somewhat lesser degree than would be expected.

3. Moderate: Enjoys thinking about doing various activities in the future, but to a much lesser degree than would be expected; however, experiences some enjoyment.

4. Marked: Can experience substantial pleasure when thinking about doing some activities in the future, but generally does not.

5. Severe: Rarely enjoys thinking about doing various activities in the future, even when the activity would usually be very enjoyable.

6. Extreme: Does not enjoy thinking about doing various activities in the future, regardless of the activity.

0. Normal: Expected ability to experience distress or negative emotions.

1. Questionable: Experiences distress in response to unpleasant events, but less than many other people; still within the normal range.

2. Mild: Experiences distress in response to unpleasant events, but to a slightly lesser degree than would be expected.

3. Moderate: Clearly much less upset by unpleasant events than would be expected, but still experiences some distress.

4. Marked: Can experience substantial distress, but generally only in response to a serious problem.

5. Severe: Experiences only moderate distress even when there is a serious problem.

6. Extreme: Does not experience distress regardless of the problem encountered.

0. No impairment: often interacts with other people; openly discusses personal matters with one or more people; within normal limits.

1. Minimal deficit: has a close relationship with one person in which most personal matters can be discussed; actively interacts with others; discusses some personal matters with other people.

2. Mild deficit: social contacts are not infrequent, but the patient is not as socially active as most people; only some personal matters are discussed; relationships are not close or deep.

3. Moderate deficit: has no close, deep relationships with other people; relationships and interactions at events are superficial and not deep, but generally does not avoid other people.

4. Pronounced deficit: contacts and communication with other people are more often infrequent and superficial; tends to avoid other people. As a rule, does not discuss personal matters with other people.

5. Marked deficit: interaction with other people is almost always superficial; by choice, spends little time with other people.

6. Severe deficit: rarely has contact with other people; may actively avoid other people most of the time.

0. No impairment: The patient is very interested in relationships and regards relationships with other people as one of the most important parts of life; when in isolation, often feels lonely and thinks it would be good not to be alone.

1. Minimal deficit: The patient considers relationships important and is interested in other people; when in isolation, sometimes feels lonely and thinks it would be good not to be alone.

2. Mild deficit: The patient considers close relationships with family member(s) to be somewhat important; has a moderate interest in other people; has no close and deep relationships with others; sometimes thinks about relationships.

3. Moderate deficit: The patient considers close relationships to be of little importance; the desire to be closer to other people arises infrequently.

4. Moderately severe deficit: When it comes to forming close relationships with other people, the patient may not care whether or not to enter into relationships. The patient generally does not wish to discuss personal matters with other people, and rarely misses close relationships or wishes to be in a closer relationship.

5. Marked deficit: The patient considers relationships to have little, if any, meaning; shows extremely low interest in close relationships with other people; does not feel lonely.

6. Severe deficit: The patient is not interested in relationships with other people, does not need any close relationships, and strongly prefers to be alone.

No deficit: the patient initiates and continues work or school, rest and leisure/hobbies/pastimes, and self-care; fully within normal limits.

Minimal deficit: the patient is somewhat less consistent in initiating and continuing activities compared with many other people, but clinical significance is questionable.

Mild deficit: moderate impairment in initiating and continuing activities; for example, the patient was able to appropriately start activities last week but continues with a moderate degree of persistence; or initiative comes from other people as often as from the patient.

Moderate deficit: noticeable impairment in initiating or continuing activities; may fail to start various activities fairly often or may not continue initiated actions for very long; often other people can provide the motivation for any activities.

Marked deficit: significant impairment in initiating; may start a few activities but does not continue them for very long. Typically, other people provide the motivation for any activities.

Severe marked deficit: obvious, serious reduction in initiating and continuing activity; in some cases may start activities but almost never continues them. Other people almost always provide the motivation for the patient’s activities.

Severe deficit: virtually complete absence of initiating activities.

No impairment: highly motivated; interested in school/work, leisure and recreation, and self-care; often thinks about these and says these things matter. Fully within normal range in this area.

Minimal deficit: somewhat less motivated and interested in these things than many other people, but clinical significance is questionable.

Mild-to-moderate impairment: generally motivated in these activities, but in some situations does not show sufficient interest or motivation; thinks about them and says these things matter, but to a somewhat lesser degree than normal.

Moderate deficit: somewhat motivated in these activities, but clear impairment in motivation and interest; may have a job but not be interested in achieving at a higher level, or thinks little about relationships or leisure activities.

Marked deficit: only weak motivation in these activities; thinks about them only in some situations.

Moderate-to-severe deficit: clear lack of interest or motivation in these activities; very rarely thinks about these things and is almost indifferent to them.

Severe deficit: essentially no interest in these activities; does not think about them and is completely indifferent to them.

0. No impairment: within normal limits; the patient vividly describes emotional experiences and facial expression changes appropriately many times.

1. Minimal deficit: very slight reduction in the frequency and expressiveness of facial changes while describing emotional experiences; clinical significance is questionable.

2. Mild-to-moderate impairment: moderate reduction in the frequency and expressiveness of facial changes; facial expression changes at least twice while describing each emotional experience.

3. Moderate deficit: noticeable reduction in the frequency and expressiveness of facial changes; for example, facial expression changes only once when answering each question.

4. Marked deficit: substantial reduction in the frequency and expressiveness of facial changes while describing emotional experiences, with facial expression changing only in response to one or two questions; over the entire interview, facial expression may change only three to four times.

5. Marked deficit: clear, profound reduction in facial expression reflecting both positive and negative emotions when answering all questions; over the entire interview, facial expression may change slightly only once or twice.

6. Severe deficit: complete or almost complete absence of changes in facial expression throughout the entire interview.

No impairment: normal variation across all three parameters (speech rate, volume, and pitch during speech).

Minimal deficit: slight reduction in one of the three parameters.

Moderate impairment: moderate reduction in two parameters or moderate-to-marked reduction in one parameter.

Moderate deficit: moderate reduction in one parameter.

Marked deficit: moderate reduction in two or more parameters or severe reduction in one parameter.

Moderately severe deficit: severe reduction in at least one parameter and moderate reduction in at least one additional parameter.

Severe deficit: severe reduction in two or more parameters (speech rate, volume, and pitch during speech).

0. No impairment: gesturing is within normal limits; the patient uses a wide range of gestures with the arms, hands, shoulders, head, and/or body while describing emotional experiences.

1. Minimal deficit: very slight reduction in the frequency of expressive gesturing; of questionable clinical significance; a slight reduction in the use of the arms, hands, head, or body is observed.

2. Mild-to-moderate impairment: moderate reduction in the frequency of expressive gesturing; uses at least two expressive gestures while describing each emotional experience.

3. Moderate deficit: noticeable reduction in the frequency of expressive gesturing; may use one barely noticeable gesture in response to each question.

4. Pronounced deficit: significant impairment in the use of expressive gestures, with one gesture used in response to only one or two questions; the patient may use only three or four gestures during the entire interview.

5. Marked deficit: clear impairment in the use of expressive gestures. A reduced number of gestures is observed in response to all questions; the patient may use only one or two barely noticeable gestures during the entire interview.

6. Severe deficit: near-complete absence of expressive gesturing; there are virtually no movements of the arms, hands, head, or body while describing any emotional experiences.

0. No impairment: quantity of speech is within normal limits, or the patient speaks excessively.

1. Minimal deficit: questionable reduction in quantity of speech; responses are usually succinct.

2. Moderate impairment: responses are generally brief.

3. Moderate deficit: many responses consist of one or two words.

4. Marked deficit: at least half of responses consist of one or two words.

5. Substantial deficit: most responses consist of one or two words.

6. Severe deficit: all or nearly all responses consist of one or two words.

0. No impairment: the patient generally provides more information than necessary to answer the question; this information may or may not be relevant; the patient may even be overly talkative or have pressured speech.

1. Minimal deficit: the patient often provides more information than necessary to answer the question, although at times more information could have been appropriate.

2. Mild impairment: the patient provides additional information several times, but responses are generally limited to the required information.

3. Moderate deficit: the patient sometimes provides additional information; the interviewer may sometimes ask the patient to add details/elaborate.

4. Pronounced deficit: the patient rarely provides more information than necessary to answer the question; the interviewer may ask several times for the patient to elaborate.

5. Marked deficit: virtually all responses contain only the necessary information, or less than necessary; the interviewer may repeatedly ask the patient to add information.

6. Severe deficit: no spontaneous speech at any point during the interview.