Background <p>The positive and negative syndrome scale (PANSS) has long been used in the assessment of patients with schizophrenia; however, its lengthy administration process, which can even exceed an hour, has led to interest in developing a shorter version. PANSS-6 was created as a more efficient and streamlined alternative, and in this study, we aimed to evaluate its application in assessing severity and improvement in patients with schizophrenia undergoing a multicenter, open-label study of paliperidone.</p> Methods <p>A total of 271 patients aged 18–60 years with a DSM-IV diagnosis of schizophrenia participated in the study. Over a 6-week observation period, patients received paliperidone monotherapy and underwent clinical assessments using PANSS. The study conducted a comprehensive analysis of internal consistency, the effectiveness of antipsychotic treatment, response and remission assessments, and early response prediction, comparing PANSS-6 with PANSS-30.</p> Results <p>PANSS-6 showed good reliability and was highly correlated with PANSS-30. It was effective in evaluating the severity of schizophrenia and monitoring the score reduction over time. We observed no significant difference in the mean effect sizes (ES) between PANSS-6 and PANSS-30. Furthermore, using PANSS-6, early response at week 2 was found to be predictive of ultimate response and remission at week 6.</p> Conclusion <p>In this study, PANSS-6 demonstrated good internal consistency and a strong correlation with PANSS-30. These findings support its value for assessing treatment outcomes and predicting early response in patients with schizophrenia undergoing antipsychotic therapy. The use of PANSS-6 may offer a practical and streamlined method for symptom monitoring in clinical settings.</p> Clinical trial number <p>Not applicable.</p>