Remission criteria for schizophrenia: Evaluation in a large naturalistic cohort (original) (raw)
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Remission in schizophrenia: Applying recent consensus criteria to refine the concept
Schizophrenia Research, 2007
Although the concept of remission has been widely accepted and utilized in depression and anxiety disorders, there has been much less emphasis on defining remission in schizophrenia. Recently, an expert consensus definition of remission in schizophrenia was proposed along specific operational criteria for the attainment of remission focusing on the three core dimensions of psychopathology identified within schizophrenia: psychoticism, disorganization and negative symptoms. To date, the criteria have been applied retrospectively to several clinical studies, and these have demonstrated that the proposed definition of remission correlates significantly with established measures of symptom severity, functioning and quality of life, and appears achievable for a significant proportion of patients receiving at least 3 months of pharmacotherapy. In this article we extend the notion of remission to include an examination of the possible association of several modifiable and unmodifiable factors and co-morbidities on remission status. We also propose an investigation into the likelihood of different patient populations in achieving remission as well as assessing the impact of remission on health care costs and family burden. Since cognitive dysfunction and negative symptoms may be strongly correlated with a lower likelihood of achieving remission, we recommend retrospective and/or prospective studies to determine the relationship between neurocognitive status and the predominance of negative symptoms at treatment start and the probability of achieving remission. Taken together, these studies should help identify key predictors of remission, further define the remitted state, reduce therapeutic pessimism, raise treatment expectations and chart a strategy for further research in this important area.
The Journal of Clinical Psychiatry, 2006
questions (1) how is remission defined? (2) how many patients achieve remission? and (3) which parameters predict remission? Several prospective and retrospective studies in first-1-4 and multiple-episode patients 5-8 provided definitions for remission using a wide range of criteria and time periods during which the criteria must be maintained. 9,10 The lack of consistent definitions of remission and the heterogeneity of assessed populations thereby hampered cross-study comparisons and limited the generalizability of these results. Most recently, in accordance with previous studies, 1-8 the Remission in Schizophrenia Working Group published a consensus statement on the criteria and the time frame of remission in schizophrenia. 9 Remission was defined as a state of no greater than low-to-mild intensity in core symptoms, sustained for a minimum duration of 6 months. These criteria were recently applied in a 1-year
Remission criteria and functional outcome in patients with schizophrenia, a longitudinal study
The Australian and New Zealand journal of psychiatry, 2015
The Remission in Schizophrenia Working Group (RSWG) has proposed remission criteria for schizophrenia, which were shown to be valid in terms of functional and clinical outcomes. However, studies investigating the association between dynamics in remission status in relation to longitudinal functional and clinical outcome are scarce. A total of 648 patients were allocated to four change-in-remission groups, i.e. remission/remission, remission/no-remission, no-remission/remission, and no-remission/no-remission. Remission status was based on PANSS ratings. Multilevel linear modelling techniques were used to investigate whether enduring remission was associated with more improvement in functional outcome at follow-up. Further, change in functional and clinical outcome at follow-up measurement was assessed for each remission category separately. Both at baseline and at follow-up, remission status was associated with better functioning. At baseline, patients who subsequently moved out of r...
Schizophrenia Research, 2009
Objectives: This report presents the results of an observational empirical clinical investigation about the prevalence and correlates of a proposed definition of recovery from schizophrenia in outpatients in Spain. Methods: Of 1010 outpatients with schizophrenia (DSM-IV-TR), a subgroup of 452 patients in symptomatic remission (SR) was followed for 1 year. SR was defined according to Andreasen's severity criteria based on the Scales for the Assessment of Positive (SAPS) and Negative (SANS) Symptoms. A Global Assessment of Functioning scale score of N 80 was considered to be indicative of adequate functioning (AF). Correlates of recovery were identified by logistic regression. Results: At baseline,103 (22.8%; N = 452) patients fulfilled the recovery definition (SR + AF). After 1 year, 338 patients (89.9%; N = 376) maintained SR. Among these, the proportion of patients in recovery increased to 27.1% (102 out of 376). Better premorbid adjustment (PA) and improved social cognition correlated with recovery at baseline. After 1 year, PA, duration of untreated psychosis (DUP), type of pharmacotherapy, attitudes toward medication, and variation of depressive symptoms and social cognition determined the likelihood of recovery. Conclusions: The proportion of patients in recovery increased among those fulfilling SR criteria. After 1 year, in addition to known factors like shorter DUP and better PA, social cognitive abilities and depressive symptoms were found to correlate with recovery.
BMC Psychiatry, 2013
Background: This study aims to compare severity criteria defined by the Remission in Schizophrenia Working Group (RSWGcr) with other criteria in relation to functional and neurocognitive outcome. Methods: 112 chronic psychotic outpatients were examined. Symptomatic remission according to RSWGcr was compared with the outcome achieved using criteria based on PANSS Positive and Negative Scales (PANSS-PNScr) and the entire PANSS (PANNS-TScr). Results: Remission rates were 50%, 35% and 23% respectively at RSWGcr, PANSS-PNScr and PANNS-TScr; functional remission rates were 32%, 42% and 54%. Sensitivity, specificity, predictive value and ROC analysis demonstrated the superiority of PANSS-PNScr in identifying patients with higher functional and cognitive outcomes. Regression analysis showed a significant predictive effect of PANSS-TScr on functioning. General linear model analyses demonstrated significantly higher mean scores at PSP and BACS for patients remitted according to PANSS-TScr. Conclusion: The use of more restrictive severity criteria of remission seems to be associated with improved identification of truly remitted patients.
Acta Psychiatrica Scandinavica, 2008
Objective: Few studies have prospectively examined remission and recovery as well as their predictors in schizophrenia simultaneously. Aims of the study were to identify remission and recovery rates as well as their predictors in schizophrenia.Method: 392 never-treated patients with schizophrenia were assessed over 3 years. Combined remission and recovery required concurrent achievement of symptomatic and functional remission as well as adequate quality of life for at least 6 and 24 months respectively. Predictors were analysed using stepwise logistic regression models.Results: At 3 years, remission rates for symptoms, functioning and subjective wellbeing were 60.3%, 45.4% and 57.0%; recovery rates were 51.7%, 35.0% and 44.3%. Of those, 28.1% were in combined remission and 17.1% in combined recovery. Predictors mainly included the baseline functional status and early remission within the first 3 months.Conclusion: The proportion of patients who met combined remission or recovery criteria is low. Early treatment adaptations in case of early non-remission are mandatory.