Remission in schizophrenia: validity, frequency, predictors, and patients' perspective 5 years later (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.
Remission criteria for schizophrenia: Evaluation in a large naturalistic cohort
Schizophrenia Research, 2007
Background: Recently, remission criteria for schizophrenia have been proposed, based on low symptom severity of core symptoms (severity criterion), sustained over minimally 6 months (time criterion). Little is known, however, about the added value of the time criterion in addition to the cross-sectional severity criterion. Methods: In order to evaluate whether remission is a valid concept for daily clinical practice, the cumulative incidence of patients meeting remission criteria was evaluated in a large naturalistic prospective study of patients with schizophrenia or schizoaffective disorder in different treatment settings in Belgium. The impact of being in remission on global and daily functioning was evaluated. Results: Over time, nearly 1 out of 3 patients with a diagnosis of schizophrenia or schizoaffective disorder (29%) met criteria for remission at study endpoint. Patients in remission had better insight in their disorder, a higher level of global functioning and functioned better with respect to daily living tasks, both compared to patients never meeting remission criteria and to patients only meeting the severity criterion but not the time criterion. Of the patients not meeting remission criteria at baseline, 21% attained remission at study endpoint. Conclusion: The remission severity and time criteria appear to combine into a valid concept for daily clinical practice and should be a target for treatment.
Schizophrenia Research, 2019
Background: Despite being recommended for use in clinical trials, the consensus remission criteria were found to leave patients with persisting symptoms, relevant areas of functional impairment and a decreased sense of wellbeing. Therefore, to evaluate the appropriateness of the schizophrenia consensus criteria, a definition of remission based on the Clinical Global Impression Scale (CGI) was developed and remitter subgroups were compared. Methods: 239 patients with a schizophrenia spectrum disorder were evaluated regarding their remission status after inpatient treatment. Remission in schizophrenia was defined according to the symptom-severity component of the consensus criteria by Andreasen et al. and a CGI based definition was calculated using sensitivity and specificity using receiver operating curves (asymptomatic remitter). Both remitter groups (schizophrenia consensus versus asymptomatic remitters) were compared regarding different clinical variables at discharge as well as the likelihood to relapse within a 1-year follow-up period. Both schizophrenia remitter subgroups were compared to remitters in major depression as a reference value. Results: Following the consensus criteria, 63% of the schizophrenia patients were in remission compared to only 18% following the asymptomatic criterion. The schizophrenia consensus remitters were less likely to be
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.
Remission in schizophrenia: Results from a 1-year follow-up observational study
2009
Objectives: This study used the Remission in Schizophrenia Working Group operationalseverity criteria to, a) provide descriptive data on prevalence and stability of symptomatic remission, b) attempt a criterion (concurrent) validation of this measure of remission, and c) explore correlates of remission stability. Methods: From an unselected sample of 1010 stable outpatients with schizophrenia (DSM-IV-TR), a subgroup of 452 (44.8%) in symptomatic remission was followed for 1 year. Of these, 376 were re-evaluated in a research diagnostic assessment. In addition to relevant sociodemographic and clinical data, measures included symptoms, depression, functioning, social cognition, attitudes towards medication, and quality of life. Estimates of point prevalence are provided. Correlates of remission were identified by logistic regression. Results: Symptomatic remission at baseline correlated with better premorbid adjustment, better social cognition, good treatment compliance, younger age, the absence of comorbid substance abuse, current or past participation in psychotherapy, and a lack of past participation in rehabilitation. After 1 year, 338 out of the 376 (89.9%) patients re-evaluated were found again in remission. In this assessment, better premorbid adjustment, good treatment compliance, and improvement of depressive symptoms and social cognition during follow-up again correlated with remission. Conclusions: The results of this study suggest that symptomatic remission (as defined above) has considerable criterion validity and is a realistic goal in the treatment of schizophrenia. Attaining and sustaining remission may warrant better clinical and functional outcomes for patients.
Psychiatric Quarterly, 2012
Remission and recovery are major outcome goals in schizophrenia yet their predictors have not been studied in detail. Therefore, 186 patients were examined regarding remission and recovery including their potential sociodemographic and clinical predictors 1 year after discharge. Remission was defined according to the consensus remission criteria and recovery following the definition by . Of the 186 patients 54% achieved remission and 26% recovery at the 1-year follow-up. The remission status at discharge was found to significantly influence remission and recovery at follow-up. A higher SOFAS score (P = 0.0002) as well as a positive attitude towards treatment at discharge (P = 0.0038) were identified to be significant predictors of remission at 1-year follow-up. Having a job (P = \0.0001) and being without pharmacological treatment at follow-up (P = 0.0113) were found to be significantly predictive of recovery. Our results underline the need to implement more specific treatment strategies to improve long-term outcome.