Abstract
In schizophrenia, a better level of functioning has been generally associated with symptomatic remission. However, this association has been supported by cross-sectional studies or by studies with a short follow-up period. Forty-eight patients with schizophrenia were evaluated by the Positive and Negative Symptoms Scale and the Social and Occupational Functioning Assessment Scale (SOFAS) at the first episode and after a mean period of 16 years. At follow-up, patients were defined as remitters (R) or non-remitters (NR) according to the Remission Schizophrenia Working Group criteria. R (n = 18; 37.5%) compared to NR showed at the first episode a lower illness severity and a better level of functioning. A functional decline was found in both groups at follow-up, even though NR showed a more than twofold reduction than R. Better SOFAS scores at follow-up were predicted by baseline SOFAS score and less severe negative symptoms at follow-up. Schizophrenia implies a functional decline over time, regardless of the symptomatic remission status with negative symptoms playing a major role.
Highlights
In schizophrenia, a better level of functioning has been generally associated with symptomatic remission
Remission has long been considered largely impossible in schizophrenia, to the extent that diagnosis and prognosis were viewed as essentially the same (McGlashan, 2008) and a dramatic improvement during the course of the illness was viewed as a sign of earlier misdiagnosis
Patients were included in the study if (1) they were aged over 17 years; (2) they were admitted for the first time in a psychiatric unit for a first psychotic episode; (3) they were discharged with a diagnosis of Schizophrenia, according to the DSM-IV; and (4) they gave a written informed consent
Summary
A better level of functioning has been generally associated with symptomatic remission. Maintaining low levels of psychopathology may promote productive social and occupational pursuits in these patients (Opler et al, 2007) In support to this view, studies assessing the relationship between remission (defined according to the RSWG criteria) and functional outcome found significantly better levels of functioning in remitted versus nonremitted patients, even though remitted patients showed areas with an inadequate level of functioning (Addington and Addington, 2008; Bobes et al, 2009; Bodén et al, 2009; Karow et al, 2012; Oorschot et al, 2012). No study investigated if the level of functioning at first admission declines in patients who achieve remission in the course of a long-term follow-up and long duration of illness
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