Influencing factors and predictors of early improvement in the acute treatment of schizophrenia and schizophrenia spectrum disorder

Abstract

Background To examine the influencing factors and predictors of early improvement in schizophrenia patients. Methods 370 patients suffering from a schizophrenia spectrum disorder were examined within a naturalistic multicenter study. Early improvement was defined as a ≥30% PANSS total score reduction within the first two treatment weeks, response as a ≥50% improvement of the PANSS total score from admission to discharge and remission according to the consensus remission criteria. Baseline and course-related variables such as positive, negative and depressive symptoms, side effects, functioning and subjective well-being were examined regarding their explanatory value for early improvement. Results 46% of the patients were identified to be early improvers. Of these, 77% became treatment responder at discharge and 74% achieved the consensus remission criteria. Amongst others, early improvers were significantly more often first-episode patients ( p = 0.009), with a significantly shorter duration of current episode ( p = 0.024) and a shorter duration of the illness ( p = 0.0094). A higher PANSS positive subscore ( p = 0.0089), a higher score in the Strauss-Carpenter-Prognostic Scale (SCPS) ( p < 0.0001), less extrapyramidal side effects ( p = 0.0004) at admission and the development of less extrapyramidal side effects within the first two treatment weeks ( p = 0.0013) as well as a duration of current episode of ≤6 months ( p = 0.0373) were identified to be significant predictors of early improvement. Conclusion Early improvement is associated with less illness chronicity and seems to be independent of the type of antipsychotic and the antipsychotic dosage applied. The SCPS was found to be a valuable tool to detect early improvers already at the initiation of antipsychotic treatment.