Predictors of symptomatic remission in patients with first-episode schizophrenia: A 16 years follow-up study

Carlo Marchesi,Andrea Affaticati,Alberto Monici,Chiara De Panfilis,Paolo Ossola,Matteo Tonna

doi:10.1016/j.comppsych.2013.12.011

Carlo Marchesi, Andrea Affaticati + Show 4 more

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https://doi.org/10.1016/j.comppsych.2013.12.011

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Journal: Comprehensive Psychiatry	Publication Date: Dec 18, 2013
Citations: 45	License type: cc-by

Affiliation: University of Parma

Abstract

ObjectiveRecent views on schizophrenia outcome and treatment suggest that symptomatic remission is possible, and a definition of remission has been proposed by the Remission in Schizophrenia Working Group (RSWG).This study evaluated whether patients who achieved remission after several years of illness (R) showed psychopathological differences at the onset of their disorder compared to non-remitted (NR) patients. MethodForty-eight patients with first-episode schizophrenia were evaluated with the Positive and Negative Symptoms Scale (PANSS) both at the onset of illness and after a mean period of 16years. Patients were defined as R or NR according to the RSWG criteria. ResultsEighteen patients (37.5%) were classified as R at follow-up. At onset, R patients showed a lower illness severity, less severe negative and general psychopathology symptoms compared to NR. Furthermore, they underwent fewer psychotic episodes than NR over the course of follow-up. Remission was predicted by lower severity of negative and general psychopathology symptoms at onset and by lesser number of psychotic episodes during follow-up. ConclusionsThe symptomatic remission may be a viable outcome in schizophrenia, particularly for patients with a mild illness and less severe negative symptoms at onset and with few psychotic episodes over time.

Highlights

Since the description of “dementia praecox” by Kraepelin [1], schizophrenia has been conceptualized as a chronic illness leading to mental deterioration, lack of volition and social incompetence with no hope for sustained remission or recovery [2]
Standardized Remission in Schizophrenia Working Group (RSWG) consensus criteria for remission are based on severity of core psychopathological symptoms as assessed by the Positive and Negative Symptoms Scale (PANSS) which is sustained over a minimum of 6 months [11]
At follow-up, symptoms severity had decreased in both groups: such decrease was statistically significant for PANSS positive and general psychopathology scores, but not for the negative symptoms score, in both R and NR patients (Table 2)

Summary

Introduction

Since the description of “dementia praecox” by Kraepelin [1], schizophrenia has been conceptualized as a chronic illness leading to mental deterioration, lack of volition and social incompetence with no hope for sustained remission or recovery [2]. Standardized RSWG consensus criteria for remission are based on severity of core psychopathological symptoms as assessed by the PANSS (symptomatic remission) which is sustained over a minimum of 6 months (time criterion) [11]. According to these criteria, a percentage of patients ranging from 45% to 70% were defined as remitters at some point during the course of their illness [12]. Some of the existing studies failed to fully apply the RSWG criteria, for example by omitting the time criterion or by using different measures of symptom severity [12]. As claimed by Lambert [12], “comparability in terms of validity of criteria as well as frequencies and predictors of remission is limited”, and further research is warranted in this area

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