Abstract
A definable concept of symptomatic remission in schizophrenia has been proposed by the Remission in Schizophrenia Working Group (RSWG). Nevertheless no studies to date assessed eventual differences in core symptoms at onset between remitters and non-remitters. The present study evaluated whether the severity of core symptoms differed among 48 patients with first episode schizophrenia (FES), and whether it predicted long-term (16-years) remission. Particularly, the present study aimed to verify if RSWG remission criteria might identify a sub-group of patients with mild core symptoms at their first episode. In the present study the severity of core symptoms was significantly lower in remitted than in non-remitted patients; interestingly, five out of the eight core symptoms already satisfied the severity criteria for remission in most remitted patients. Among the core symptoms only the severity of social withdrawal predicted the long-term outcome, while age at onset, duration of untreated psychosis and employment status did not exert any effect. Concluding, patients with FES presenting, mild core symptoms, particularly low negative symptoms, were more likely to reach long-term remission. Therefore, RSWG remission criteria seem to identify a subgroup of FES patients with mild severe core symptoms so with a higher probability to reach remission.
Highlights
Since the description of dementia praecox (Kraepelin, 1899, schizophrenia has been conceptualized as a chronic illness and remission has long been considered largely impossible, with the consequence that diagnosis and prognosis were viewed as essentially the same (McGlashan, 2008)
The present study aimed to evaluate whether 1) patients with first episode schizophrenia (FES) who gained remission after several years of illness differed from non-remitters with respect to the severity of the core symptoms, and 2) which of the core symptoms predicted long-term remission
Patients were included in the study if: 1) they were aged over 17 years; 2) they were hospitalized 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; 4) they accepted to be revaluated after many years from the index admission; and 5) they gave a written informed consent during the index hospitalization
Summary
Since the description of dementia praecox (Kraepelin, 1899, schizophrenia has been conceptualized as a chronic illness and remission has long been considered largely impossible, with the consequence that diagnosis and prognosis were viewed as essentially the same (McGlashan, 2008). In the recent years the Remission in Schizophrenia Working Group (RSWG) (Andreasen et al, 2005) posited that “symptomatic remission is a definable concept and an achievable stage in the treatment of schizophrenia” and proposed criteria for symptomatic remission. According to such criteria, remission is defined as: “a state in which patients have experienced an improvement in core symptoms, to the extent that these symptoms no longer interfere significantly with daily life”. Remitted patients could have shown, at illness onset, a different severity of the core symptoms when compared to patients who will not achieve remission, even though no studies have investigated this topic
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