Functional Remission In Schizophrenia Research Articles

Patients' awareness of recovery mediates the link between clinical and level of functional remission in schizophrenia to a larger extent in those treated with long-acting antipsychotics.

Clinical remission is a step towards functional remission for subjects with schizophrenia. While recovery is both a subjective personal journey and a clinical outcome to be targeted, data on patient self-rated outcomes are scarce. (i) To determine the extent to which the association between clinical and functional remission is mediated by the subjective experience of recovery as reported by patients versus their relatives or their psychiatrist and (ii) to assess differences according to treatment, specifically with oral antipsychotics only versus long-acting injectable antipsychotics (LAIs). Clinical observational study. Community-dwelling participants with schizophrenia enrolled in the EGOFORS cohort (N = 198) were included. Clinical symptoms and remission were assessed using the Positive and Negative Syndrome Scale. Functional remission was assessed with the Functional Remission of General Schizophrenia Scale. Awareness of recovery was assessed with one question 'What percentage of recovery do you think you have now (from 0% - no recovery - to 100% - full recovery)?', asked of the patient, also of the patient's close relative, and the psychiatrist. We used mediation analyses, taking into account the type of pharmacological treatment. Remission criteria and perceived remission measures were significantly correlated, both within and between groups (r > 0.330). The patient's awareness of recovery mediated the relationship between clinical remission and level of functional remission, while the level of recovery according to psychiatrists or close relatives did not. The direct effect of clinical remission on the level of functional remission became non-significant when taking into account the mediator (patients' awareness of recovery) in the group of patients with LAI (t = 1.5, p = 0.150) but not in the group of patients with other treatments (t = 3.1, p = 0.003). Patients with LAIs may be more efficient in reporting their level of functional remission. Higher patient awareness could be an interesting candidate to explain this. However, as the study was cross-sectional, such a proposal should be tested with a more specifically designed protocol, such as a long-term cohort.

Symptomatic Remission Along the Clinical Psychosis Spectrum: A Historical and Conceptual Review.

Introduction:In this review, a historical and conceptual panorama of symptomatic remission will be provided with a focus on the whole clinical psychosis beyond schizophrenia.Methods:We included all published articles on remission in psychosis, without any restrictions regarding language or year. We used a string to detect relevant articles in PubMed. We reviewed the abstracts to exclude out of scope results. Then, we evaluated the remaining articles to extract data. Variables included year of publication, language of publication, country of origin, type of article, main topic of research, main disorder studied, and reference to remission criteria.Results:The final dataset included 439 citations which dates back to 1950. The Remission in Schizophrenia Working Group (RSWG) criteria which was proposed in 2005 had a major effect on remission research in schizophrenia. The RSWG criteria changed the yearly published numbers of research, the main land of remission research and the scope of the articles. After 2005, the number of publications rapidly increased, and English became the primary language of the articles. Beyond prominent clinical effect, the criteria did have little impact on functional remission in schizophrenia. And also research in the last decade provided very few information about remission in other clinical aspects of psychosis spectrum including acute, transient and chronic forms. Furthermore, although there has been a conceptual unity in the last decade the heterogeneity of the studies is still far from decreasing, which still blurs the efforts to evaluate remission in psychosis.Conclusion:Although studies on remission in schizophrenia started in the 1950s, the criteria published in 2005 changed the whole area. However, remission discussions are not yet valid for psychotic diagnoses other than schizophrenia and are limited.

Depressive symptoms and chronic peripheral inflammation are associated with impaired functional remission in schizophrenia independently of psychotic remission.

BackgroundWhile psychotic remission in schizophrenia (SZ) has been defined by consensus and associated with a rank of clinical predictive factors, there is a lack of data of factors associated with functional remission. ObjectivesTo identify clinical and biological factors associated with impaired functional remission in a non-selected chronic stabilized SZ outpatients. MethodsThis study was a cross-sectional study carried out on all admitted SZ stabilized outpatients in an academic daily care psychiatric hospital. Functional remission was defined by a global assessment of functioning score ≥61. Psychotic remission was defined according to international criteria. Depression was assessed with the Calgary Depression Rating scale for Schizophrenia. Sociodemographic variables, tobacco status, clozapine treatment and obesity were reported. Chronic peripheral inflammation was defined by a highly sensitive C-reactive protein serum level ≥3 mg/L and metabolic syndrome according to international recommendations. Results273 patients were included, among them 51 (18.7%) were classified in the functional remission group. In the multivariate analysis, higher rate of functional remission was associated with psychotic remission (adjusted Odd ratio = 18.2, p <0.001), lower depressive symptoms (aOR=0.8, p = 0.018) and lower peripheral inflammation (aOR=0.4, p = 0.046). No association of functional remission with age, gender, illness duration, second-generation antipsychotics, clozapine treatment, tobacco smoking, obesity or metabolic syndrome has been found. ConclusionDepressive symptoms and chronic peripheral inflammation are associated with impaired functional remission in SZ independently of psychotic remission. Future intervention studies should determine if improving depressive symptoms and chronic peripheral inflammation may improve SZ patients reaching functional remission.

Functional remission in schizophrenia: A FROGS-based definition and its convergent validity

Functional remission concerns only one third of schizophrenia patients who achieved symptomatic remission. We previously developed a scale devoted to functional remission, named the FROGS (Functional Remission Of General Schizophrenia). This instrument encompasses three clinically relevant dimensions. The aim of this study is to provide a threshold for functional remission relying on these three dimensions, and to compare its psychometric properties with other scales devoted to functional remission. We tested the characteristics of functional remission according to the FROGS. The FROGS was used in different European countries and compared to other valid scales (GAF, PSP and PSRS) in a sample of 295 schizophrenia patients. The association with different parameters as external validators was assessed, including clinical remission. A comparison of the classifying properties of each scale compared to the others was made. The four instruments were equally influenced by the PANSS score, the clinical remission according Andreassen's criteria, the number of past hospitalizations and the presence of a paid working activity. These findings provide a simple threshold for the FROGS, tightly linked to the definition of functional remission, with a good convergent validity. This instrument might be easily used to facilitate the assessment of functional remission in schizophrenia.

Concomitant psychotropic medications and functional remission in schizophrenia patients

Along with the rise of symptomatic and functional remission concepts in schizophrenia, multiple aspects of the disease treatment have been explored in their link to vocational prognosis. Although antipsychotics are the corner stone treatment, monotherapy is seldom. In fact, concomitant psychotropic medications (CPM) use during treatment of schizophrenia has dramatically increased worldwide.AimTo examine whether concomitant psychotropic medications use is associated to functional remission in schizophrenia patients.MethodsA cross-sectional, retrospective and descriptive study was conducted in the psychiatry department “C”, in Razi hospital (Tunis), between October 2014 and March 2015. Sixty patients suffering from schizophrenia spectrum disorder (DSM IV-R) were included. Functional status was explored with the Global Assessment of Functioning Scale (GAF), the Social and Occupational Functioning Assessment scale and the Social Autonomy Scale (EAS). Sociodemographic and therapeutic characteristics have been collected during a semi-structured interview.ResultsRates of functional remission were respectively: 63.30% at the GAF scale, 48.30% at the SOFAS and 51.70% at the SAS. Antipsychotics were prescribed alone in more than half patients (56.70%), mood stabilizers in 40% and antidepressants in 1.7% of the cases. Benzodiazepines were prescribed in 40% of the patients. There was no association between CPM use and functional remission, using three scales (GAF: P = 0.091; SOFAS = 0.125; EAS = 0.728).ConclusionLargely used, concomitant psychotropic medications can increase side effects, cause drug interactions, escalate treatment costs, and lead to non-adherence. That is said, their therapeutic effectiveness should be thoroughly investigated, aiming to recovery not only symptoms control.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Extrapyramidal side effects and functional remission in schizophrenia

Treating patients with schizophrenia has evolved towards including, as an effective goal, their functional remission. Beyond the discrepancies in this concept definition, a plethora of studies has been conducted trying to identify predictors of functioning in schizophrenia. Among which antipsychotic prescription and related side effects.AimExplore extrapyramidal side effects link with functional prognosis of patients with schizophrenia spectrum disorder.MethodsWe conducted a cross-sectional, retrospective and descriptive study in the psychiatry department “C”, in Razi hospital (Tunis), between October 2014 and March 2015. Sixty patients suffering from schizophrenia spectrum disorder (DSM IV-R) were included. Functional status was explored with the Global Assessment of Functioning Scale (GAF), the Social and Occupational Functioning Assessment Scale (SOFAS) and the Social Autonomy Scale (EAS). Extrapyramidal side effects (EPS) were evaluated using the Simpson and Angus Rating Scale (SAS).ResultsFunctional remission was achieved according to GAF, SOFAS and EAS in respectively: 63,30%, 48,30% and 51,70% of the patients. SAS mean score was 0.898 ± 0.29 (0.4–2). Although SAS showed no significant association with GAF, SOFAS and EAS global scores, patient with less EPS had better autonomy in EAS’ dimension “Relationship with the outside” (P = 0.048).ConclusionEPS may influence functional remission at several levels starting from the neurobiological to the social stigmatization and the treatment adherence levels. Further research in this matter is required.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Validation of a functional remission threshold for the Functional Remission of General Schizophrenia (FROGS) scale

ObjectiveThe aim of this study was to develop a functional remission threshold for the Functional Remission Of General Schizophrenia (FROGS) scale, and test its validity regarding clinical and quality of life outcomes. MethodsDesign: Cross-sectional study. Inclusion criteria: Schizophrenia according to DSM-IV-TR criteria. Data collection: Functioning was assessed using the FROGS and the Global Assessment of Functioning (GAF) scales; psychotic symptoms using the Positive and Negative Syndrome Scale; memory, attention, and executive functions were assessed using the California Verbal Learning Test, the D2 attention task, the Stroop color–word test, the verbal fluency test, the Trail Making Test A and B and the Wechsler Adult Intelligence Scale; and quality of life using the schizophrenia quality of life (S-QoL 18) scale. Analysis: A logistic regression analysis including the different dimensions of the FROGS was used to create a composite score to classify patients into remitted and non-remitted according a gold standard (cut-off: GAF>= 61). Receiver operating characteristics analyses were then performed to determine the area under the curve (AUC). ResultsOf 137 patients enrolled, 26 were functionally remitted and 111 were not remitted according to GAF score. The AUC for the combination of the FROGS’s dimensions to detect functional remission was 0.903 (p<0.001). Sensitivity and specificity for the combination of the FROGS dimensions using the Youden index were 88.5 [69.8; 97.6] and 81.1 [72.5; 87.9], respectively. Validity of this combination was satisfactory. Patients in functional remission had a lower severity of the disease, especially for PANSS negative (p<0.001) and general psychopathology (p<0.001) symptoms. Only two cognitive functions (i.e. fluency and episodic memory) were improved in remitted patients. Higher quality of life levels were globally associated with better functioning. ConclusionsThese findings provide for first accurate FROGS thresholds to detect functional remission in schizophrenia.

Évaluation de la rémission fonctionnelle dans le trouble schizophrénique : l’échelle FROGS

Functional remission is an important treatment goal in schizophrenia, as independent living and reintegration of patients into the community is the ultimate goal of any treatment. Nevertheless, assessing functional remission in schizophrenia is problematic, as it is a multifactorial entity reflecting various aspects such as symptoms severity, personal skills and sociocultural expectancies. The purpose of this study was to create and validate a novel scale for the evaluation of functional remission in schizophrenia. Unlike previous scales, this one was built on the basis of patients with few schizophrenia symptoms. The "Functional Remission of General Schizophrenia" (FROGS) scale was developed using the expert consensus method following a MEDLINE and standard database search. Out of the 61 initially proposed, 19 items were selected as gathering the core aspects of functional remission in schizophrenia detected in the literature. The FROGS was then evaluated in 432 patients with DSM-IV criteria of schizophrenia, all of them meeting Andreasen's symptomatic remission criteria. Such an instrument should have a stable structure over time but also be able to detect improvement in functioning with time. So we have further analysed the validity of the FROGS scale, specifically assessing time stability. We re-evaluated the initial patient sample around 1.5 years after the first evaluation (mean=17.1 months ± 1.9), restricting the analyses to patients who were still being followed-up and in clinical remission (n=140). Total score was highly reliable. Exploratory factor analysis after oblique rotation revealed that a three-factor solution was the most meaningful. On the basis of item content these three factors were labelled 'Social Functioning', 'Daily Life' and 'Treatment'. The FROGS total score can be used to measure a general construct for the evaluation of functional remission in schizophrenia. The mean FROGS total score was 75.8 (sd=10.8) at the second evaluation showing a significant improvement with time (3.8; P<0.0001 versus the first evaluation). The internal consistency/reliability of the FROGS scale was still very high (Cronbach's α=0.919). Significant improvement between the first and second evaluation were also apparent for all the individual items in the FROGS scale (P<0.01) as well as for the subscores for three extracted factors (P<0.0001). Statistically significant correlations were observed between the FROGS scale and other indices, including the Global Assessment of functioning (r=0.58; P<0.0001). These results provide further evidence of the solid psychometric properties of the FROGS scale. The results of these two validation studies provide further evidence of the scale's utility and its solid psychometric properties. Furthermore, it is sensitive to the duration of clinical remission. Our scale may be a step towards developing a consensual definition of functional remission in schizophrenia.

W04-02 - Psychosocial functioning (PSF) - definition and measurement

Functional remission is an important treatment goal in schizophrenia, as independent living and reintegration of patients into the community and the workplace is the ultimate goal of any treatment. Nevertheless, assessing functional remission in schizophrenia is problematic, as it is a multifactorial and complex entity reflecting various aspects such as symptoms severity, personal skills and socio-cultural expectancies. The different instruments available for clinicians will be reviewed, with large differences regarding way of administration (self-report, clinican or informant rating, tests), strength (speed, easiness, accurency, capacity to involve patients, stardardized, objectivity), and limits (validity, biases, tto narrow, costly, time-consuming, culture specific). These will be detailed for GAF, PSP, UPSA, CAN, FSRS and FROGS. A shorter (and quicker) version of the FROGS will also be presented, restricting the instrument on four items that are able to capture a large part of the variance of the functional impriovement which is associated wityh longer clinical remission (time and improvement sensitive).

Time-stability of the “Functional Remission of General Schizophrenia” (FROGS) scale

Functional remission in schizophrenia is an important treatment goal, particularly for patients who have achieved symptomatic remission. The Functional Remission of General Schizophrenia (FROGS) scale has recently been developed, with the FROGS total score being reported as reliable in a cross-sectional study, with an exploratory factor analysis showing three oblique meaningful factors. As such an instrument should have a stable structure over time, but also be able to detect improvement of functioning with time, we have further analysed the validity of the FROGS scale, specifically assessing time-stability. We re-evaluated the initial patient sample around 1.5years after the first evaluation (mean=17.1months, standard deviation=1.9), restricting the analyses to patients who were still being followed-up and in clinical remission (n=140 patients). The mean (standard deviation) FROGS total score was 75.82 (10.85) at the second evaluation, showing a significant improvement with time (3.84; P<0.0001 versus the first evaluation). The internal consistency/reliability of the FROGS scale was still very high (Cronbach's α=0.919). Significant improvements between the first and second evaluations were also apparent for all the individual items in the FROGS scale (P<0.01) as well as for the subscores for the three extracted factors (P<0.0001). Statistically significant correlations were observed between the FROGS scale and other indices, including the Global Assessment of Functioning (r=0.58; P<0.0001). These results provide further evidence of the solid psychometric properties of the FROGS scale.

The “Functional Remission of General Schizophrenia” (FROGS) scale: Development and validation of a new questionnaire

Functional remission is an important treatment goal in schizophrenia, as independent living and reintegration of patients into the community and the workplace is the ultimate goal of any treatment. Nevertheless, assessing functional remission in schizophrenia is problematic, as it is a multifactorial and complex entity reflecting various aspects such as symptoms severity, personal skills and socio-cultural expectancies.The purpose of this study was to create and validate a novel scale for the evaluation of functional remission in schizophrenia. Unlike previous scales, the scale was built on the basis of patients with few schizophrenia symptoms. The “Functional Remission of General Schizophrenia” (FROGS) scale was developed using the expert consensus method following a MEDLINE and standard database search. Out of the 61 initially proposed, 19 items were selected as gathering the core aspects of functional remission in schizophrenia detected in the literature. The FROGS was then evaluated in 432 patients with DSM-IV criteria of schizophrenia, all of them meeting the symptomatic remission criteria of Andreasen et al. [Andreasen, N.C., Carpenter, W.T., Kane, J.M., Lasser, R.A., Marder, S.R., Weinberger, D.R., 2005. Remission in schizophrenia: proposed criteria and rationale for consensus. Am. J. Psychiatry 162 441–449]. Total score was highly reliable. Exploratory factor analysis after oblique rotation revealed that a three-factor solution was the most meaningful. On the basis of item content these three factors were labelled ‘Social Functioning,’ ‘Daily Life’ and ‘Treatment.’ The FROGS total score can be used to measure a general construct for the evaluation of functional remission in schizophrenia.. Further work is required to measure the acceptability, predictive validity, sensitivity to change, and stability of the factor structure of the FROGS.