Non-remission Group Research Articles

Characteristics of Depression Remission and Its Relation With Cardiovascular Outcome Among Patients With Chronic Heart Failure (from the SADHART-CHF Study)

Depression is prevalent in patients with heart failure and is associated with a significant increase in hospitalizations and death. Primary results of the Sertraline Against Depression and Heart Disease in Chronic Heart Failure (SADHART-CHF) trial revealed that sertraline and placebo had comparable effects on depression and cardiovascular outcomes. In this study, we explored whether remission from depression was associated with better survival and aimed to characterize participants who remitted during the trial. Based on depression response during the 12-week treatment phase, SADHART-CHF participants were divided into 2 groups: (1) remission, defined as participants whose last measured Hamilton Depression Rating Scale (HDRS) score was <8, and (2) nonremission, defined as participants whose last measured HDRS score was ≥8. Patients who dropped out before having any repeat HDRS were not included. Baseline characteristics and survival differences up to 5 years were evaluated between the remission and nonremission groups. Of the 469 SADHART-CHF participants, 208 (44.3%) achieved remission, 194 (41.4%) remained depressed, and 67 (14.3%) dropped out or died without any repeat HDRS assessment. Patients in the remission group had significantly fewer cardiovascular events than those in the nonremission group (1.34 ± 1.86 vs 1.93 ± 2.71, adjusted p = 0.01). Men patients were more likely to remit than women patients (56.5 vs 44.8%, p = 0.02). The remission group had milder depressive symptoms at baseline compared to the nonremission group (HDRS 17.0 ± 5.4 vs 19.6 ± 5.5, Beck Depression Inventory scale 17.9 ± 6.5 vs 20.3 ± 7.2, p <0.001 for the 2 comparisons). In conclusion, this study indicates that remission from depression may improve the cardiovascular outcome of patients with heart failure.

Association between health related quality of life and severity of depression in patients with major depressive disorder

To investigate the association between health related quality of life (HRQoL) and severity of depression in patients with major depressive disorder (MDD). Short Form 36 Health Survey Questionnaire (SF-36) was administered to 103 MDD patients at the baseline and 6-week follow-up. Hamilton Depression Rating for Depression (HAMD) and Clinical Global Impression (CGI) were administered at the baseline, 2- and 6-week follow-up, respectively. All SF-36 component scores in the 6-week follow-up were significantly higher than those at the baseline (P<0.01). The overall and subscale scores of HAMD except weight and CGI scores at the 2- and 6-week follow-up were significantly lower than those at the baseline (all P<0.01). The role-emotion score of the clinical remission group was significantly lower than that of the non-remission group. After a 6-week antidepressant treatment, all SF-36 component scores in both groups were significantly higher than those at the baseline, except body pain in the non-remission group. While scores of role-physical, general health, vitality, social functioning, role-emotion and mental health were significantly higher in the remission group than those in the non-remission group (P<0.05 or P<0.01). A higher overall score of HAMD, scores of cognitive disturbance and CGI were significantly associated with a worse SF-36 at the baseline (P<0.05 or P<0.01). After the 6-week treatment, a worse health transition was significantly associated with higher scores of HAMD and sleep disturbance at the baseline (P<0.01), a worse general health and role-emotion were strongly associated with higher score of anxiety/somatization at the baseline (both P<0.05). Score of general health was positively associated with reduction rate of cognitive disturbance at the 2-week endpoint (P<0.05) and scores of vitality and reported health transition were positively associated with the reduction rate of sleep disturbance at the 2-week endpoint (both P<0.05). The increasing severity of depression was significantly associated with a worse HRQoL in patients with MDD. A 6-week antidepressant treatment may result in comparable HRQoL improvements. The components of HRQoL vary with severity of various symptoms of depression at the baseline and their early improvement after the treatment.

High Rate of Regression From Micro-Macroalbuminuria to Normoalbuminuria in Children and Adolescents With Type 1 Diabetes Treated or Not With Enalapril

OBJECTIVETo evaluate the frequency of normalization, the persistence of remission, and the impact on normalization of glycemic control and lipid profile, we analyzed data from a retrospective observational cohort study of type 1 diabetic children and adolescents with abnormal urinary albumin excretion (UAE).RESEARCH DESIGN AND METHODSAll diabetic children and adolescents (n = 41) who had persistent abnormal UAE in the period of 1984 to 2008 and followed up until 2009 (follow-up duration = 13.1 ± 6.2 years) were included in the study. Nine patients progressed to macroalbuminuria; 24 patients were administered ACE inhibitor treatment.RESULTSThe cumulative prevalence of abnormal UAE was 9%. During follow-up, 14 of 17 untreated and 19 of 24 treated patients reverted to normoalbuminuria. In the remission group compared with the nonremission group, A1C levels during follow-up decreased (7.5 ± 1.0 vs. 9.4 ± 1.2%, P < 0.0001) and serum HDL cholesterol increased (52.7 ± 11.3 vs. 42.7 ± 8.6 mg/dL, P < 0.05). The micro-macroalbuminuric patients had lower HDL cholesterol (51.0 ± 11.4 vs. 62.4 ± 13.6 mg/dL, P < 0.0001) than 134 normoalbuminuric diabetic patients.CONCLUSIONSMicroalbuminuria and macroalbuminuria were not permanent in most of our diabetic children and adolescents. If abnormal UAE values are high and persist for >1 year, only long-lasting treatment with ACE inhibitors seems able to induce persistent remission, especially when associated with good metabolic control and high HDL cholesterol levels.

Decrement of serum cartilage oligomeric matrix protein (COMP) in rheumatoid arthritis (RA) patients achieving remission after 6 months of etanercept treatment: Comparison with CRP, IgM-RF, MMP-3 and anti-CCP Ab

ObjectiveThe aim of this study was to evaluate whether serum COMP can estimate the therapeutic response of RA after 6 months of treatment with etanercept. MethodsForty-five RA patients receiving 25mg of etanercept twice a week for 6 months were registered in this prospective observational study. Clinical response to the therapy was evaluated by DAS 28. Laboratory variables– COMP, CRP, ESR, IgM-RF, MMP-3, and anti-CCP Ab –were assessed at baseline and after 6 months of treatment. We assessed the correlations between serum COMP and other variables and whether serum COMP is associated with DAS28 remission. ResultsSerum COMP correlated with DAS28-ESR (p<0.05, r=0.40) at baseline. At 6 months of etanercept treatment, 10 patients entered remission (DAS28-ESR<2.6) whereas the other 35 patients did not (DAS28-ESR>2.6). The decrement of serum COMP at 6 months was significant in the remission group (N=10) but not in the non-remission group (N=35). On the other hand, CRP, ESR and MMP-3 decreased at 6 months regardless of remission status. IgM-RF titer as well as anti-CCP Ab titer did not differ at 6 months. ConclusionsSerum COMP at baseline reflects clinical disease activity of RA. Serum COMP is a valuable serologic marker to identify the subset of RA patients achieving remission during treatment with etanercept.

Characteristics and outcomes of septic shock in onto-hematological malignancy children with granulocytopenia in the pediatric intensive care unit

Objective To describe the characteristics and prognostic factors of septic shock in onco-hematological malignancy children with granulocytopenia,admitted to pediatric intensive care unit(PICU). Methods Retrospective cohort study was conducted among septic shock children with hematological cancer and granulocytopenia (n=40) admitted to PICU between January 2002 and May 2008. All the patients were in bone marrow inhibition phase with malignancy post-chemotherapy or had bone marrow hypoplasia. Results Eighteen out of 40 patients died (60%) and twelve survived,ten quitted. All patients were significantly fe-brile (>38.5 ℃) when they had septic shock; C-reaction protein (CRP) was significantly elevated. The main causes were pulmonary infections (35%) ,gastrointestinal tract infections (30%). Twenty patients had positive blood culture results, among whom 14 were Gram-negative bacilli infections (14/20,70%) and pseudomonas aemginosa was the main pathogen (8/14,57%). There were significant differences in serum glucose,serum albumin level,pH,standard base excess(SBE) ,serum lactic acid level and the Pediatric Risk Index Score for Mortality Ⅲ (PRISM Ⅲ) between the survival group and the death group (P<0.05). The mortality were 41% and 85% in patients with septic shock between primary remission or secondary remission group and relapse or non-remission group, and there was significantly difference (P<0.05). For the septic shock with dysfunction of 1,2,3 ,or more organs,mortality were 0,27% ,89%, 100% (excluded the quitted cases), and there was significantly difference (P<0.05). Conclusion For granulocytopenia children who were in bone marrow inhibition phase with malignancy post-chemotherapy or had bone marrow hypoplasia, there was an increase in mortality if complicated with septic shock. High fever was the main clinical manifes-tation; pulmonary and gastrointestinal tract are the main infection foci. Gram-negative bacteria (especially pseudomonas aeruginosa) was the main pathogen;so we suggested enhance the early empirically antibiotic therapy,especially preventive therapy for anti-gram-negative pathogens. The elevation of CRP was helpful in the early diagnosis of sepsis. Serum glucose, serum albumin level, pH, SBE, lactic acid level, and PRISM Ⅲ were significantly associated with the mortality of septic shock. Aggressively enhancing the primary diseases therapies,early recognition and proper treatment of septic shock would decrease the mortality of granulocyto-penia children complicated with septic shock, who were in bone marrow inhibition phase with malignancy post-chemotherapy or bone marrow hypoplasia. Key words: Septic shock; Granulocytopenia; Onco-hematological malignancy; Child; Pediatric inten-sive care unit

The protective effect of the RAS inhibitor on diabetic patients with nephropathy in the context of VEGF suppression

The aim of the present study was to explore whether renin angiotensin system (RAS) inhibitor can reduce the production of vascular endothelium growth factor (VEGF). Further, we sought to elucidate the correlation between VEGF level and certain clinical parameters, such as albumin excretion rate (AER), before and after treatment with angiotensin type 1 receptor blocker. We recruited 166 type 2 diabetic patients at various stages of diabetic nephropathy (DN) and 46 healthy control subjects for a cross-sectional study. We recruited another 42 hypertensive type 2 diabetic patients with microalbuminuria for a longitudinal study involving a 6-month irbesartan treatment protocol. Urinary VEGF (uVEGF) levels were determined using ELISA. In the cross-sectional study, hypertensive type 2 diabetic patients who received RAS inhibitor presented lower uVEGF levels than those who did not receive the RAS inhibitor. Statistical analysis indicated that uVEGF level was independently correlated with the AER. In the longitudinal study involving the 6-month irbesartan treatment, we demonstrated that uVEGF levels decreased significantly in patients who achieved a 50% AER reduction (remission group, n=32). In contrast, uVEGF levels remained unchanged in patients who did not exhibit a 50% AER reduction (nonremission group, n=10). Furthermore, the change in uVEGF was significantly correlated with the change in AER (r=0.65, P<0.01) before and after 6 months of irbesartan treatment. This result held true even after we had adjusted for the decrease in average blood pressure. The protective effect of the RAS inhibitor in DN patients is associated with the suppression of VEGF. Accordingly, it may be possible to use uVEGF as a marker of DN progression. We suggest that uVEGF may be an important target for therapeutic intervention in the context of DN.

Remission rate and remission predictors of Graves disease in children and adolescents

Purpose:Medical therapy is the initial treatment for children with Graves disease to avoid complications of other treatments. However, optimal treatment for childhood Graves disease is controversial because most patients require relatively long periods of medical therapy and relapse is common after medication discontinuation. Therefore, this study aimed to search clinical or biochemical characteristics that could be used as remission predictors in Graves disease. Methods:We retrospectively studied children diagnosed with Graves disease, treated with anti-thyroid agents, and observed for at least 3 years. Patients were categorized into remission and non-remission groups, and the groups were compared to determine the variables that were predictive of achieving remission. Results:Sixty-four patients were enrolled, of which 37 (57.8%) achieved remission and 27 (42.2%) could not achieve remission until the last visit. Normalization of thyroid-stimulating hormone-binding inhibitory immunoglobulin (TBII) after treatment was faster in the remission group than in the non-remission group (remission group, 15.5112.07 vs. non-remission group, 41.6935.70 months). Thyrotropin-releasing hormone (TRH) stimulation tests were performed in 28 patients. Only 2 (8.3%) of 26 patients who showed normal or hyper-response in TRH stimulation test relapsed. Binary logistic regression analysis identified rapid achievement of TBII normalization after treatment as a significant predictor of remission. Six percent of patients achieved remission within 3 years and 55.8% achieved it within 6 years. Conclusion:Rapid achievement of TBII normalization can be a predictor of remission in childhood Graves disease. The TRH stimulation test can be a predictor of maintenance of remission.

Symptom remission in first episode patients

Recently, new remission criteria for schizophrenia has been proposed, based on low symptom severity of core symptoms (the severity criteria), which is sustained over a minimum of 6 months (time criterion). The purpose of this study was to examine, in a secondary analysis, these criteria in a cohort of 240 first episode patients with a mean follow-up of 26.4 months from the Calgary Early Psychosis Program. Eighty-eight subjects (36.7%) met both the severity criteria and time criteria for remission (in-remission group); 47 subjects (19.6%) met only the severity criteria at their most recent assessment (severity only group); 49 (20.4%) subjects had met severity criteria at one or more assessments but did not meet severity or severity and time at the most recent assessment (fluctuating group); and 56 (23.3%) did not meet remission criteria (non-remission group). Those who achieved remission had lower levels of symptoms and higher functioning at baseline and at the final follow-up assessment, improved premorbid functioning, shorter duration of untreated psychosis and increased changes in symptoms over time.

Serum adiponectin level in patients of chronic pulmonary heart disease with cardiac failure

To investigate the changes of the concentration of serum adiponectin in patients of chronic pulmonary heart disease (CPHD) with cardiac failure. Thirty-eight CPHD patients with cardiac failure underwent conventional treatment, and were divided into 2 subgroups: remission subgroup (n = 32) and non-remission subgroup (n = 6) according to the therapeutic effects 2 weeks later. Peripheral blood samples were collected from these 38 CPHD patients (CPHD group), including the remission subgroup and non-remission subgroup, and 30 healthy persons (as normal control group). Enzyme linked immunosorbent assay (ELISA) was used to detect the serum levels of adiponectin, interleukin (IL)-6, and tumor necrosis factor (TNF)-alpha before and 2 weeks after treatment. The serum adiponectin of the CPHD group was (9.5 +/- 7.1) ng/L in general, significantly lower than that of the normal control group [(21.5 +/- 9.0) ng/L, P < 0.01]. The serum adiponectin of the remission group was (17.0 +/- 6.3) ng/L, significantly higher than that of the non-remission group [(8.1 +/- 4.8) ng/L, P < 0.01], but still significantly lower than that of the normal control group (P < 0.05). The IL-6 and TNF-alpha levels of the CPHD group were (50.0 +/- 17.6) and (53.8 +/- 16.2) ng/L respectively, both significantly higher than those of normal control group [(24.4 +/- 9.1) and (28.4 +/- 11.4) ng/L respectively, both P < 0.01]. The IL-6 and TNF-alpha levels of the remission group were (29.0 +/- 12.1) ng/L and (32.3 +/- 13.5) ng/L respectively, both significantly lower than those of the non-remission group [(56.0 +/- 16.0) and (59.3 +/- 19.1) ng/L respectively, both P < 0.01], but not significantly different from those of the normal control group. There were no significant differences in the adiponectin, IL-6, and TNF-alpha levels between the non-remission group and the CPHD group. Adiponectin is involved in the pathophysiological process of heart failure in the CPHD patients. It may be a useful index to guide treatment and judge prognosis by dynamically determining the serum adiponectin.

Clinical features and natural history of physical urticaria in children

Physical triggers are the most common precipitating factors for chronic urticaria in childhood. We investigate the natural history of physical urticaria (PU) and attempt to identify prognostic features. A retrospective study covering a 3 yr period (1999-2002) identified 82 children with PU seen in a tertiary referral centre. Parents of 53 children with PU responded to follow up by questionnaire and were included in the data analysis. The questionnaire ascertained symptom severity, remission status, effects of treatment and prognostic factors in determining resolution of the urticaria. Not all parents answered every question. Fisher's exact test was used to compare the remission and non-remission groups and Kaplan-Meir survival analysis was used to derive estimates of time to achieve remission. All 53 children with PU had chronic urticaria, with dermatographic, cholinergic and mixed subtypes of PU forming over 70% of the subtypes. Overall, 13% (6/45) of the children reported respiratory symptoms with the episodes of urticaria, and 67% (35/52) reported associated angioedema. In univariate analysis, a history of other allergic conditions in the child was associated with a greater chance of non-remission (p = 0.007). No significant difference in the age of onset of urticaria and duration of individual bouts was noted between the remission and non-remission groups. Episodes of urticaria were significantly less frequent (p = 0.02) in the remission group (monthly/weekly/daily - 70%/30%/0%) than the non-remission group (38%/34%/28%). Among the 20 children achieving remission, on average this occurred 30 months after onset of symptoms. In the survival analysis, the number of children becoming urticaria free was 11.6% (95% CI: 5.4%-23.9%) at 1 yr post-onset and 38.4% (95% CI: 25.9%-54.3%) 5 yr post-onset. In conclusion, based on this selected tertiary population, the prognosis for PU may not be as benign as has previously been reported. A history of allergic conditions and more frequent episodes of urticaria were associated with a poorer prognosis.

Validity, reliability, and responsiveness of the work productivity and activity impairment questionnaire in Crohn's disease

Background: Crohn's disease (CD) is a chronic inflammatory bowel disease usually diagnosed in early adult life and characterized by unpredictable flares and debilitating symptoms such as diarrhea, abdominal pain, and fever, which can interfere with a patient's ability to work and perform daily activities.Objective: The aim of this study was to assess the validity, reliability, and responsiveness of the Work Productivity and Activity Impairment questionnaire in CD (WPAI:CD).Methods: The WPAI:CD was tested in CD patients enrolled in a 26-week randomized clinical trial of cer-tolizumab pegol versus placebo. Discriminative validity of WPAI:CD absenteeism, presenteeism(reduced on-the-job effectiveness), overall work productivity loss (absenteeism + presenteeism), and activity impairment scores was assessed relative to 5 measures of disease severity and health status: CD Activity Index (CDAI), Short Form-36 physical component summary (PCS) and mental health component summary (MCS) scores, Inflammatory Bowel Disease Questionnaire (IBDQ), and the 5-dimensional EuroQoL health-related quality-of-life visual analog scale (EQ-VAS). Responsiveness was assessed by comparing changes in WPAI:CD scores from baseline to week 26 for patients in remission (CDAI <150 points) versus no remission. Standardized Response Means (SRMs) were calculated to evaluate the magnitude of the changes.Results: A total of 662 patients (mean [range] age, 37.4 [18–77] years; male, 288 [43.5%]; white, 629 [95.0%]) were enrolled in the study. Patients with CD of the worst severity (CDAI > median) showed significantly higher impairment in work (+10.5%) and activities (+10.4%) versus patients with "best health" (no problems) (both, P ≤ 0.001). Patients with "worst" IBDQ, PCS, MCS, and EQ-VAS scores also showed significantly higher impairments in work (IBDQ, VAS -24.2%; PCS, -24.1%; MCS, -15.9%; EQ-VAS, -16.5%) and activities (IBDQ, -23.3%; PCS, -21.8%; MCS, -16.5%; EQ-VAS, -17.2%) versus "best" scores (all, P < 0.05). There were significant differences between WPAI:CD impairment scores for patients in remission versus patients failing to achieve remission (P < 0.05). SRMs were small (ie, <0.5) in the nonre-mission group, and moderate to large (ie, >0.5) for patients in remission.Conclusions: The discriminative validity, reliability, and responsiveness of the WPAI:CD were demonstrated. The WPAI:CD may be useful for evaluating drug impact on CD.

Long-term Follow-up of Plasma Cells in Bone Marrow and Serum Free Light Chains in Primary Systemic AL Amyloidosis

Primary systemic AL amyloidosis arises from immunoglobulin light chains produced by plasma cell dyscrasia. To prospectively investigate the production of M-protein and plasma cells in bone marrow before and after chemotherapy, we performed flow cytometry and analysis of serum free light chains (FLCs). Fifty-nine patients with primary systemic AL amyloidosis (mean age, 59.9+/-8.8 years) were enrolled in this study, and of these 31 were serially studied before and after chemotherapy. Complete hematological remission was defined as normalization of the FLC kappa/lambda ratio. MPC-1(-)CD45(-) (p<0.05) and MPC-1(+)CD45(-)CD49e(-) (p<0.005) were significantly higher, and MPC-1(-)-CD45(+) (p<0.05), MPC-1(+)CD45(+)CD49e(-) (p<0.0001) and MPC-1(+)CD45(+)CD49e(+) (p<0.0005) were significantly lower in the patients with AL amyloidosis than in controls. There was a significantly positive correlation between the serum predominant FLC/serum creatinine ratio and MPC-1(+)CD45(-)CD49e(-) (p<0.05). After chemotherapies, such as high-dose melphalan with autologous stem cell support, 20 of 31 patients with AL amyloidosis achieved complete hematological remission. There were no significant differences in any subtype of plasma cells before treatment between the remission and non-remission groups, but in the former group MPC-1(+)CD45(-)CD49e(-) and MPC-1(-)CD45(+) were significantly decreased and increased after chemotherapy compared with before, respectively. Abnormal plasma cells in the bone marrow, particularly the MPC-1(+)CD45(-)CD49e(-) subset, may be important as a follow-up marker before and after chemotherapy in primary systemic AL amyloidosis. These cells maintain low levels as long as no relapse occurs.

Predictive Factors of Clinical Outcome in Patients with Diffuse Proliferative Lupus Nephritis Treated Early by Intravenous Methylprednisolone Pulse Therapy

Background. Diffuse proliferative lupus nephritis (DPLN) is associated with significant morbidity and mortality unless aggressive immunosuppressive therapy is initiated early in the course of the disease. It has been observed that with steroid pulse therapy, some patients with DPLN enter clinical remission while others do not. The factors predictive of clinical remission with steroid pulse therapy in these patients has not yet been elucidated. Methods. The authors retrospectively reviewed the records of 52 consecutive patients of DPLN treated by steroid pulse therapy in order to compare the characteristics of patients in the clinical remission group and those in the non-remission group. Clinical remission was defined as a serum creatinine level of ≤1.2 mg/dL, negative or trace proteinuria, and the observation of ≤1–4 red blood cells / high-power field in a routine urine examination. The 52 patients were divided into the clinical remission group (n = 29) and the non-remission group (n = 23), and also into subcategories of DPLN, namely, the IV-G group (n = 28) and the IV-S (n = 24). The characteristics of the patients were then compared between the two respective groups to identify factors that might be significantly related to clinical remission using Mann-Whitney's U test and the Cox proportional hazards model. Results. In regard to the clinical and immunological characteristics of the patients, except for a significant difference in the serum albumin level, there were no significant differences in any of the parameters examined, including blood pressure, degree of proteinuria, and serum creatinine, between the remission group and non-remission group. Added to that, in the non-remission group, the pretreatment period was significantly longer than in the remission group. In relation to the histological characteristics, the Chronicity Index (CI) and severity of interstitial fibrosis were significantly higher (p = 0.021) in the non-remission group than in the remission group. The result of the Cox proportional hazards analysis revealed that the serum albumin, pretreatment period, CI, and severity of interstitial fibrosis were strongly related to the clinical outcome, whereas the results of the multivariate Cox proportional hazards analysis revealed only a weak correlation between the CI and the outcome. Conclusion. It was concluded that the diagnosis should be performed early and the pretreatment period should be shortened before treatment. Also, an aggressive therapeutic intervention should be initiated early, before chronic renal injury becomes established, to increase the likelihood of remission in patients with DPLN.

Remission in early psychosis: Rates, predictors, and clinical and functional outcome correlates

Background Recently, the “Remission in Schizophrenia Working Group” proposed remission criteria consisting of a reduction to mild levels on key symptoms for at least 6 months. Aims This study applied these remission criteria to a large first-episode psychosis sample in order to (1) determine the rates of remission; (2) explore predictors of remission; and (3) test the external validity of these criteria. Methods We analyzed data from 462 subjects with a first-episode of psychosis who participated in a long-term, multinational, randomized, double-blinded trial of risperidone and haloperidol over 2 to 4 years. Results At some time point in the study 323 (70%) of the 462 subjects had a reduction to mild levels on the key symptoms as measured by the PANSS although only 109 (23.6%) maintained this level for at least 6 months thereby meeting remission criteria. The two strongest predictors of remission were shorter duration of untreated psychosis ( p = 0.01) and treatment response at 6 weeks ( p = 0.001). Compared to non-remitted patients, those in remission experienced greater improvement on all PANSS subscales ( p < .0001), CGI-S ( p < .0001), better quality of life ( p = 0.006), fewer relapses ( p < .0001), displayed a more favorable attitude towards their medication ( p = .002), had lower EPS levels according to the ESRS ( p = < .0001) and received lower doses of antipsychotic medication ( p = 0.003). The remission and non-remission groups did not differ significantly regarding composite cognitive scores, suicidality and body mass index. Conclusions The results suggest that the remission criteria, although based solely on core symptom improvement, can effectively identify patients who have a more favorable overall outcome.

0428 EFFECTIVENESS OF ANTIPSYCHOTIC TREATMENT IN NEVER TREATED PATIENTS WITH SCHIZOPHRENIA: 36-MONTH RESULTS FROM THE SCHIZOPHRENIA OUTPATIENTS HEALTH OUTCOMES (SOHO) STUDY

Recently, the “Remission in Schizophrenia Working Group” proposed remission criteria consisting of a reduction to mild levels on key symptoms for at least 6 months.This study applied these remission criteria to a large first-episode psychosis sample in order to (1) determine the rates of remission; (2) explore predictors of remission; and (3) test the external validity of these criteria.We analyzed data from 462 subjects with a first-episode of psychosis who participated in a long-term, multinational, randomized, double-blinded trial of risperidone and haloperidol over 2 to 4 years.At some time point in the study 323 (70%) of the 462 subjects had a reduction to mild levels on the key symptoms as measured by the PANSS although only 109 (23.6%) maintained this level for at least 6 months thereby meeting remission criteria. The two strongest predictors of remission were shorter duration of untreated psychosis (p = 0.01) and treatment response at 6 weeks (p = 0.001). Compared to non-remitted patients, those in remission experienced greater improvement on all PANSS subscales (p < .0001), CGI-S (p < .0001), better quality of life (p = 0.006), fewer relapses (p < .0001), displayed a more favorable attitude towards their medication (p = .002), had lower EPS levels according to the ESRS (p = < .0001) and received lower doses of antipsychotic medication (p = 0.003). The remission and non-remission groups did not differ significantly regarding composite cognitive scores, suicidality and body mass index.The results suggest that the remission criteria, although based solely on core symptom improvement, can effectively identify patients who have a more favorable overall outcome.

Induction of Long-term Glycemic Control in Newly Diagnosed Type 2 Diabetic Patients Is Associated With Improvement of β-Cell Function

To investigate whether long-term optimal glycemic control can be achieved without medication by transient continuous subcutaneous insulin infusion (CSII) and the possible mechanisms responsible for this remission. Newly diagnosed type 2 diabetic patients (n = 138, fasting glucose >11.1mmol/l) were hospitalized and treated with CSII for 2 weeks. Intravenous glucose tolerance tests (IVGTTs) were performed, and blood glucose, HbA(1c), lipid profiles, proinsulin, insulin, and C-peptide were measured before and after CSII. Patients were followed longitudinally on diet alone after withdrawal of insulin. Optimal glycemic control was achieved within 6.3 +/- 3.9 days by CSII in 126 patients. The remission rates (percentages maintaining near euglycemia) at the third, sixth, twelfth, and twenty-fourth month were 72.6, 67.0, 47.1, and 42.3%, respectively. Patients who maintained glycemic control >12 months (remission group) had greater recovery of beta-cell function than those who did not (nonremission group) when assessed immediately after CSII. Homeostasis model assessment of beta-cell function (HOMA-B) and the area under the curve (AUC) of insulin during IVGTT were higher in the remission group (145.4 +/- 89.6 vs. 78.5 +/- 68.5, P = 0.002, and 1,423.4 +/- 523.2 vs. 1,159.5 +/- 476.8 pmol x l(-1) x min(-1), P = 0.044). Change in acute insulin response was also greater in the remission group than that in the nonremission group (621.8 +/- 430.4 vs. 387.3 +/- 428.8 pmol x l(-1) x min(-1), P = 0.033). Short-term intensive insulin therapy can induce long-term glycemic control in newly diagnosed type 2 diabetic patients with severe hyperglycemia. The improvement of beta-cell function, especially the restoration of first-phase insulin secretion, could be responsible for the remission.

Anti-Leukemia Chemotherapy of High-Risk Myelodysplastic Syndromes

We evaluated the outcome of anti-leukemia chemotherapy on 42 patients with the high-risk myelodysplastic syndromes (MDS)-refractory anemia with excess of blasts (RAEB), 8 cases; RAEB in transformation (RAEB-T), 18 cases; chronic myelomonocytic leukemia (CMMOL), 6 cases; and leukemic transformation of MDS, 10 cases. The median age was 67 (range 20 to 84). As a remission-induction therapy, 35 patients received low-dose chemotherapy, such as low-dose cytarabine infusion, and seven patients received high-dose combination chemotherapy. The complete remission (CR) rates of the low-dose chemotherapy group and the high-dose combination chemotherapy group were 29% and 57%, respectively, and the overall CR rate was 33%. The median survival durations after induction chemotherapy of the CR group (14 cases), the partial remission (PR) group (11 cases), and non-remission (NR) group (17 cases) were 19 months, 8 months, and 3 months, respectively. As a post-remission consolidation chemotherapy, high-dose combination chemotherapy seemed to be superior to low-dose chemotherapy judging from the median CR duration (16 months versus 4 months), but a long-term disease-free survival is hardly expected, in contrast with results in cases of de novo acute myeloid leukemia.

Expressed emotion and short-term treatment outcome of outpatients with major depression

Expressed emotion (EE) is the attitude of criticism and emotional overinvolvement of a key relative toward a patient, and is one of the family factors that contribute to the course of psychiatric illness. The relationship between EE and 6-month outcome in 40 outpatients with major depression was investigated in this study. In the nonremission group (n = 17,43.7%), there was a higher prevalence of past history of depression ( P < .01) and high-EE relatives ( P < .05) than in the remission group (n = 23). On an EE profile based on a Five-Minute Speech Sample (FMSS), 15.0% (n = 6) of the cases were high-EE: three were rated as emotional overinvolvement (EOI), two as critical, and one as EOI and critical. On the critical subscale, the rate of non-remission increased gradually in response to the level of criticism (from pure low-EE, to borderline-Critical [b-critical], and then to high-critical). Multiple logistic regression analysis showed that the level of criticism and a past history of depression were significant predictors of poor outcome ( P < .05). These results indicate that criticism from family members may be one factor that prolongs depressive episodes.

The natural history of cryptosporidial diarrhoea in HIV-infected patients

To determine the natural history of cryptosporidial infection in HIV-infected individuals. Retrospective study. University teaching hospital HIV inpatient and outpatient unit. Thirty-eight HIV-infected patients presenting with cryptosporidial diarrhoea between April 1986 and July 1991 were identified retrospectively from laboratory records. Eleven of the 38 patients had a clinical remission of their diarrhoea. Median lymphocyte count of the remission group was significantly higher than that of the non-remission group (1100 and 550 x 10(6)/l, respectively; P = 0.003). Median survival times were 66 and 11.5 weeks for the remission and non-remission groups, respectively (P = 0.001). Liver function tests performed at the initial diagnosis of cryptosporidial diarrhoea were available for 28 patients. Aspartate transaminase was raised in 16 and alkaline phosphatase in 10 of these 28 patients. Ten patients showed evidence of AIDS-associated sclerosing cholangitis, one patient had an episode of acute pancreatitis and another presented with acute cholecystitis. This study suggests that HIV-associated cryptosporidial diarrhoea does not have a uniformly poor prognosis. Eleven out of 38 patients had a spontaneous clinical remission, which appears to be predicted by the absolute lymphocyte count. Abnormal liver function tests and hepatobiliary disease were common.

Spontaneous remissions in spasmodic torticollis.

We reviewed the frequency of spontaneous remissions in spasmodic torticollis (ST). One hundred sixteen patients with idiopathic ST (72 F, 44 M) were examined. The age at onset ranged from 9 to 69 (mean, 38.1 +/- 1.3). Twenty-one patients (18%) were Jewish. Eleven patients (9%) had a history of familial dystonia. Remissions longer than 1 year unrelated to treatment were observed in 14 patients (12%) (9 F, 5 M). They occurred in the first year of ST in 13 patients (93%) and in the eighth year in 1. Duration of remissions ranged from 1 to 20 years (mean, 6.5 +/- 1.6). Two patients had three remissions, and another had two. The mean age at the onset of ST in patients with remission was 26.4 +/- 3.3 (SEM) and ranged from 9 to 49. The age at the onset in the patients without remissions was 39.7 +/- 1.4, ranging from 10 to 69 (p less than 0.01). In the remission group, 3 patients were Jewish (21%); in the non-remission group, 18 (18%) were Jewish. There was a familial history in 1 case with remission (7%) and in 10 cases (10%) without remission. Spontaneous remissions in the course of ST seem to be more frequent in patients with early onset, and they occur usually during the first year.