Remission in schizophrenia: results of cross-sectional with 6-month follow-up period and 1-year observational therapeutic studies in an outpatient population

Abstract

BackgroundA standardized definition of remission criteria in schizophrenia was proposed by the International group of NC Andreasen in 2005 (low symptom threshold for the eight core Positive and Negative Syndrome Scale (PANSS) symptoms for at least 6 consecutive months).MethodsA cross-sectional study of remission rate, using a 6-month follow-up to assess symptomatic stability, was conducted in two healthcare districts (first and second) of an outpatient psychiatric service in Moscow. The key inclusion criteria were outpatients with an International Classification of Diseases, 10th edition (ICD-10) diagnosis of schizophrenia or schizoaffective disorder. Remission was assessed using modern criteria (severity and time criteria), PANSS and Global Assessment of Functioning (GAF). Patients who were stable but did not satisfied the symptomatic criteria were included in a further 1-year observational study, with the first group (first district) receiving risperidone (long-acting, injectable) (RLAI) and the second group (second district) continuing to receiving routine treatment. Symptoms were assessed with PANSS, social functioning with the personal and social performance scale, compliance with rating of medication influences scale, and extrapyramidal side effects with the Simpson-Angus scale.ResultsOnly 64 (31.5%) of 203 outpatients met the criteria for symptomatic remission in the cross-sectional study, but at the end of the 6-month follow-up period, 158 (77.8%) were stable (irrespective of remission status). Among these only 53 (26.1%) patients fulfilled the remission criteria. The observational study had 42 stable patients in the RLAI group and 35 in the routine treatment group: 19.0% in the RLAI group and 5.7% in the control group met remission criteria after 12 months of therapy. Furthermore, reduction of PANSS total and subscale scores, as well as improvement in social functioning, was more significant in the first group.ConclusionsOnly around one-quarter of our outpatient schizophrenic population met full remission criteria. Use of RLAI gave a better remission rate than achieved in standard care with routine treatment. Criteria for remission should take into account clinical course and functioning to support clinical care.

Does sex influence the diagnostic evaluation of autism spectrum disorder in adults?

“…Second, co-morbid psychiatric conditions are common in ASD (Hofvander et al, 2009; Joshi et al, 2013; Russell et al, 2005, 2015) and symptoms of ASD are often difficult to disentangle from additional or alternative conditions (Mazzone et al, 2012; Rydén and Bejerot, 2008). This may lead to inaccurate diagnoses (Attwood, 2007) or misguided referrals to specialist clinics.…”

Effect of psychoeducation and telepsychiatric follow up given to the caregiver of the schizophrenic patient on family burden, depression and expression of emotion

“…1 , 2 Most family intervention programs include cognitive therapy techniques and psychoeducation. Psychoeducation promotes the development of the coping abilities of the patients and caregivers by providing information about treatment and care of the mental disorders.…”

Design and validation of standardized clinical and functional remission criteria in schizophrenia

“…While using IRC as a treatment efficacy measure, it was found out that after switching to RLAI, three times more patients achieved remission (19%) in comparison to the control group continuing routine therapy (5.7%) 25. The correlation, ANCOVA and regression analyses demonstrated that, first, a lower PANSS total score (status severity) and more favorable diagnosis, according to the ICD10, are associated with a higher probability of remission.…”

“…In addition, the authors insisted on including the item “lack of judgment and insight” (G12), showing interplay between cognitive impairment and adequate patient self-judgment and self-control. Other studies showed a close relationship between cognitive deficit and the stability of remission 17,20,25. A number of authors indicated that the IRC were mainly nonspecific and hardly differed from the psychosis global severity assessment of the Clinical Global Impression-Schizophrenia scale, which determined remission as a “not more than mild” level of psychotic intensity 16,18,36.…”