Early improvement with treatment is thought to be important in patients with first-episode schizophrenia, yet a valid definition is still outstanding.
To develop a valid definition of early improvement and test its predictive validity regarding response and remission.
We examined 188 in-patients with first-episode schizophrenia. Early improvement was defined as improvement in Positive and Negative Syndrome Scale (PANSS) total score at week 2, response as a 40% PANSS total score improvement at end-point, and remission according to consensus criteria.
Reasonable predictive validity of early improvement was found for a 46% PANSS total score improvement at week 2 and a 50% improvement for remission (area under the curve: response 0.707, remission 0.692). Estimated confidence intervals ranged from 26 to 62% PANSS reduction for response and remission.
Patients with a first episode of schizophrenia should improve by at least 30% in PANSS total score at week 2 to achieve response and remission.
"So far there are no clinically validated biochemical, genetic or molecular tests for diagnostics, treatment evaluation, outcome prediction and Sz diagnosis, and the management most often relies on the clinicians' observation and patients' reports. Another milestone in Sz treatment is the largely unpredictable response to the generally applied various antipsychotics, and their combinations       . The most promising approaches, but with still limited clinical value, for evaluating treatment response are the brain imaging techniques     along with pharmacogenetic methods   . "
[Show abstract][Hide abstract] ABSTRACT: Schizophrenia (Sz) is a multifactorial mental disorder with high frequency. Due to its chronic and relapsing nature there is a strong need for biomarkers for early psychosis detection and objective evaluation of drug (usually antipsychotics) treatment effect. Here differential scanning calorimetry (DSC) is applied to thermodynamically characterize the blood serum proteome of paranoid schizophrenia patients on routine antipsychotic treatment in comparison to healthy controls. DSC revealed significant modifications in
the thermodynamic behavior of blood sera from Sz patients, the overall thermal profile being changed in all Sz cases under study. The calorimetric profiles were classified in four distinct groups, reflecting different thermal stabilization of the high-abundance portion of the serum proteome. The observed positive (thermograms becoming closer to the healthy profile) or negative (thermograms deviating stronger from the healthy profile) proteome thermal stability switches and the Sz thermograms persistence in patients’
follow-up corresponded well with the effect of drug treatment.
"The authors found and estimated cumulative response rates of 39.59% by week 8 and 65.19% by week 16, but they did not find any level of percentage symptom reduction at weeks 2,4 or 8 to be a clinically useful predictor of response by week 16.24) Possibly, the predictive power of early response in FES patients might depend on the assessment time point. Within our own working group and a trial performed by the Competence Network on Schizophrenia in Germany, we were able to show that when examining a short-term treatment phase (8 weeks acute treatment comparing the efficacy of risperidone and haloperidol) patients improving at least 30% in the PANSS within the first two treatment weeks could be reliably identified to be the ones achieving response (≥50% PANSS improvement from baseline to endpoint) and remission (defined following the criteria by the Remission in Schizophrenia Working Group) at endpoint.25) However, when trying to predict response one year after the patients were discharged from hospital, the psychopathological improvement beginning with week 6 of treatment was the earliest time point reliably predicting response at week 52.26) "
[Show abstract][Hide abstract] ABSTRACT: First episode schizophrenia (FES) patients tend to be more responsive to treatment. An adequate response has been associated with a favourable long-term course in FES patients. Yet, despite the generally very favourable response profile around one quarter of the patients shows persisting symptoms of psychosis. To improve the outcome and course of psychosis great effort has emerged in identifying biological and clinical variables associated with non-response in order to identify non-responders as early as possible and adopt specific treatment strategies improving illness outcome. Different antipsychotic treatment regimens have been evaluated in terms of their efficacy in reducing symptoms of FES with psychological interventions gaining increasing importance in the treatment concept of patients suffering from their first illness episode. Therefore, aim of this review is to summarize current evidence on the response patterns, the most important predictors of response/non-response as well as on effective treatment interventions in FES patients.
Clinical Psychopharmacology and Neuroscience 08/2012; 10(2):78-87. DOI:10.9758/cpn.2012.10.2.78
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.