An early improvement threshold to predict response and remission in first-episode schizophrenia

Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Nussbaumstrasse 7, Muenchen 80336, Germany.
The British journal of psychiatry: the journal of mental science (Impact Factor: 7.99). 06/2010; 196(6):460-6. DOI: 10.1192/bjp.bp.109.069328
Source: PubMed


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.

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    • "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 [9] [10] [11] [12] [13] [14] [15]. The most promising approaches, but with still limited clinical value, for evaluating treatment response are the brain imaging techniques [16] [17] [18] [19] along with pharmacogenetic methods [20] [21] [22]. "
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    • "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) "
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