Article

Sustained remission of schizophrenia

American Journal of Psychiatry (Impact Factor: 13.56). 10/2005; 162(9):1763; author reply 1763-4. DOI: 10.1176/appi.ajp.162.9.1763
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    ABSTRACT: A definition of clinical remission in schizophrenia has recently been proposed. However, it is also known that neuropsychological (NP) impairments may be better predictors of functional outcomes than clinical symptoms. Understanding the relationship between clinical remission and cognitive improvement may be required in order to predict functional improvements, so we examined the development and convergence of clinical remission and neuropsychological improvements in a sample of patients with schizophrenia whose medication was switched to ziprasidone. One hundred eighty-four patients were switched from their previous treatment with risperidone, olanzapine, or conventional antipsychotics to open-label ziprasidone treatment. One hundred and thirty seven patients were not in remission at baseline and 40 met the clinical criteria for remission at study entry. We rated their symptoms with the PANSS at baseline and after 6 months of treatment. We performed an NP assessment and generated a composite score which was examined for improvements. Of the 184 cases, 48 (26.1% of the total sample) met the remission criteria at baseline. Of these cases, 41 (85%) sustained their remission at the 6-month follow-up. Of the remaining 136 cases, 33% developed remission by the 6-month follow-up. Thus, a total of 55% of the total sample were in remission at the 6-month endpoint. A comparable number of the patients, 34%, improved by 0.5 SD or more in their cognitive performance. Baseline NP performance was not associated with remission at baseline and did not predict achieving remission over time. Further, clinical remission was not correlated with concurrent NP improvements. However, 33 patients achieved clinical remission and improved by 0.5 SD in their NP performance. After a switch from previous treatment to open-label ziprasidone more than half of patients with schizophrenia experienced sustained clinical remission over 6 months and 32% of the patients achieving remission experienced a concurrent NP improvement. Later research will be required to determine which aspects of improvement (clinical remission and/or cognitive improvements) are required for functional improvements.
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    ABSTRACT: Schizophrenia is a serious and prolonged illness between whose psychosocial treatments one of the most effective is the psychoeducation. This treatment involves the family and succeeds in reducing rates of relapse and improves the course of the illness. The Psychiatry Service of Zamora years ago develops an intervention of this kind. In Zamora, the geographical and transport are obstacles who characterize its territory, and cause of some difficulties in access of families to this important therapy. In view of this circumstances an alternative is develop a distance therapy founded in internet. This work is an approach to test this possibility. This research conducted an exhaustive review of the literature regarding psychoeducation as e-therapy. Analyzed the results of the traditional treatment previously made by the Service of Zamora, and explored the difficulties of access for their users. The results indicate that the intervention traditional in Zamora increases knowledge and requires some improvement; also described the difficulties that families have accessing to the intervention (mainly distance and transportation). Finally, both families and professionals would be prepared to use a therapy at a distance based on Internet. This research has developed a methodology for analysis of the instruments used in the Service of Zamora; has known the outcome of the psychoeducational intervention; have been identified the difficulties in access to interventions and; have been explored the possible acceptances of an e-therapy. These results are the foundation and justification to develop a psychoeducational program called PsicoED that fits the pattern of service to the needs of its population.
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    ABSTRACT: The concept of “resistant schizophrenia” is linked to the development of antipsychotic drugs. Although there were previous attempts, the first definition acknowledged in the scientific literature, was closely linked to the development of clozapine in dichotomic terms of response/no response to previous drug. This article reviews the influence of the psychopharmacologic treatment of schizophrenia on the evolving definition of treatment-resistance. It also addresses other concepts of interest, such as remission and recovery, as well as definitions of schizophrenia in which deterioration is an integral part of the psychopathology, thereby implicitly ruling out the possibility of a complete remission of symptoms. Instead of treatment-resistance, we are suggesting the term “lack of adequate response,” which is closer to operational dimensional models that integrate the idea of a continuum with response levels related to an individual's life expectations, and which allow different pharmacological approaches to be integrated.
    Journal of Experimental and Clinical Medicine 04/2012; 4(2):98–102. DOI:10.1016/j.jecm.2012.02.003

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