Symptomatic remission in psychosis and real-life functioning

Department of Psychiatry and Neuropsychology, Maastricht University, PO Box 616 (VIJV), 6200 MD Maastricht, The Netherlands. .
The British journal of psychiatry: the journal of mental science (Impact Factor: 7.99). 06/2012; 201(3):215-20. DOI: 10.1192/bjp.bp.111.104414
Source: PubMed


In 2005 Andreasen proposed criteria for remission in schizophrenia. It is unclear whether these criteria reflect symptom reduction and improved social functioning in daily life.
To investigate whether criteria for symptomatic remission reflect symptom reduction and improved functioning in real life, comparing patients meeting remission criteria, patients not meeting these criteria and healthy controls.
The Experience Sampling Method (ESM), a structured diary technique, was used to explore real-life symptoms and functioning in 177 patients with (remitted and non-remitted) schizophrenia spectrum disorders and 148 controls.
Of 177 patients, 70 met criteria for symptomatic remission. These patients reported significantly fewer positive and negative symptoms and better mood states compared with patients not in remission. Furthermore, patients in remission spent more time in goal-directed activities and had less preference for being alone when they were with others. However, the patient groups did not differ on time spent in social company and doing nothing, and both the remission and non-remission groups had lower scores on functional outcome measures compared with the control group.
The study provides an ecological validation for the symptomatic remission criteria, showing that patients who met the criteria reported fewer positive symptoms, better mood states and partial recovery of reward experience compared with those not in remission. However, remission status was not related to functional recovery, suggesting that the current focus on symptomatic remission may reflect an overly restricted goal.

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Available from: Philippe Delespaul, Nov 27, 2015
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    • "This is consistent with findings that patients choose to expend less effort during laboratory-based tasks [9] [10]. In addition, one recent study found that individuals with schizophrenia-spectrum disorders in symptomatic remission engaged in less goal-directed activities and spent more time doing 'nothing' versus healthy controls using an experience sampling method [11]. "
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    ABSTRACT: Background Impairment in community functioning is characteristic of many individuals with schizophrenia. Despite a wealth of literature documenting such functional impairments, how patients spend their time on a daily basis and the types of activities they engage in remains less clear. The present investigation set out to examine the daily activity patterns of remitted first-episode patients with schizophrenia. Methods Twenty-eight first-episode schizophrenia patients in symptomatic remission and twenty-eight age-, gender-, and education-matched healthy comparison subjects participated in the present study. The Day Reconstruction Method (DRM) was employed to evaluate daily life activities, while the Social and Occupational Functional Assessment Scale was used to for assessment of community functioning. Psychopathology was assessed using the Positive and Negative Syndrome Scale, depressed mood using the Calgary Depression Scale for Schizophrenia, and clinical insight using the Schedule for the Assessment of Insight. Neurocognition was also evaluated with the Brief Assessment of Cognition in Schizophrenia. Results First-episode schizophrenia patients experienced marked impairment in functioning, despite being in symptomatic remission. Patients and controls did not differ in the number of activities reported throughout their day. However, first-episode schizophrenia patients had significantly shorter days than comparison subjects and spent significantly less time engaged in non-passive (i.e., effortful) activities, which was related to poorer functional status. Conclusions Individuals with first-episode schizophrenia and in symptomatic remission demonstrate decreased levels of non-passive activities and poorer functional outcomes. A better understanding of the underlying factors is very likely critical to the development of strategies aimed at enhancing functional recovery in schizophrenia.
    Full-text · Article · Jul 2014 · Comprehensive psychiatry
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    • "Although it remains uncertain whether our results can be replicated in other settings or for longer follow-up periods, we believe that these results offer support for the validity of the clinical remission definition proposed by the RSWG. Although clinical remission does not necessarily translate into functional remission or recovery (Andreasen et al., 2005; Oorschot et al., 2012), it is interesting to find such associations with verbal memory. This could mean that patients who do not show symptom remission according to the RSWG definition also present at intake into treatment specific cognitive deficits associated with a more severe course of illness , one in which adequate real-life functioning might be more difficult to achieve. "
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    ABSTRACT: With the introduction of a clear definition of symptomatic remission from the Remission in Schizophrenia Working Group (RSWG), studies have sought to characterize cognitive functioning in remitted and non-remitted schizophrenia patients. However, most investigations of cognition and remission are cross-sectional or have studied samples of chronically ill patients. Therefore, the aim of this study was to compare cognitive performance between remitted and non-remitted first-episode psychosis (FEP) patients longitudinally. Seventy patients were categorized as remitted (n = 17) or non-remitted (n = 53) using the full RSWG criteria after being treated for approximately 15 months, during which cognition was evaluated twice. Since our previous investigations in FEP have isolated verbal memory as a potential cognitive marker of symptomatic remission, analyses were limited to verbal, visual and working memory. We have found that non-remitted patients had a significantly worse verbal memory performance than remitted patients after 3 months (F(1,68) = 6.47, p = 0.006) and 15 months of treatment (F(1,68) = 19.49, p < 0.001). Visual memory was also significantly lower in non-remitted patients compared to those in remission but only at initial assessment (F(1,68) = 8.21, p = 0.003) while working memory performance was similar at both time points. Our findings suggest that verbal memory may be a specific and stable marker of clinical remission in FEP patients. This cognitive domain can easily be evaluated at treatment intake in the hope of identifying early on patients who are less likely to remit.
    Full-text · Article · Mar 2014 · Schizophrenia Research
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    • "Indeed, a study aimed at investigating symptomatically remitted and non remitted patients demonstrated a significantly better level of functioning for remitted patients, although the latter continued to display significant areas of inadequate functioning, low levels of subjective wellbeing and moderate-severe emotional distress [11]. Moreover, a recent study attempting to provide an ecological validation for the symptomatic remission criterion, showed how although remitted patients reported fewer positive symptoms, better mood states and partial recovery of reward experience, remission status was not related to functional recovery [12]. Starting from these premises, and taking into account the need for further investigation into the validity of current criteria for symptomatic remission, the present study was devised to compare the efficacy of three different and increasingly “stringent” sets of criteria in evaluating remission by means of PANNS in relation to functional and cognitive status. "
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    ABSTRACT: This study aims to compare severity criteria defined by the Remission in Schizophrenia Working Group (RSWGcr) with other criteria in relation to functional and neurocognitive outcome. 112 chronic psychotic outpatients were examined. Symptomatic remission according to RSWGcr was compared with the outcome achieved using criteria based on PANSS Positive and Negative Scales (PANSS-PNScr) and the entire PANSS (PANNS-TScr). Remission rates were 50%, 35% and 23% respectively at RSWGcr, PANSS-PNScr and PANNS-TScr; functional remission rates were 32%, 42% and 54%. Sensitivity, specificity, predictive value and ROC analysis demonstrated the superiority of PANSS-PNScr in identifying patients with higher functional and cognitive outcomes. Regression analysis showed a significant predictive effect of PANSS-TScr on functioning. General linear model analyses demonstrated significantly higher mean scores at PSP and BACS for patients remitted according to PANSS-TScr. The use of more restrictive severity criteria of remission seems to be associated with improved identification of truly remitted patients.
    Full-text · Article · Sep 2013 · BMC Psychiatry
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