Criteria for symptom remission revisited: a study of patients affected by schizophrenia and schizoaffective disorders

Abstract

Background: 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. Methods: 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). Results: 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. Conclusion: The use of more restrictive severity criteria of remission seems to be associated with improved identification of truly remitted patients.

Assessment of functioning in patients with schizophrenia and schizoaffective disorder with the Mini-ICF-APP: a validation study in Italy

“…Indeed, the sample was made up prevalently by middle-aged, single, unemployed, fairly well educated males, with a long duration of illness, early age at onset, and continuous course of the disorder; ratings obtained at CGI-SCH, PANSS, MMSE, BACS and MMSE, relating to symptoms, cognition and functioning, denote a fairly stable clinical condition characterized by a low/moderate symptoms’ severity, cognitive impairment and social disability, as expected in a cohort of relatively stable, chronic patients in a community setting. Indeed, approximately 50 % of our patients were in clinical remission, slightly less than one-third in functional remission, and about one quarter viewed as recovered in line with the adopted criteria, a finding largely consistent with previous data published by our group [ 14 , 33 ] and with literature findings [ 34 – 37 ]. Mean and median scores obtained at Mini-ICF-APP were generally comprised between 1 and 2 for the majority of items, thus indicating a low-moderate level of impairment, with only two items (self-care and mobility) showing very low scores (both means and medians lower than one), indicating the absence of, or minimal impairments in these areas; this finding was very similar to that of Balestrieri et al in their validation study of the Italian version of the Mini-ICF-APP [ 13 ].…”

“…Although schizophrenic symptomatology and functioning are only partially inter-related, being seen as semi-independent outcome measures [ 39 ], and despite the fact that clinical remission does not always imply functional remission [ 33 , 35 ], significant positive correlations between symptom severity and impaired functioning are generally reported in the literature [ 1 ]. In our study, Mini-ICF-APP total scores were significantly correlated with overall scores of both CGI-SCHs and PANSS, a finding indicating a clear relationship between severity of symptomatology and degree of severity of functional deficits measured by Mini-ICF-APP, while no correlations were observed with ratings of positive symptoms evaluated by both CGI-SCHs and PANSS.…”

Clinical Global Impression-severity score as a reliable measure for routine evaluation of remission in schizophrenia and schizoaffective disorders

“…Moreover, the possibility of a more user-friendly method for use in the evaluation of remission, may contribute towards extending this approach to the routine care system, with the consequent advantage of a more concise, and in our opinion, more useful way of assessing outcomes of therapeutic interventions. However, it should be highlighted that although time-consuming, the use of the entire PANSS, not limited to selected items such as those included in RSWG criteria [ 4 ], would seem to be better suited for research purposes, being associated with the best performances in describing remission [ 33 ].…”

Mismatch Negativity Indices as a Prognostic Factor for Remission in Schizophrenia

“…Patients were judged to be in clinical remission according to severity criteria (scores obtained on each of these items had to be ≤ 3 points, indicating mild severity of symptoms) [19]. In this study, clinical remission was evaluated, taking into account the severity criteria alone, excluding the duration criterion (remission maintained for six months) [26]. PANSS administrations were conducted by two psychiatrists (JSK & SHS) and the interrater reliability value was 0.81.…”