Defining Treatment Response, Remission, Relapse, and Recovery in First-Episode Psychosis: A Survey among Korean Experts

Abstract

Objective For the proper treatment of first-episode psychosis, assessment of treatment response, remission, relapse, and recovery is important. Therefore, the present study aimed to develop operational definitions of clinical outcomes in first-episode psychosis.Methods A questionnaire was developed by a panel of experts and underwent three revisions. The final survey was presented to 150 psychiatrists who were members of the Korean Society for Schizophrenia Research. Respondents selected factors that they believed were important to consider while defining treatment response, remission, relapse, and recovery using a 6-point Likert scale. Selected factors that constituted each definition were statistically extracted, and operational definitions were developed.Results A total of 91 experts responded to the survey. The extent of reduction in psychopathology, socio-occupational functioning, and duration of each state were the core factors of each definition. Outcomes obtained from discussions and consultations by experts have been summarized and proposed.Conclusion The criteria developed in this survey tended to be somewhat stricter than those used by other studies. The fundamental reason for this is that this survey focused on first-episode psychosis. A better understanding of each definition in first-episode psychosis is necessary to improve effective treatment outcomes.

Guidelines for Discontinuation of Antipsychotics in Patients Who Recover From First-Episode Schizophrenia Spectrum Disorders: Derived From the Aggregated Opinions of Asian Network of Early Psychosis Experts and Literature Review

“…Because a systematic review reported a mean relapse rate of 77% and 90% by 1 and 2 years, respectively, following antipsychotic discontinuation ( Zipursky et al, 2014 ), using the criteria for full recovery rather than remission criteria would be more appropriate. In the survey, Korean psychiatrists favored the definition of remission as the complete absence of positive and negative symptoms or scores ≤2 on each item of the PANSS ( Lee et al, 2020 ). Asian psychiatrists considered “absence of any relapse following first episode” as the most important criterion for antipsychotic discontinuation ( Hui et al, 2019 ).…”

Temporal Dynamics in Degree Centrality of Brain Functional Connectome in First-Episode Schizophrenia with Different Short-Term Treatment Responses: A Longitudinal Study

“…Participants were followed up for 12 weeks (81.29±12.11 days) and subgrouped as schizophrenia responders (SRs) or nonresponders (NRs) based on whether they reached the criteria of a 50% reduction of the baseline score evaluated with the PANSS, ie, SRs consisted of FEPs with PANSS reduction ≥50%, and NRs a reduction <50%. 30 , 31 Reduction in total PANSS score was calculated: 32 , 33 …”

Clinical Staging in Schizophrenia Spectrum Disorders

“…Although there are various criteria on how remission is defined, it essentially means a period of the disorder when symptoms are mild and/or there is no "active" psychosis [53]. When symptoms start to reappear after this mild or symptom-free period, and the patient is experiencing a worsening in functioning, we are talking about relapse [54,55]. Nonetheless, as mentioned previously, a third of patients might not relapse rather achieve recovery [50], a state where the patient is able to function both socially and occupationally and has considerable symptomatic improvement [55,56].…”

“…Nonetheless, in most cases, the negative and depressive / anxiety-like symptoms [25] are highly dominant in-between relapses, affecting the patient's quality of life enormously [57]. Throughout a relapse the positive and hostilityrelated symptoms might particularly increase [25,55].…”