Predictive factors of functional remission in patients with early to mid-stage schizophrenia treated by long acting antipsychotics and the specific role of clinical remission

Gorwood, Philip; Bouju, Sophie; Déal, Cécile; Gary, C.; Delva, Catherine; Lancrenon, S.; Llorca, Pierre‐Michel

doi:10.1016/j.psychres.2019.112560

Cited by 17 publications

(11 citation statements)

References 63 publications

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“…For multiple-episode patients, the proportion achieving SR was 16-62% with a weighted mean of 37%; such variability may be explained by the differing length and frequency of follow ups, and differing drop-out rates. 33 The remission status achieved with oral medication decreased over time, whereas remission achieved following treatment with long-acting injectable antipsychotics tended to be increased, with a high level of sustainability (84-94%), 33,34 in line with the outcomes of the REMISSIO study. The majority of patients (93.5%) in the current study who achieved SR at Month 6 retained their remission status until the end of study.…”

Section: Discussionmentioning

confidence: 71%

Symptomatic and functional outcomes after treatment with paliperidone palmitate 3-month formulation for 52 weeks in patients with clinically stable schizophrenia

García-Portilla

Llorca²,

Maina

et al. 2020

Therapeutic Advances in Psychopharmacology

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Background: Paliperidone palmitate 3-monthly (PP3M) formulation is a long-acting, injectable antipsychotic treatment approved in many countries worldwide for the maintenance treatment of adult patients with schizophrenia. This single-arm, open-label, phase IIIb study evaluated the efficacy and safety of converting patients with schizophrenia stabilized with paliperidone palmitate 1-month (PP1M) to PP3M in a naturalistic clinical setting. Methods: After screening (days –7 to 1), patients were converted from PP1M (50–150 mg eq.) to PP3M (175–525 mg eq.), and entered a 52-week, flexible-dose PP3M treatment period. The primary efficacy endpoint was symptomatic remission (SR) (Andreasen criteria) at last observation carried forward (LOCF) endpoint. Results: Patients ( n = 305) received PP3M, of whom 291 (95.4%) completed the study. Doses of PP3M remained stable during the 12-month treatment period, and changes in dose were uncommon. Overall, 56.8% of patients [95% confidence interval (CI): 51.0, 62.4] achieved SR, and 31.8% achieved both symptomatic and functional remission (Personal and Social Performance scale total score > 70) at LOCF endpoint. Secondary endpoint results were generally consistent with primary endpoint results. There were improvements in Positive and Negative Syndrome Scale total, subscale and Marder factor scores, and also Clinical Global Impression-Severity and -Change scores from baseline to LOCF endpoint. Carer burden was reduced, and the proportion of patients requiring hospitalization for psychiatric reasons decreased from 13.5% in the 12 months prior to baseline to 4.6% during the treatment period. No new safety signals were identified. Conclusion: Results from this naturalistic study were similar to those observed in previous randomized clinical trials of PP3M and underline the importance of continuous maintenance treatment in patients with schizophrenia.

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Section: Discussionmentioning

confidence: 71%

Symptomatic and functional outcomes after treatment with paliperidone palmitate 3-month formulation for 52 weeks in patients with clinically stable schizophrenia

García-Portilla

Llorca²,

Maina

et al. 2020

Therapeutic Advances in Psychopharmacology

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“…The authors proposed that clinical remission 'facilitated' functional remission, particularly during the early phase of the illness. 42 PANSS total and subscale scores indicated a reduction in disease severity during the 1-year follow-up period in both age groups. Improvements were seen in both negative symptoms and other non-psychotic symptoms.…”

Section: Discussionmentioning

confidence: 87%

“…The authors proposed that clinical remission ‘facilitated’ functional remission, particularly during the early phase of the illness. 42 …”

Section: Discussionmentioning

confidence: 99%

Stable patients with schizophrenia switched to paliperidone palmitate 3-monthly formulation in a naturalistic setting: impact of patient age and disease duration on outcomes

Pungor

Bozikas

Emsley

et al. 2020

Therapeutic Advances in Psychopharmacology

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Background: Paliperidone palmitate 3-monthly (PP3M) is a second-generation, long-acting injectable antipsychotic formulation indicated for the maintenance treatment of adults with schizophrenia first stabilized with paliperidone palmitate 1-monthly (PP1M). This exploratory post hoc subgroup analysis of the 52-week, phase 3b REMISSIO study analysed outcomes according to patient age and disease duration in a naturalistic clinical setting. Methods: Outcomes of patients with schizophrenia were analysed according to age [<35 years ( n = 123) versus ⩾35 years ( n = 182)] and disease duration [⩽3 years ( n = 72) versus >3 years ( n = 233)]. The primary efficacy outcome was the proportion of patients achieving symptomatic remission according to the Andreasen criteria. Adverse events were monitored throughout the study. Results: At endpoint (last observation carried forward), 60.7% (95% CI: 51.4%, 69.4%) of younger patients and 54.1% of older patients (95% CI: 46.6%, 61.6%) achieved symptomatic remission. The proportions for patients with disease duration ⩽3 years and >3 years were similar: 57.8% (45.4%, 69.4%) versus 56.5% (49.8%, 62.9%). Functional remission was reached by 45.4% (36.2%, 54.8%) of patients aged <35 years and 36% (28.9%, 43.6%) of patients aged ⩾35 years with a similar pattern when analysed by disease duration. PP3M had a favourable safety profile and was generally well tolerated in both age groups. Conclusion: Patients with schizophrenia, previously stabilized on PP1M, may benefit from PP3M treatment with some additional potential improvements if started early in the disease course. Clinical trials.gov: NCT02713282

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“…Five studies used different tools: the Beck Cognitive Insight Scale (BCIS) (Burton et al, 2011) assessing self-reported cognitive insight according to self-reflectiveness and self-certainty (Beck et al, 2004; Jaafari, 2018); the Cognitive Problems and Strategies Assessment (CPSA) assessing self-reported frequency of cognitive problems (Burton & Twamley, 2015); the Birchwood scale (Birchwood et al, 1994; Gorwood et al, 2019) assessing self-reported clinical insight as a three-dimensional construct (Jaafari, 2018); and two hetero-evaluation scales: (a) the Evaluation of Cognitive Processes involved in Disability in Schizophrenia (ECPDS) assessing insight with two items on the social cognition domain scale (Passerieux et al, 2018) and (b) the Brown Assessment of Beliefs Scale (BABS) (Vigne et al, 2014) assessing insight as a dimensional construct defined as strength of beliefs (Jaafari, 2018). Correlations between “cognitive insight,” measured with BCIS, and vocational outcomes, measured with UPSA, SSPA, and ILSS, were not statistically significant (Burton et al, 2011).…”

Section: Resultsmentioning

confidence: 99%

Impact of insight and metacognition on vocational rehabilitation of individuals with severe mental illness: A systematic review.

Manoli¹,

Cervello²,

Franck³

2021

Psychiatric Rehabilitation Journal

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Objective: Identifying specific insight and/or metacognitive measures predicting vocational outcomes would lead to a refinement of cognitive and behavioral assessment and treatment of people with severe mental illness. Methods: We conducted a systematic review of empirical research following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Studies published in PubMed and PsycINFO from January 1, 2000 to April 30, 2020 and including words referring to "vocational outcomes", "insight," and "metacognition" were screened. Results: Twenty-eight studies were included, 19 assessing insight and 9 assessing metacognition and their relationships with vocational outcomes in patients with severe mental illness. Thirteen studies (68%) identified statistically significant relationships between insight scores and vocational outcomes. Five studies (56%) identified statistically significant relationships between metacognition scores or metacognitive training and vocational outcomes. The most common tools whose measures were significantly related to vocational outcomes were the Schedule for the Assessment of Insight, the Scale to assess Unawareness of Mental Disorder and the Metacognition Assessment Scale-Abbreviated. Conclusions and Implications for Practice: Insight and metacognition appeared to be related to the vocational outcomes of people with severe mental illness. However, due to the heterogeneity of variables used to operationalize insight, metacognition, and vocational outcomes, it was not possible to determine the overall effect of insight and metacognition. Nevertheless, assessment including the measures of insight and metacognition would be relevant in vocational rehabilitation centers and in centers providing care through employment. The literature lacks predictive models of employment variables including insight and metacognition, so further studies should address this. Impact and ImplicationsInsight and metacognitive levels of people with severe mental illness appeared to be related to their vocational outcomes. Assessment including the measures of insight and metacognition would be relevant in vocational rehabilitation centers and in centers providing care through employment. Further studies should focus on possible predictive relationships between insight/metacognition and the ability to (return to) work of people with severe mental illness.

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Predictive factors of functional remission in patients with early to mid-stage schizophrenia treated by long acting antipsychotics and the specific role of clinical remission

Cited by 17 publications

References 63 publications

Symptomatic and functional outcomes after treatment with paliperidone palmitate 3-month formulation for 52 weeks in patients with clinically stable schizophrenia

Symptomatic and functional outcomes after treatment with paliperidone palmitate 3-month formulation for 52 weeks in patients with clinically stable schizophrenia

Stable patients with schizophrenia switched to paliperidone palmitate 3-monthly formulation in a naturalistic setting: impact of patient age and disease duration on outcomes

Impact of insight and metacognition on vocational rehabilitation of individuals with severe mental illness: A systematic review.

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