Remisión sintomática y recuperación funcional en pacientes que padecen esquizofrenia

Abstract

SUMMARYA recently proposed definition for remission and recovery in schizophrenia is receiving increased attention by clinicians and researchers. The interest on these issues is based on the recent proposed definition for symptomatic remission, and the development of operational criteria for its assessment, by the Remission in Schizophrenia Working Group (RSWG), in the United States, in 2005. Remission is assessed using eight items of the Positive and Negative Syndrome Scale (PANSS), all of which have to be scored with a symptom severity of ≤3 points (mild or better), sustained for a minimum duration of six months. In Europe, since 2006, proposed definition criteria about response and remission were introduced. Response can be assessed, with the PANSS, using a cut-off of at least 50% reduction of the baseline score for the acutely ill, and a cut-off of at least of 25% reduction for refractory patients. Remission could be assessed using a formula for calculating percentage PANSS reduction from baseline. Definition criteria have also been introduced to assess functional recovery that includes the combination of clinical and social outcomes for two consecutive years, including dimensions such as psychosocial functioning, cognition, and quality of life.The purpose of this review is to examine existing research on symptomatic remission and functional recovery in schizophrenia. We included clinical and epidemiological studies, reviews and meta-analyses published between January 1970 and July 2013. Sixty two studies on remission and recovery were included, with a total of 94 940 patients, comprising six months to 37 years follow-up. Thirty two studies on functional recovery were included, with a total of 6 483 patients with a range of six months to 42 years follow-up. Research indicates that symptomatic remission can be achieved in 20-97%, and functional recovery in 10-68% of people with schizophrenia. The use of remission and recovery criteria has been recommended for clinical practice and scientific research.Key words: Symptomatic remission, functional recovery, symtomatology, psychosocial functioning. RESUMENRecientemente los conceptos de remisión sintomática y recuperación funcional en los pacientes que padecen esquizofrenia han recibido una considerable atención por parte de los clínicos y los investigadores. El interés en estos aspectos tiene que ver con la propuesta realizada en el 2005 por el "Grupo de trabajo para evaluar la remisión en esquizofrenia", con el objetivo de proponer una definición de remisión sintomática, así como el desarrollo de criterios operacionales para su evaluación. La remisión sintomática se evalúa utilizando ocho reactivos de la escala PANSS, los cuales deben puntuar tres o menos, con una duración mínima de seis meses de remisión. En Europa, desde el 2006, también se han propuesto criterios para evaluar la respuesta al tratamiento, así como la remisión sintomática. La remisión se puede evaluar usando una fórmula para calcular el porcentaje de reducción de síntomas desde el inicio del tr...

Service users' perceptions of recovery from recent‐onset psychosis and their long journey to and through psychiatric treatment

“…Psychotic disorders are known to affect functioning (Sumskis, 2013; Valencia et al, 2014; Whiteford et al, 2013). Individuals with psychosis do not only have impaired functioning, they also often have inactive lifestyles due to the impacts of the illness that are further exacerbated by the side effects of antipsychotics (Robson & Gray, 2007; Thongsai et al, 2016).…”

Cerebral, Psychosocial, Family Functioning and Disability of Persons with Schizophrenia

“…Invariably, they will need antipsychotic medication to achieve symptomatic remission and psychosocial treatment to improve functioning in the community with the support of their relatives that would need psychoeducation considering recovery as the ultimate goal. Research indicates that symptomatic remission can be achieved by 20-97% of patients and functional recovery by 10-68% 53,[108][109][110][111] Outcome for a person with schizophrenia should be based on medicine-based practices that should include: 1) optimal dose of antipsychotic medication to attain remission of symptoms, 2) Psychosocial and Psychoeducational strategies for patients and relatives to have a real knowledge about the illness that will allow them to cope more efficiently with environmental stresses and learn the corresponding skills for survival in the community, and 3) patients and relatives should have the necessary skills for an assertive home-based management to resolve social problems and needs that would help to prevent crises such as symptom exacerbation. 112 It has been reported that schizophrenia patients satisfied with their life in general had less severe symptoms as well as better functioning than patients who were not satisfied with their lives.…”

Perspectives on recovery in psychosis

“…None of the mental disorders have generally accepted criteria for remission. For schizophrenia, two main research groups, in the USA 5 and in Europe, propose different sets of remission criteria . 6 Andreasen's working group defines remission as "a state in which patients have experienced an improvement in core signs and symptoms to the extent that any remaining symptoms are of such low intensity that they no longer interfere significantly with behavior and are below the threshold typically utilized in justifying an initial d i a g n o s i s o f s c h i z o p h r e n i a . "…”