Remission in Schizophrenia: Critical and Systematic Review

Abstract

In 2005, the Remission in Schizophrenia Working Group published consensus criteria to define remission. These criteria have been widely accepted and utilized and have provided further insights about schizophrenia management and prognosis. We systematically reviewed studies that utilized these criteria, with the aim of assessing the remission rate in follow-up studies and the variables predicting or associated with remission. Remission has a reported rate of 17% to 78% (weighted mean = 35.6%) in first-episode schizophrenia and 16% to 62% (weighted mean = 37%) in multiple-episode patients, with no statistical difference between the two weighted means (p = .79). Patients who were treated with long-acting injectable risperidone showed high maintenance of remission status. Studies comparing second-generation antipsychotics versus haloperidol showed higher remission rates for the former. The variables most frequently associated with remission were better premorbid function, milder symptoms at baseline (especially negative symptoms), early response to treatment, and shorter duration of untreated psychosis. Variability in the length and frequency of follow-ups, as well as differences in dropout rates, could partially explain the differences in reported rates. Rates of symptomatic remission exceeded reported rates for functional recovery. Moreover, the majority of studies used Remission in Schizophrenia Working Group severity criteria only, neglecting duration. To enhance comparison between future research findings, we suggest further specifiers of the working group's criteria, to better define frequency and duration of follow-up, and proxy measures of remission.

Current Data on and Clinical Insights into the Treatment of First Episode Nonaffective Psychosis: A Comprehensive Review

“…This concept includes the remission of positive psychotic, disorganized, and negative symptoms to a severity of mild or less, but also a minimum duration time for this remission of 6 months, and has been used in FEP. Rates of remission vary widely in different studies and most of them do not provide duration criteria [173]. As an example, after a 1-year follow-up, only 31% of the initial subjects enrolled in the PAFIP program achieved remission [174], in particular due to persistence of negative symptoms or to relapse in the last 6 months, which seem to be related to duration of untreated psychosis and premorbid functioning.…”

“…As an example, after a 1-year follow-up, only 31% of the initial subjects enrolled in the PAFIP program achieved remission [174], in particular due to persistence of negative symptoms or to relapse in the last 6 months, which seem to be related to duration of untreated psychosis and premorbid functioning. Remission is closely related to functional recovery, although symptomatic remission rates tend to exceed functional recovery rates [173]. The best ways to achieve remission after improving initial symptoms seem to be preventing relapses and also detecting and treating secondary negative symptoms as early as possible.…”

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

“…3 points or less) at all eight “core” symptoms was considered sufficiently representative of a level of impairment consistent with symptomatic remission of the disorder [7]. According to recent reviews [8,9] reported remission rates vary widely across studies (17-88%), likely due to use of symptom severity criterion alone in the majority of studies [9]. A number of studies have demonstrated the validity of these remission criteria using two different approaches, namely comparison of different definitions of symptomatic remission and association of remission criteria with various outcome dimensions, mainly overall symptomatic status and functional outcome [10].…”

Antipsychotic treatments; focus on lurasidone

“…There have been some suggestions for the former two, e.g., clozapine for treatment-resistant schizophrenia (Kane et al, 1988; Meltzer, 1989), and risperidone and olanzapine for prevention (McGorry et al, 2002; McGlashan et al, 2006). On the other hand, there seems to be a relative paucity of information on whether AAPDs increase remission in schizophrenia (Takeuchi et al, 2012), due, partly, to the limited number of valid assessment methods (Alaqeel and Margolese, 2012). …”