Remission in Schizophrenia: Proposed Criteria and Rationale for Consensus

Abstract

New advances in the understanding of schizophrenia etiology, course, and treatment have increased interest on the part of patients, families, advocates, and professionals in the development of consensus-defined standards for clinical status and improvement, including illness remission and recovery. As demonstrated in the area of mood disorders, such standards provide greater clarity around treatment goals, as well as an improved framework for the design and comparison of investigational trials and the subsequent evaluation of the effectiveness of interventions. Unlike the approach to mood disorders, however, the novel application of the concept of standard outcome criteria to schizophrenia must reflect the wide heterogeneity of its long-term course and outcome, as well as the variable effects of different treatments on schizophrenia symptoms. As an initial step in developing operational criteria, an expert working group reviewed available definitions and assessment instruments to provide a conceptual framework for symptomatic, functional, and cognitive domains in schizophrenia as they relate to remission of illness. The first consensus-based operational criteria for symptomatic remission in schizophrenia are based on distinct thresholds for reaching and maintaining improvement, as opposed to change criteria, allowing for alignment with traditional concepts of remission in both psychiatric and nonpsychiatric illness. This innovative approach for standardizing the definition for outcome in schizophrenia will require further examination of its validity and utility, as well as future refinement, particularly in relation to psychosocial and cognitive function and dysfunction. These criteria should facilitate research and support a positive, longer-term approach to studying outcome in patients with schizophrenia.

Five years of specialised early intervention versus two years of specialised early intervention followed by three years of standard treatment for patients with a first episode psychosis: randomised, superiority, parallel group trial in Denmark (OPUS II)

“…The scale contains five domains, but in line with later factor analyses,30 we only included the four global domains considered the most robust and most used in proposed criteria for remission in schizophrenia31: avolition-apathy, anhedonia, alogia, and affective blunting. The average of these four scores yielded a composite negative dimension score ranging from 0 to 5 points 30…”

Candidate-gene association analysis of response to risperidone in African-American and white patients with schizophrenia

“…Remission was defined as scores of 3 (mild), 2 (minimal) or 1 (absent) on all of the following 8 PANSS items: P1-delusions; P2-conceptual disorganization; P3-hallucinatory behavior; G9-unusual thought content; G5-mannerisms and posturing; N1-blunted affect; N4-passive/apathetic withdrawal; and N6-lack of spontaneity and flow of conversation (criteria adapted from Andreasen). 21 …”

Prevalence and clinical correlates of depression in the acute phase of first episode schizophrenia

“…The PANSS -D has a total score of 28, the PANSS-N a total of 49, as does the PANSS-P. Other studies have taken remission of symptoms as being classified by no score greater than 3 over the previous month on any PANSS item. 15,16 We propose using a cut-off score of >16 (corresponding to an average score of >4 on each item) to define depression as measured by the PANSS-D.…”