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David Baxter

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Complete remission not achieved by majority of schizophrenia patients

Researchers have found that close to 90% of patients with schizophrenia do not reach complete remission with regard to symptoms, functional ability, and subjective wellbeing.

In their 24-month follow-up study of 2960 patients with schizophrenia, Martin Lambert (University Medical Center Hamburg-Eppendorf, Germany) and colleagues report that just over 50% of patients were still symptomatic, almost 60% still had impairment in subjective wellbeing, nearly 60% neither had a job nor attended school or university, and almost 40% were not living independently.

"Factors that contribute to this unfavorable outcome may be the illness disability itself, a long duration of untreated illness before initial presentation, and insufficient quality of treatment," the team writes in the Journal of Clinical Psychiatry.

The researchers defined complete remission as fulfilling three criteria over a period of at least 6 months. These were symptomatic remission, with a Clinical Global Impressions Severity of Illness score of 3 points or below for overall severity and positive, negative, and cognitive subscores; functional remission, defined as being employed in a professional or vocational role, being an active student, and living independently; and adequate subjective wellbeing if a Subjective Wellbeing Under Neuroleptic Treatment Scale total score of 80 or above was met.

At the end of the 2-year follow-up, 12.8% of participants achieved complete remission, while 35.1% of patients met none of the three remission criteria.

The scientists found that the biggest obstacle in achieving complete remission was meeting the vocational/occupational criterion. Omission of this criterion would have meant 23.4% of the participants would have achieved complete remission rather than 12.8%.

Each remission criteria and complete remission were mainly predicted by early remission within the first 3 months. This was true for patients receiving treatment for the first time and those with a long history of illness, which points towards a critical "window of opportunity" in the course of treatment, say Lambert et al.

In addition, first-line treatment with atypical antipsychotics, compared with conventional antipsychotics, increased the likelihood of complete remission.

"Our results suggest that there may be a subgroup of patients with traitlike incomplete remission in all or single outcome domains," the team says.

"The question remains to be answered whether the current strategies for the treatment of incomplete remission improve long-term outcome considerably in this subgroup of patients with schizophrenia."

J Clin Psychiatry 2006; 67: 1690-1697
 

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