David Baxter PhD
Late Founder
Functional recovery viable goal in schizophrenia management
By Liam Davenport
09 January 2009
Schizophr Bull 2009: Advance online publication
Functional remission in schizophrenia is a viable concept and a separate domain from clinical remission, and its achievement would allow greater autonomy for patients, argue US researchers in a review.
Many features of schizophrenia do not form part of the diagnostic criteria for the illness, such as functional disability, cognitive impairment, comorbidities, and symptoms such as depression and anxiety. While the primary focus for management has been on clinical symptoms and their consequences, this does not address the majority of problems faced by schizophrenia patients.
Recovery is now more commonly viewed as a process and not an outcome, and functional recovery is recognized as a valid goal, despite a lack of agreement as to the relevant functional domains and the definition of remission, note Philip Harvey, from Emory University School of Medicine in Atlanta, Georgia, and colleagues.
Although patients often display premorbid functional disability, levels of disability often worsen substantially after the onset of illness and, although this does not imply that reversal is possible, its dynamic nature suggests that remission is a viable concept. In addition, despite negative symptoms being regarded as temporally stable, many patients meet the criteria for remission.
The team suggests that productive activities, residential and self-maintenance activities, and social relationships, along with medication adherence, are broad domains indicative of functional ability, and lead to greater patient autonomy. They also note that these domains require effort in order to perform the relevant skills, including attending rehabilitation clinics, receiving treatment, and applying the skills, and argue that such attempts to gain skills form a part of achieving remission.
However, the definition of remission is a challenge, as there is considerable variation in functioning across the healthy population, and at different developmental time points, and any improvements must be weighed against premorbid functioning and intrinsic ability. Nevertheless, the team says that remission should be measured across a combination of domains, with multiple levels of achievement, giving an overall picture of recovery.
Clinical remission is indexed to 6 months. However, functional remission is likely to take longer, the researchers explain, and the minimum timeframe for evaluation is more likely to be, for example, 6 months after clinical remission.
It should also be noted that the receipt of disability compensation can be a disincentive to obtain employment, and societal factors such as stigma may prevent employment. In addition, the patients? subjective response to their illness, and their recovery, should be taken into account, and any assessment of functional remission should include objective measures.
The team concludes in the Schizophrenia Bulletin: ?We see functional remission as a separate domain of functioning from clinical remission and subjective response and argue that the process of recovery includes all of these domains.?
Abstract
By Liam Davenport
09 January 2009
Schizophr Bull 2009: Advance online publication
Functional remission in schizophrenia is a viable concept and a separate domain from clinical remission, and its achievement would allow greater autonomy for patients, argue US researchers in a review.
Many features of schizophrenia do not form part of the diagnostic criteria for the illness, such as functional disability, cognitive impairment, comorbidities, and symptoms such as depression and anxiety. While the primary focus for management has been on clinical symptoms and their consequences, this does not address the majority of problems faced by schizophrenia patients.
Recovery is now more commonly viewed as a process and not an outcome, and functional recovery is recognized as a valid goal, despite a lack of agreement as to the relevant functional domains and the definition of remission, note Philip Harvey, from Emory University School of Medicine in Atlanta, Georgia, and colleagues.
Although patients often display premorbid functional disability, levels of disability often worsen substantially after the onset of illness and, although this does not imply that reversal is possible, its dynamic nature suggests that remission is a viable concept. In addition, despite negative symptoms being regarded as temporally stable, many patients meet the criteria for remission.
The team suggests that productive activities, residential and self-maintenance activities, and social relationships, along with medication adherence, are broad domains indicative of functional ability, and lead to greater patient autonomy. They also note that these domains require effort in order to perform the relevant skills, including attending rehabilitation clinics, receiving treatment, and applying the skills, and argue that such attempts to gain skills form a part of achieving remission.
However, the definition of remission is a challenge, as there is considerable variation in functioning across the healthy population, and at different developmental time points, and any improvements must be weighed against premorbid functioning and intrinsic ability. Nevertheless, the team says that remission should be measured across a combination of domains, with multiple levels of achievement, giving an overall picture of recovery.
Clinical remission is indexed to 6 months. However, functional remission is likely to take longer, the researchers explain, and the minimum timeframe for evaluation is more likely to be, for example, 6 months after clinical remission.
It should also be noted that the receipt of disability compensation can be a disincentive to obtain employment, and societal factors such as stigma may prevent employment. In addition, the patients? subjective response to their illness, and their recovery, should be taken into account, and any assessment of functional remission should include objective measures.
The team concludes in the Schizophrenia Bulletin: ?We see functional remission as a separate domain of functioning from clinical remission and subjective response and argue that the process of recovery includes all of these domains.?
Abstract
