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David Baxter

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Remission 'valid concept' in schizophrenia, should be therapy target
17 May 2007
Schizophr Res 2007; 92: 68?73

Remission is a measurable and achievable therapy goal for schizophrenia, data from a large-scale "naturalistic" study suggest.

Schizophrenia has traditionally been viewed as a chronic degenerative mental illness in which remission is not possible and outcomes are "gloomy," says the international team of researchers who undertook the analysis.

However, this view has increasingly been challenged over recent years, after improvements in pharmacologic, psychosocial, and psychotherapeutic treatments and, most recently, after the development of remission criteria.

The proposed remission criteria are based on having a low severity of symptoms (severity criterion) that is sustained over a period of at least 6 months (time criterion). Symptoms assessed include delusions, unusual thought content, hallucinatory behavior, conceptual disorganization, mannerisms/posturing, blunted affect, social withdrawal, and lack of spontaneity.

To investigate the validity of assessing remission in clinical practice, Marc De Hert (University Psychiatric Center Catholic University Louvain, Leuvensesteenweg, Belgium) and colleagues, evaluated data from a large, prospective study, which involved 15 psychiatric hospitals in Belgium.

The trial included patients who had been hospitalized for psychosis (including 1215 patients with DSM-IV diagnosed schizophrenia or schizoaffective disorder) and used the Psychosis Evaluation tool for Common use by Caregivers (PECC) to assess patients' mental state.

De Hert and team note that patients are assessed every 3 months and that their analysis only assessed those patients with schizophrenia/schizoaffective disorder who have been evaluated at least three times over a minimum period of 1 year. All patients included in their analysis also had to be stable on their antipsychotic medication.

The team found 341 patients who met their inclusion criteria, with 19% defined as being in remission at the start of the study (severity criterion alone used). By the study's end, 29% met the full remission criteria (severity and time criteria both met), with a further 15% meeting the severity criterion alone.

"Patients in remission had better insight in their disorder, a higher level of global functioning and functioned better with respect to daily living tasks," the researchers report in the journal Schizophrenia Research.

They conclude: "The remission severity and time criteria appear to combine into a valid concept for daily clinical practice and should be a target for treatment."
 

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