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Early improvement as a predictor of remission and response in schizophrenia: Results from a naturalistic study

Published online by Cambridge University Press:  16 April 2020

M. Jäger ,
M. Schmauß ,
G. Laux ,
H. Pfeiffer ,
D. Naber ,
L. G. Schmidt ,
W. Gaebel ,
J. Klosterkötter ,
I. Heuser  and
W. Maier
...Show all authors
M. Jäger*
Affiliation:
Department of Psychiatry, Ludwig-Maximilians University, Munich, Germany Department of Psychiatry II, Ulm University, BKH Günzburg, 2, Ludwig-Heilmeyer Street 89312Günzburg, Germany
M. Schmauß
Affiliation:
Psychiatric Clinic, District Hospital of Augsburg, Augsburg, Germany
G. Laux
Affiliation:
Psychiatric Clinic, Inn-Salzach Hospital, Wasserburg-Gabersee, Germany
H. Pfeiffer
Affiliation:
Psychiatric Clinic, Isar-Amper Hospital, Munich-East, Germany
D. Naber
Affiliation:
Department of Psychiatry, University of Hamburg, Hamburg, Germany
L. G. Schmidt
Affiliation:
Department of Psychiatry, University of Mainz, Mainz, Germany
W. Gaebel
Affiliation:
Department of Psychiatry, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany
J. Klosterkötter
Affiliation:
Department of Psychiatry, University of Cologne, Cologne, Germany
I. Heuser
Affiliation:
Department of Psychiatry, Charité Berlin, Campus Benjamin Franklin, Berlin, Germany
W. Maier
Affiliation:
Department of Psychiatry, University of Bonn, Bonn, Germany
M.R. Lemke
Affiliation:
Psychiatric Clinic, Rheinische Kliniken, Bonn, Germany
D. Degner
Affiliation:
Department of Psychiatry, University of Göttingen, Göttingen, Germany
G. Buchkremer
Affiliation:
Department of Psychiatry, University of Tübingen, Tübingen, Germany
M. Gastpar
Affiliation:
Department of Psychiatry, University of Essen, Essen, Germany
H.-J. Möller
Affiliation:
Department of Psychiatry, Ludwig-Maximilians University, Munich, Germany
M. Riedel
Affiliation:
Department of Psychiatry, Ludwig-Maximilians University, Munich, Germany
*
*Corresponding author. Tel: ++49 8221 96 2204; fax: ++49 8221 96 2737. E-mail address:[email protected]
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Abstract

Objective

To examine the predictive validity of early improvement in a naturalistic sample of inpatients and to identify the criterion that best defines early improvement.

Methods

Two hundred and forty-seven inpatients who fulfilled ICD-10 criteria for schizophrenia were assessed with the Positive And Negative Syndrome Scale (PANSS) at admission and at biweekly intervals until discharge from hospital. Remission was defined according to the recently proposed consensus criteria, response as a reduction of at least 40% in the PANNS total score from admission to discharge.

Results

Receiver operating characteristic (ROC) analyses showed that early improvement (reduction of the PANSS total score within the first 2 weeks of treatment) predicts remission (AUC = 0.659) and response (AUC = 0.737) at discharge. A 20% reduction in the PANSS total score within the first 2 weeks was the most accurate cut-off for the prediction of remission (total accuracy: 65%; sensitivity: 53%; specificity: 76%), and a 30% reduction the most accurate cut-off for the prediction of response (total accuracy: 76%; sensitivity: 47%; specificity: 90%).

Conclusion

The findings of clinical drug trials that early improvement is a predictor of subsequent treatment response were replicated in a naturalistic sample. Further studies should examine whether patients without early improvement benefit from an early change of antipsychotic medication.

Keywords

SchizophreniaAntipsychotics
Type
Original article
Information
European Psychiatry , Volume 24 , Issue 8 , December 2009 , pp. 501 - 506
Copyright
Copyright © Elsevier Masson SAS 2009

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