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Symptomatic remission and social/vocational functioning in outpatients with schizophrenia: Prevalence and associations in a cross-sectional study

Published online by Cambridge University Press:  16 April 2020

Luis San ,
Antonio Ciudad ,
Enrique Álvarez ,
Julio Bobes  and
Inmaculada Gilaberte
Luis San
Affiliation:
Hospital San Rafael, Barcelona, Spain
Antonio Ciudad*
Affiliation:
Lilly Research Laboratories S.A., Avda. de la Industria 30, 28108 Alcobendas, Madrid, Spain
Enrique Álvarez
Affiliation:
Department of Psychiatry, Hospital de Sant Pau, UAB, REM-TAP, Barcelona, Spain
Julio Bobes
Affiliation:
Área de Psiquiatría, Facultad de Medicina, Universidad de Oviedo, Oviedo, Spain
Inmaculada Gilaberte
Affiliation:
Lilly Research Laboratories S.A., Avda. de la Industria 30, 28108 Alcobendas, Madrid, Spain
*
*Corresponding author. Tel.: +34 91 623 35 70; fax: +34 91 663 34 71. E-mail addresses:[email protected] (L. San), [email protected] (A. Ciudad), [email protected] (E. Álvarez), [email protected] (J. Bobes), [email protected] (I. Gilaberte).
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Abstract

Purpose

Progress in therapeutic options for schizophrenia has revived long-term expectations of researchers, practitioners and patients. At present, definitions of therapeutic outcome include both maintained symptomatic remission and appropriate functioning in a conceptual framework that targets patient's recovery as the ultimate goal. We aimed to know the prevalence and clinical features of patients with schizophrenia achieving these outcomes.

Methods

A multi-centre, cross-sectional study was performed in more than 100 mental health facilities within Spain. Recently published consensus-based operational criteria for symptomatic remission and the Global Assessment of Functioning scale were used to evaluate outcomes. Other clinical aspects like depressive symptoms, social cognition, premorbid adjustment and patients' attitudes to medication were also evaluated.

Results

Data from 1010 patients were analysed. Of these, 452 (44.8%) were at clinical remission, but only 103 (10.2%) showed an adequate social and/or vocational functioning. Factors predicting both outcomes were better pre-morbid adjustment (odds ratio, OR = 1.56) and better social cognitive function (OR = 1.14). Other factors, like treatment adherence, current or past psychotherapy and patient's age were not associated to functionality but only to clinical remission. Current substance use and previous rehabilitation were associated to a lower likelihood of symptomatic remission.

Conclusion

Although symptomatic remission in patients with schizophrenia is a realistic and reachable goal, future efforts should be directed to a sustained appropriate functioning in these patients.

Keywords

SchizophreniaRemissionRecoveryCross-sectional studies
Type
Original article
Information
European Psychiatry , Volume 22 , Issue 8 , November 2007 , pp. 490 - 498
Copyright
Copyright © Elsevier Masson SAS 2007

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References

Alvarez, E., Ciudad, A., Olivares, J.M., Bousono, M., Gomez, J.C.randomized A: A1-year follow-up study of olanzapine and risperidone in the treatment of negative symptoms in outpatients with schizophrenia. J Clin Psychopharmacol 2006;26:238–249.Google Scholar
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed.Washington, DC: American Psychiatric Association; 2000.Google Scholar
Andreasen, N.C.Negative symptoms in schizophrenia. Definition and reliability. Arch Gen Psychiatry 1982;39:784–788.CrossRefGoogle ScholarPubMed
Andreasen, N.C.Positive vs. negative schizophrenia: a critical evaluation. Schizophr Bull 1985;11:380–389.CrossRefGoogle ScholarPubMed
Andreasen, N.C., Carpenter, W.T. Jr., Kane, J.M., Lasser, R.A., Marder, S.R.et al.Remission in schizophrenia: proposed criteria and rationale for consensus. Am J Psychiatry 2005;162:441–449.CrossRefGoogle ScholarPubMed
Andreasen, N.C., Olsen, S.Negative v positive schizophrenia. Definition and validation. Arch Gen Psychiatry 1982;39:789–794.CrossRefGoogle Scholar
Birchwood, M., Mason, R., MacMillan, F., Healy, J.Depression, demoralization and control over psychotic illness: a comparison of depressed and non-depressed patients with a chronic psychosis. Psychol Med 1993;23:387–395.CrossRefGoogle ScholarPubMed
Cannon-Spoor, H.E., Potkin, S.G., Wyatt, R.J.Measurement of premorbid adjustment in chronic schizophrenia. Schizophr Bull 1982;8:470–484.CrossRefGoogle ScholarPubMed
Ciudad, A., Prieto, L., Olivares, J.M., Montejo, A.L., Ros, S., Novick, D.The European schizophrenia outpatient health outcomes (SOHO) study: baseline findings of the Spanish sample. Actas Esp Psiquiatr 2004;32:227–235.Google ScholarPubMed
Docherty, J.P., Bossie, C.A., Lachaux, B., Bouhours, P., Zhu, Y., Lasser, R.et al.Patient-based and clinician-based support for the remission criteria in schizophrenia. Int Clin Psychopharmacol 2007;22:51–55.Google Scholar
Emsley, R., Oosthuizen, P.P., Kidd, M., Koen, L., Niehaus, D.J., Turner, H.J.Remission in first-episode psychosis: predictor variables and symptom improvement patterns. J Clin Psychiatry 2006;67:1707–1712.CrossRefGoogle ScholarPubMed
Emsley, R., Rabinowitz, J., Medori, R.Remission in early psychosis: Rates, predictors, and clinical and functional outcome correlates. Schizophr Res 2007;89:129–139.CrossRefGoogle ScholarPubMed
Helldin, L., Kane, J.M., Karilampi, U., Norlander, T., Archer, T.Remission and cognitive ability in a cohort of patients with schizophrenia. J Psychiatr Res 2006;40:738–745.CrossRefGoogle Scholar
Hogan, T.P., Awad, A.G.Subjective response to neuroleptics and outcome in schizophrenia: a re-examination comparing two measures. Psychol Med 1992;22:347–352.CrossRefGoogle ScholarPubMed
Kohler, C.G., Lallart, E.A.Postpsychotic depression in schizophrenia patients. Curr Psychiatry Rep 2002;4:273–278.CrossRefGoogle ScholarPubMed
Lambert, M., Schimmelmann, B.G., Naber, D., Schacht, A., Karow, A., Wagner, T.et al.Prediction of remission as a combination of symptomatic and functional remission and adequate subjective well-being in 2960 patients with schizophrenia. J Clin Psychiatry 2006;67:1690–1697.CrossRefGoogle ScholarPubMed
Lasser, R.A., Bossie, C.A., Gharabawi, G.M., Kane, J.M.Remission in schizophrenia: Results from a 1-year study of long-acting risperidone injection. Schizophr Res 2005;77:215–227.CrossRefGoogle ScholarPubMed
Leucht, S., Lasser, R.The concepts of remission and recovery in schizophrenia. Pharmacopsychiatry 2006;39:161–170.CrossRefGoogle Scholar
Liberman, R.P., Kopelowicz, A.Recovery from schizophrenia: a challenge for the 21st century. Int Rev Psychiatry 2002;14:245–255.CrossRefGoogle Scholar
Liberman, R.P., Kopelowicz, A., Ventura, J., Gutkind, D.Operational criteria and factors related to recovery from schizophrenia. Int Rev Psychiatry 2002;14:256–272.CrossRefGoogle Scholar
Lopez-Garcia, E., Banegas, J.R., Graciani Perez-Regadera, A., Gutierrez-Fisac, J.L., Alonso, J., Rodriguez-Artalejo, F.Population-based reference values for the Spanish version of the SF-36 Health Survey in the elderly. Med Clin (Barc) 2003;120:568–573.Google ScholarPubMed
Lublin, H., Eberhard, J., Levander, S.Current therapy issues and unmet clinical needs in the treatment of schizophrenia: a review of the new generation antipsychotics. Int Clin Psychopharmacol 2005;20:183–198.CrossRefGoogle ScholarPubMed
Mandel, M.R., Severe, J.B., Schooler, N.R., Gelenberg, A.J., Mieske, M.Development and prediction of postpsychotic depression in neuroleptic-treated schizophrenics. Arch Gen Psychiatry 1982;39:197–203.CrossRefGoogle ScholarPubMed
Ott, S.L., Spinelli, S., Rock, D., Roberts, S., Amminger, G.P., Erlenmeyer-Kimling, L.The New York High-Risk Project: social and general intelligence in children at risk for schizophrenia. Schizophr Res 1998;31:1–11.CrossRefGoogle ScholarPubMed
Perkins, D., Lieberman, J., Gu, H., Tohen, M., McEvoy, J., Green, A.et al.Predictors of antipsychotic treatment response in patients with first-episode schizophrenia, schizoaffective and schizophreniform disorders. Br J Psychiatry 2004;185:18–24.CrossRefGoogle ScholarPubMed
Robinson, D.G., Woerner, M.G., McMeniman, M., Mendelowitz, A., Bilder, R.M.Symptomatic and functional recovery from a first episode of schizophrenia or schizoaffective disorder. Am J Psychiatry 2004;161:473–479.CrossRefGoogle ScholarPubMed
Rosenheck, R.A., Leslie, D.L., Sindelar, J., Miller, E.A., Lin, H., Stroup, T.S.et al.Cost-effectiveness of second-generation antipsychotics and perphenazine in a randomized trial of treatment for chronic schizophrenia. Am J Psychiatry 2006;163:2080–2089.CrossRefGoogle Scholar
Sanjuan, J., Prieto, L., Olivares, J.M., Ros, S., Montejo, A., Ferrer, F.et al.GEOPTE Scale of social cognition for psychosis. Actas Esp Psiquiatr 2003;31:120–128.Google Scholar
Strauss, J.S., Carpenter, W.T. Jr.The prediction of outcome in schizophrenia. II. Relationships between predictor and outcome variables: a report from the WHO international pilot study of schizophrenia. Arch Gen Psychiatry 1974;31:37–42.CrossRefGoogle ScholarPubMed
Swartz, M.S., Perkins, D.O., Stroup, T.S., Davis, S.M., Capuano, G., Rosenheck, R.A.et al.Effects of Antipsychotic Medications on Psychosocial Functioning in Patients With Chronic Schizophrenia: Findings From the NIMH CATIE Study. Am J Psychiatry 2007;164:428–436.CrossRefGoogle ScholarPubMed
Swartz, M.S., Wagner, H.R., Swanson, J.W., Stroup, T.S., McEvoy, J.P., McGee, M.et al.Substance use and psychosocial functioning in schizophrenia among new enrollees in the NIMH CATIE study. Psychiatr Serv 2006;57:1110–1116.CrossRefGoogle ScholarPubMed
van Mastrigt, S., Addington, J.Assessment of premorbid function in first-episode schizophrenia: modifications to the Premorbid Adjustment Scale. J Psychiatry Neurosci 2002;27:92–101.Google ScholarPubMed
van Os, J., Burns, T., Cavallaro, R., Leucht, S., Peuskens, J., Helldin, L.et al.Standardized remission criteria in schizophrenia. Acta Psychiatr Scand 2006;113:91–95.Google Scholar
van Os, J., Drukker, M., a Campo, J., Meijer, J., Bak, M., Delespaul, P.Validation of remission criteria for schizophrenia. Am J Psychiatry 2006;163:2000–2002.CrossRefGoogle Scholar
Ware, J. Jr., Kosinski, M., Keller, S.D.A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care 1996;34:220–233.CrossRefGoogle ScholarPubMed
Zimmerman, M., Posternak, M.A., Chelminski, I.Defining remission on the Montgomery-Asberg depression rating scale. J Clin Psychiatry 2004;65:163–168.CrossRefGoogle ScholarPubMed
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