Early improvement predicts remission, response in schizophrenia
MedWire News: Early improvement is a predictor of subsequent remission and response in the treatment of schizophrenia, show researchers who have replicated clinical drug trial findings in a naturalistic sample of patients.
Current guidelines for the treatment of schizophrenia recommend attempting treatment with a certain antipsychotic for several weeks before switching to another drug. However, recent studies have shown that antipsychotic response occurs within the first weeks of treatment.
“However, most of these studies were based on re-analyses of randomized or open clinical trials with selected patient samples and rigid treatment regimes. It is unclear whether these results can be generalized to naturalistic samples,” explain Markus Jäger (Ludwig-Maximilians University, Munich, Germany) and co-authors.
In total, 237 inpatients aged on average 34.5 years who fulfilled diagnostic criteria for schizophrenia were assessed with the Positive and Negative Syndrome Scale (PANSS) at admission and at biweekly intervals until discharge from hospital.
Patients had a mean 10.3-year duration of illness, with inpatient treatment lasting from 21 to 431 days. One-third of patients were experiencing a first episode of schizophrenia.
In all, 65% of patients received first-generation antipsychotics, 55% second-generation antipsychotics, 55% tranquilizers, 8% mood-stabilizers, and 19% antidepressants.
Positive, negative, and general psychopathology symptoms improved from admission to week 2 and from week 2 to discharge.
Receiver operating characteristic (ROC) analyses showed that early improvement – defined as a reduction in the PANSS total score within the first 2 weeks of treatment – predicted remission (area under the curve [AUC]=0.659) and response (AUC=0.737) at discharge.
The authors note, however, that “in contrast to the predictive validity for response, the discriminative ability of early improvement for the prediction of remission failed to achieve a reasonable value.”
An improvement of 20% in the PANSS total score after the first 2 weeks was identified as the most accurate cutoff for predicting remission discharge with a total accuracy of 65%, a sensitivity of 53%, and a specificity of 76%.
Furthermore, a cutoff point of 30% improvement in the first 2 weeks gave the most accurate prediction of response at discharge, with a total accuracy of 76%, a sensitivity of 47%, and a specificity of 90%.
Writing in the journal European Psychiatry, the authors point out: “The discriminative power of early improvement does not seem to exceed values of conventional predictor models, which are based upon the psychopathological symptom level at the start of antipsychotic treatment.
“Further studies should examine whether patients without early improvement will benefit from an early change of antipsychotic medication.”
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By Ingrid Grasmo