Enduring remission from schizophrenia an achievable goal
medwireNews: Most schizophrenia patients who adhere to antipsychotics can expect to reach a full symptomatic remission within the first year of maintenance treatment following a first episode, researchers report.
They note, however, that this symptomatic remission is often temporary. "Only about 60% of patients who are treated for 6 months or more reach enduring remission," they say.
For those patients who do achieve enduring remission - symptomatic remission for at least 6 months - the outcome appears good, with Wolfgang Gaebel (Heinrich-Heine-University, Dusseldorf, Germany) and team finding most maintained this status throughout the year following a first episode.
The researchers analyzed the outcomes of 166 patients with a first episode of schizophrenia who were participating in a trial by the German Research Network on Schizophrenia. The patients were in their first year of maintenance antipsychotic treatment following an acute 8-week treatment phase.
Within the year, 152 (91.5%) patients achieved symptomatic remission, defined as a score of 3 or lower for the following Positive and Negative Syndrome Scale (PANSS) items: P1 (delusions), P2 (conceptual disorganization), P3 (hallucinatory behavior), N1 (blunted affect), N4 (passive/apathetic and social withdrawal), N6 (lack of spontaneity and flow of conversation), G5 (mannerisms and posturing), and G9 (unusual thought content).
Of these patients, 104 (68.4%) had already reached symptomatic remission by the end of the 8 weeks of acute treatment and as a result were in remission on entry to the 1-year study.
The researchers note in Schizophrenia Research, however, that symptoms worsened in 69.1% of the patients in remission, with some symptoms returning to threshold levels meaning the patients were no longer considered to be in remission.
In all, 111 patients remained in the 1-year maintenance phase of the study for at least 6 months, 65 (58.6%) of whom reached enduring remission, which corresponds to 39.2% of the total sample.
Enduring remission was achieved on average 29.7 weeks after acute treatment and unlike symptomatic remission it was quite stable, with the vast majority (83%) of patients who achieved enduring remission remaining in remission for the duration of the 1-year period.
Factors associated with a greater likelihood for enduring remission included being female, and few positive, negative, and general symptoms.
The main barrier to achieving enduring remission was persisting negative symptoms. "Thus, negative symptoms are still an unmet need in schizophrenia treatment, and substantial efforts are required to target these symptoms and help patients achieve a more favorable functional outcome," say Gaebel et al.
medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013
By Lucy Piper, Senior medwireNews Reporter