Symptom remission common in early course of schizophrenia
MedWire News: A significant minority of schizophrenia patients achieve symptom remission in the early course of illness, but recovery is much less common, research shows.
"Although in the early course of schizophrenia relapse prevention is of paramount importance, there is an increasing emphasis on establishing and maintaining sustained periods of symptom remission," say Joseph Ventura (University of California at Los Angeles, USA) and team.
"Recovery in the early course of illness is also possible."
However, they add: "Symptom remission and recovery rates vary considerably across recent-onset schizophrenia studies because of a lack of consistency in treatment interventions and in applying operational outcome criteria."
To investigate further, the team studied 77 patients, aged a mean of 23.6 years, who had experienced a first episode of psychosis over the 2-year period before study entry. Patients received a DSM-IV diagnosis of either schizophrenia (66%), schizoaffective disorder, depressed type (10%), or schizophreniform disorder (24%).
All of the patients were treated with continuous antipsychotic medication and received psychosocial interventions (without targeted work rehabilitation), and were assessed during the first year after hospital discharge.
Symptom remission was defined as score of 3 or less on each of two Brief Psychiatric Rating Scale reality distortion symptoms (delusions and hallucinations), each of two disorganization symptoms (conceptual disorganization and mannerisms and posturing), and one negative symptom (blunted affect). These criteria had to be met continuously for at least 6 months.
Recovery was defined as meeting criteria for symptom remission plus good or adequate social functioning, defined as a score of 2 or higher on the Frequency of Social Contact item of the Strauss-Carpenter Outcome Scale, as well as no hospitalizations.
The researchers found that 36% of patients met criteria for full symptom remission over any 6-month period in the first year after discharge, and 22% met criteria for symptom remission over the full 12-month period.
Recovery rates were significantly lower, however, with 10% of patients meeting criteria for recovery over any 6-month period and just 1% meeting criteria for recovery over the full 12-month period.
Higher scores on the comprehension measure of the Wechsler Adult Intelligence Scale were a significant predictor of good functional outcomes for at least 6 months, the researchers note.
Ventura and team conclude in the journal Schizophrenia Research: "Although some schizophrenia patients can achieve both symptom remission and recovery in the early course of illness, the overall rate of symptom remission during the first post-hospitalization year is much higher than the rate of recovery.
"This suggests that interventions targeting work and social functioning are likely necessary to raise the chances of recovery."
They add: "Cognitive factors can be predictive of good functional outcome even in the early course of schizophrenia."
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By Mark Cowen