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
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: Recently, the Remission in
Schizophrenia Working Group proposed symptomatic
remission criteria and pointed to the lack of data
regarding functional remission and quality of life
in schizophrenia. This post hoc analysis of data
from German patients in the Schizophrenia
Outpatient Health Outcomes study assessed rates and
predictors of symptomatic and functional remission
as well as adequate subjective well-being/quality
of life in a large cohort of patients with schizophrenia.
Method: Data were collected in an
observational 24-month follow-up study of 2960
patients with DSM-IV-defined schizophrenia recruited
between January and December 2001. Complete remission required that patients achieved
symptomatic remission mirroring the Remission in Schizophrenia Working Group criteria,
functional remission, and a level of adequate subjective
well-being over at least 6 months.
Results: At endpoint, 47.2% of the
patients achieved symptomatic remission, 26.6%
achieved functional remission, and 42.2% achieved
adequate subjective well-being. At endpoint, 12.8% were
in complete remission. In 35.1% of patients, none
of the 3 remission criteria were achieved. Only
8.7% of early nonremitted cases achieved remission
at endpoint. Each single remission component as
well as complete remission was mainly predicted by early remission within the first 3 months.
First-line treatment with atypical antipsychotics increased
the likelihood of complete remission compared to
Conclusions: Despite advances in
pharmacologic and psychosocial treatments in
schizophrenia, close to 90% of the patients in this study did
not fulfill the combined remission criteria. This was
in part attributable to the low functional
remission rate, particularly the low employment rate.
The finding that the course of the disorder depends
on early outcome not only in previously untreated
but also in more chronically ill patients points toward
a critical "window of opportunity" in the course