Prediction of Remission as a Combination of Symptomatic and Functional Remission and Adequate Subjective Well-Being in 2960 Patients With Schizophrenia

Martin Lambert, M.D.; Benno G. Schimmelmann, M.D.; Dieter Naber, M.D.; Alexander Schacht, Ph.D.; Anne Karow, M.D.; Thomas Wagner, Ph.D.; and Joerg Czekalla, M.D.

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 conventional antipsychotics.

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 of treatment.

(J Clin Psychiatry 2006;67:1690-1697)

Received Feb. 10, 2006; accepted July 17, 2006. From the Psychosis Early Detection and Intervention Centre (PEDIC), Centre for Psychosocial Medicine, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Drs. Lambert, Naber, and Karow); the Department of Child and Adolescent Psychiatry, University of Duisburg-Essen, Essen, Germany (Dr. Schimmelmann); and the Medical Neuroscience Department, Lilly Deutschland GmbH, Bad Homburg, Germany (Drs. Schacht, Wagner, and Czekalla).

The study was supported by Lilly Deutschland GmbH.

Baseline, 6-month outcome, and 6-month side effects data were published in Acta Psychiatrica Scandinavica.

Drs. Lambert, Schimmelmann, and Karow have received grant/research support and honoraria from Eli Lilly. Prof. Dr. Naber has received grant/research support and honoraria from and is on the advisory board of Eli Lilly (Schizophrenia Outpatient Health Outcomes [SOHO] study). Drs. Schacht, Wagner, and Czekalla are employees of the Medical Neuroscience Department, Lilly Deutschland GmbH.

The authors acknowledge the contributions of the SOHO study group. Dr. Schacht, a statistician employed at Eli Lilly Germany, conducted all statistical analyses.

Corresponding author and reprints: Martin Lambert, M.D., Psychosis Early Detection and Intervention Centre (PEDIC), Centre for Psychosocial Medicine, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany (e-mail: lambert@uke.uni-hamburg.de).