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Remission and Recovery and their Predictors in Schizophrenia Spectrum Disorder: Results from a 1-Year Follow-Up Naturalistic Trial

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Abstract

Remission and recovery are major outcome goals in schizophrenia yet their predictors have not been studied in detail. Therefore, 186 patients were examined regarding remission and recovery including their potential sociodemographic and clinical predictors 1 year after discharge. Remission was defined according to the consensus remission criteria and recovery following the definition by Liberman et al. (2002). Of the 186 patients 54% achieved remission and 26% recovery at the 1-year follow-up. The remission status at discharge was found to significantly influence remission and recovery at follow-up. A higher SOFAS score (P = 0.0002) as well as a positive attitude towards treatment at discharge (P = 0.0038) were identified to be significant predictors of remission at 1-year follow-up. Having a job (P = <0.0001) and being without pharmacological treatment at follow-up (P = 0.0113) were found to be significantly predictive of recovery. Our results underline the need to implement more specific treatment strategies to improve long-term outcome.

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References

  1. Bellack AS: Scientific and consumer models of recovery in schizophrenia: concordance, contrasts, and implications. Schizophrenia Bulletin 32:432–442, 2006.

    Article  PubMed  Google Scholar 

  2. Leucht S, Lasser R: The concepts of remission and recovery in schizophrenia. Pharmacopsychiatry 39:161–170, 2006.

    Article  PubMed  CAS  Google Scholar 

  3. Andreasen NC, Carpenter WT Jr, Kane JM, Lasser RA, Marder SR, Weinberger DR: Remission in schizophrenia: proposed criteria and rationale for consensus. American Journal of Psychiatry 162:441–449, 2005.

    Article  PubMed  Google Scholar 

  4. Liberman R, Kopelowicz A, Ventura J, Gutkind D: Operational criteria and factors related to recovery from schizophrenia. International Review of Psychiatry 4:256–272, 2002.

    Article  Google Scholar 

  5. Emsley R, Chiliza B, Schoeman R: Predictors of long-term outcome in schizophrenia. Current Opinion in Psychiatry 21:173–177, 2008.

    Article  PubMed  Google Scholar 

  6. Menezes NM, Arenovich T, Zipursky RB: A systematic review of longitudinal outcome studies of first-episode psychosis. Psychological Medicine 36:1349–1362, 2006.

    Article  PubMed  CAS  Google Scholar 

  7. Wolwer W, Buchkremer G, Hafner H, Klosterkotter J, Maier W, Moller HJ, Gaebel W: German research network on schizophrenia-bridging the gap between research and care. European Archives of Psychiatry and Clinical Neuroscience 253:321–329, 2003.

    Article  PubMed  Google Scholar 

  8. Jager M, Riedel M, Messer T, Laux G, Pfeiffer H, Naber D, Schmidt LG, Gaebel W, Huff W, Heuser I, Kuhn KU, Lemke MR, Ruther E, Buchkremer G, Gastpar M, Bottlender R, Strauss A, Moller HJ: Psychopathological characteristics and treatment response of first episode compared with multiple episode schizophrenic disorders. European Archives of Psychiatry and Clinical Neuroscience 257:47–53, 2007.

    Article  PubMed  Google Scholar 

  9. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th edn. Washington DC, American Psychiatric Association, 1994.

    Google Scholar 

  10. Cording C: Conceptual aspects in development and implementation of basic psychiatric documentation. Psychiatrische Praxis 25:175–178,1998.

    PubMed  CAS  Google Scholar 

  11. Kay SR, Opler LA, Lindenmayer JP: Reliability and validity of the positive and negative syndrome scale for schizophrenics. Psychiatry Research 23:99–110, 1988.

    Article  PubMed  CAS  Google Scholar 

  12. Hamilton M: A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry 23:56–62, 1960.

    Article  PubMed  CAS  Google Scholar 

  13. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 3rd Rev edn. Washington DC, American Psychiatric Association, 1987.

    Google Scholar 

  14. Naber D: A self-rating to measure subjective effects of neuroleptic drugs, relationships to objective psychopathology, quality of life, compliance and other clinical variables. International Clinical Psychopharmacology 10(Suppl 3):133–138, 1995.

    Google Scholar 

  15. Phillips L: Case history data and prognosis in schizophrenia. Journal of Nervous and Mental Disease 515–525, 1953.

  16. Weinstein MC, Fineberg HV: Clinical decisions analysis. Philadelphia, PA, WB Saunders, 1980.

    Google Scholar 

  17. R Development Core Team. A language and environment for statistical computing. URL http://www.R-project.org. 2008. Vienna, Austria, Foundation for Statistical Computing. Ref Type: Computer Program.

  18. Jager M, Riedel M, Schmauss M, Laux G, Pfeiffer H, Naber D, Schmidt LG, Gaebel W, Klosterkotter J, Heuser I, Kuhn KU, Lemke MR, Ruther E, Buchkremer G, Gastpar M, Bottlender R, Strauss A, Moller HJ: Prediction of symptom remission in schizophrenia during inpatient treatment. World Journal of Biological Psychiatry 1–9, 2007.

  19. Beitinger R, Lin J, Kissling W, Leucht S: Comparative remission rates of schizophrenic patients using various remission criteria. Progress in Neuro-Psychopharmacology and Biological Psychiatry 32:1643–1651, 2008.

    Google Scholar 

  20. San L, Ciudad A, Alvarez E, Bobes J, Gilaberte I: Symptomatic remission and social/vocational functioning in outpatients with schizophrenia: prevalence and associations in a cross-sectional study. European Psychiatry 22:490–498, 2007.

    Article  PubMed  Google Scholar 

  21. Alptekin K, Erkoc S, Gogus AK, Kultur S, Mete L, Ucok A, Yazici KM: Disability in schizophrenia: clinical correlates and prediction over 1-year follow-up. Psychiatry Research 135:103–111, 2005.

    Google Scholar 

  22. Bobes J, Ciudad A, Alvarez E, San L, Polavieja P, Gilaberte I: Recovery from schizophrenia: results from a 1-year follow-up observational study of patients in symptomatic remission. Schizophrenia Research 115:58–66, 2009.

    Article  PubMed  Google Scholar 

  23. Novick D, Haro JM, Suarez D, Vieta E, Naber D: Recovery in the outpatient setting: 36-month results from the Schizophrenia Outpatients Health Outcomes (SOHO) study. Schizophrenia Research 108:223–230, 2009.

    Article  PubMed  Google Scholar 

  24. Faerden A, Nesvag R, Marder SR: Definitions of the term ‘recovered’ in schizophrenia and other disorders. Psychopathology 41:271–278, 2008.

    Article  PubMed  Google Scholar 

  25. Wobrock T, Kohler J, Klein P, Falkai P: Achieving symptomatic remission in out-patients with schizophrenia–a naturalistic study with quetiapine. Acta Psychiatrica Scandinavica 120:120–128, 2009.

    Article  PubMed  CAS  Google Scholar 

  26. Brousse G, Meary A, Blanc O, Lancon C, Llorca PM, Leboyer M: Clinical predictors of response to olanzapine or risperidone during acute episode of schizophrenia. Psychiatry Research 179:12–18, 2010.

    Google Scholar 

  27. Francey SM, Nelson B, Thompson A, Parker AG, Kerr M, Macneil C, Fraser R, Hughes F, Crisp K, Harrigan S, Wood SJ, Berk M, McGorry PD: Who needs antipsychotic medication in the earliest stages of psychosis? A reconsideration of benefits, risks, neurobiology and ethics in the era of early intervention. Schizophrenia Research 119:1–10, 2010.

    Article  PubMed  CAS  Google Scholar 

  28. Lambert M, Naber D, Schacht A, Wagner T, Hundemer HP, Karow A, Huber CG, Suarez D, Haro JM, Novick D, Dittmann RW, Schimmelmann BG: Rates and predictors of remission and recovery during 3 years in 392 never-treated patients with schizophrenia. Acta Psychiatrica Scandinavica 118:220–229, 2008.

    Article  PubMed  CAS  Google Scholar 

  29. Crespo-Facorro B, Perez-Iglesias R, Ramirez-Bonilla M, Martinez-Garcia O, Llorca J, Luis Vazquez-Barquero J: A practical clinical trial comparing haloperidol, risperidone, and olanzapine for the acute treatment of first-episode nonaffective psychosis. Journal of Clinical Psychiatry 67:1511–1521, 2006.

    Article  PubMed  CAS  Google Scholar 

  30. Schooler N, Rabinowitz J, Davidson M, Emsley R, Harvey PD, Kopala L, McGorry PD, Van H, I, Eerdekens M, Swyzen W, De SG: Risperidone and haloperidol in first-episode psychosis: a long-term randomized trial. American Journal of Psychiatry 162:947–953, 2005.

    Article  PubMed  Google Scholar 

  31. Gitlin M, Nuechterlein K, Subotnik KL, Ventura J, Mintz J, Fogelson DL, Bartzokis G, Aravagiri M: Clinical outcome following neuroleptic discontinuation in patients with remitted recent-onset schizophrenia. American Journal of Psychiatry 158:1835–1842, 2001.

    Article  PubMed  CAS  Google Scholar 

  32. Perkins D, Lieberman J, Gu H, Tohen M, McEvoy J, Green A, Zipursky R, Strakowski S, Sharma T, Kahn R, Gur R, Tollefson G: Predictors of antipsychotic treatment response in patients with first-episode schizophrenia, schizoaffective and schizophreniform disorders. British Journal of Psychiatry 185:18–24, 2004.

    Google Scholar 

  33. Haro JM, Novick D, Suarez D, Ochoa S, Roca M: Predictors of the course of illness in outpatients with schizophrenia: a prospective three year study. Progress in Neuro-Psychopharmacology and Biological Psychiatry 32:1287–1292, 2008.

    Google Scholar 

  34. Haro JM, Novick D, Suarez D, Alonso J, Lepine JP, Ratcliffe M: Remission and relapse in the outpatient care of schizophrenia: three-year results from the Schizophrenia Outpatient Health Outcomes study. Journal of Clinical Psychopharmacology 26:571–578, 2006.

    Article  PubMed  Google Scholar 

  35. De HM, van WR, Wampers M, Kane J, Van OJ, Peuskens J: Remission criteria for schizophrenia: evaluation in a large naturalistic cohort. Schizophrenia Research 92:68–73, 2007.

  36. Lindenmayer JP, Liu-Seifert H, Kulkarni PM, Kinon BJ, Stauffer V, Edwards SE, Chen L, Adams DH, scher-Svanum H, Buckley PF, Citrome L, Volavka J: Medication nonadherence and treatment outcome in patients with schizophrenia or schizoaffective disorder with suboptimal prior response. Journal of Clinical Psychiatry 70:990–996, 2009.

    Article  PubMed  CAS  Google Scholar 

  37. Ciudad A, Alvarez E, Bobes J, San L, Polavieja P, Gilaberte I: Remission in schizophrenia: Results from a 1-year follow-up observational study. Schizophrenia Research 108:214–222, 2009.

    Article  PubMed  Google Scholar 

  38. Malla A, Norman R, Schmitz N, Manchanda R, Bechard-Evans L, Takhar J, Haricharan R: Predictors of rate and time to remission in first-episode psychosis: a two-year outcome study. Psychological Medicine 36:649–658, 2006.

    Article  PubMed  Google Scholar 

  39. Perkins DO, Johnson JL, Hamer RM, Zipursky RB, Keefe RS, Centorrhino F, Green AI, Glick IB, Kahn RS, Sharma T, Tohen M, McEvoy JP, Weiden PJ, Lieberman JA: Predictors of antipsychotic medication adherence in patients recovering from a first psychotic episode. Schizophrenia Research 83:53–63, 2006.

    Article  PubMed  Google Scholar 

  40. Lambert M, Karow A, Leucht S, Schimmelmann BG, Naber D. Remission in schizophrenia: its validity, frequency, predictors and patients’ perspective 5 years after. Dialogues in Clinical Neuroscience 2010 (in press).

  41. Hofer A, Rettenbacher MA, Widschwendter CG, Kemmler G, Hummer M, Fleischhacker WW: Correlates of subjective and functional outcomes in outpatient clinic attendees with schizophrenia and schizoaffective disorder. European Archives of Psychiatry and Clinical Neuroscience 256:246–255, 2006.

    Article  PubMed  Google Scholar 

  42. Wittorf A, Wiedemann G, Buchkremer G, Klingberg S: Prediction of community outcome in schizophrenia 1 year after discharge from inpatient treatment. European Archives of Psychiatry and Clinical Neuroscience 258:48–58, 2008.

    Article  PubMed  Google Scholar 

  43. Marwaha S, Johnson S: Schizophrenia and employment—a review. Social Psychiatry and Psychiatric Epidemiology 39:337–349, 2004.

    Article  PubMed  Google Scholar 

  44. Boardman J, Grove B, Perkins R, Shepherd G: Work and employment for people with psychiatric disabilities. British Journal of Psychiatry 182:467–468, 2003.

    Google Scholar 

  45. Kilian R, Matschinger H, Becker T, Angermeyer MC: A longitudinal analysis of the impact of social and clinical characteristics on the costs of schizophrenia treatment. Acta Psychiatrica Scandinavica 107:351–360, 2003.

    Article  PubMed  CAS  Google Scholar 

  46. Rund BR: Fully recovered schizophrenics: a retrospective study of some premorbid and treatment factors. Psychiatry 1990;53:127-139.

    PubMed  CAS  Google Scholar 

  47. Hafner H, an der HW: The course of schizophrenia in the light of modern follow-up studies: the ABC and WHO studies. European Archives of Psychiatry and Clinical Neuroscience 249(Suppl 4):14–26, 1999.

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Acknowledgments

The study was performed within the framework of the German Research Network on Schizophrenia, which is funded by the German Federal Ministry for Education and Research BMBF (grant 01 GI 0233).

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Authors and Affiliations

  1. Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Nussbaumstrasse 7, 80336, Munich, Germany

    Rebecca Schennach, Michael Riedel, Michael Obermeier, Markus Jäger, Florian Seemüller & Hans-Jürgen Möller

  2. Psychiatric Clinic, District Hospital, Augsburg, Germany

    Max Schmauss

  3. Psychiatric Clinic, Inn-Salzach Hospital, Wasserburg/Inn, Germany

    Gerd Laux

  4. Psychiatric Clinic, Isar-Amper Hospital, Munich-Haar, Germany

    Herbert Pfeiffer

  5. Department of Psychiatry and Psychotherapy, University of Hamburg, Hamburg, Germany

    Dieter Naber

  6. Department of Psychiatry and Psychotherapy, University of Mainz, Mayence, Germany

    Lutz G. Schmidt

  7. Department of Psychiatry and Psychotherapy, Heinrich-Heine-University, Duesseldorf, Germany

    Wolfgang Gaebel

  8. Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany

    Joachim Klosterkötter

  9. Department of Psychiatry and Psychotherapy, Charite Berlin, Campus Benjamin Franklin, Berlin, Germany

    Isabella Heuser

  10. Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany

    Wolfgang Maier

  11. Department of Psychiatry and Psychotherapy, Alsterdorf Hospital, Hamburg, Germany

    Matthias R. Lemke

  12. Department of Psychiatry and Psychotherapy, University of Göttingen, Göttingen, Germany

    Eckart Rüther

  13. Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany

    Stefan Klingberg

  14. Department of Psychiatry and Psychotherapy, University of Essen, Essen, Germany

    Markus Gastpar

  15. Psychiatric Clinic, Vinzenz-von-Paul Hospital, Rottweil, Germany

    Michael Riedel

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  1. Rebecca Schennach
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  2. Michael Riedel
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  7. Herbert Pfeiffer
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  8. Dieter Naber
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  9. Lutz G. Schmidt
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  11. Joachim Klosterkötter
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  12. Isabella Heuser
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  14. Matthias R. Lemke
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  15. Eckart Rüther
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  17. Markus Gastpar
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  18. Florian Seemüller
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  19. Hans-Jürgen Möller
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Correspondence to Rebecca Schennach.

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Schennach, R., Riedel, M., Obermeier, M. et al. Remission and Recovery and their Predictors in Schizophrenia Spectrum Disorder: Results from a 1-Year Follow-Up Naturalistic Trial. Psychiatr Q 83, 187–207 (2012). https://doi.org/10.1007/s11126-011-9193-z

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