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Measuring Remission in Schizophrenia
The currently proposed consensus criteria to measure what is traditionally understood to be remission in schizophrenia should be critically re-evaluated for accuracy, according to a new study. 239 patients with a schizophrenia spectrum disorder were evaluated regarding their remission status after inpatient treatment. Remission in schizophrenia was defined according to the symptom-severity component of the consensus criteria and a CGI-based definition was calculated using sensitivity and specificity using receiver operating curves. Both remitter groups were compared regarding different clinical variables at discharge as well as the likelihood to relapse within a 1-year follow-up period. Researchers found:
- Following the consensus criteria, 63% of the schizophrenia patients were in remission compared to only 18% following the asymptomatic criterion.
- The schizophrenia consensus remitters were less likely to be concurrent treatment responders, had a significantly greater illness severity and less functioning, as well as a significantly greater risk to relapse.
Schennach R, Obermeier M, Spellmann I, et al. Remission in schizophrenia – What are we measuring: Comparing the consensus remission criteria to a CGI-based definition of remission and to remission in major depression. [Published online ahead of print May 25, 2019]. Schizophr Res. doi: 10.1016/j.schres.2019.04.022.
In schizophrenia research, a consensus definition of remission is based upon both symptom response/severity and the time duration of this level of illness severity. However, this consensus definition is often only partially applied when categorizing patient groups as “remitted”, particularly in short-term clinical trials where follow-up time is limited. In addition, the consensus definition allows for a residual degree of symptoms, functional impairment and diminished well-being among patients. his analysis highlights the discrepancy been consensus-defined “remission” criteria and true/asymptomatic remitters. As the authors correctly point out, if remission in schizophrenia is supposed to be a clinical state that is genuinely asymptomatic or only minimally impaired, then a more rigorous and widely adopted remission criterion needs to be developed. —Martha Sajatovic, MD, Professor of Psychiatry and of Neurology; Willard Brown Chair in Neurological Outcomes Research; Director, Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center; Case Western Reserve University School of Medicine.