Symptom severity predicts remission in first-episode schizophrenia




Severity of symptoms in the first episode of schizophrenia might be an indicator of whether patients will achieve remission, recently published findings suggest.

Dr. Carlo Marchesi and associates at the University of Parma (Italy) studied 48 first-episode schizophrenia patients admitted to the university’s psychiatric clinic between January 1995 and December 1999. Patients were 17 years of age and older, hospitalized for the first time for a psychotic episode, and were discharged with a DSM-IV diagnosis of schizophrenia (Psychiatry Res. 2015;225:129-32).

Symptom severity was assessed using the Positive and Negative Syndrome Scale (PANSS), with the eight core symptoms being delusions, hallucinations, unusual thoughts, conceptual disorganization, mannerisms/posturing, blunted affect, social withdrawal, and lack of spontaneity. Exclusion criteria included drug abuse, delirium, mental retardation, previous treatment with psychotropic medication, and discontinuation of treatment after discharge.

Patients attended monthly mental health visits following discharge, with a follow-up re-evaluation in 2010, the authors reported. During monthly visits, data were collected about patients’ psychiatric state, treatment adherence, medications, and illicit drug use.

At follow-up, 18 of the 48 patients had achieved remission (R) and 30 had not achieved remission (NR). Duration of illness was similar in both groups (16.0 ± 4.8 years in the R group; 16.3 ± 5.1 years in the NR group). The number of psychotic episodes requiring hospitalization was higher in patients who did not achieve remission (3.6 ± 1.0 in the NR group; 2.2 ± 0.6 in the R group; P < 0.001), Dr. Marchesi and his colleagues reported.

Severity of core symptoms at baseline was lower in R patients than in NR patients, with 61% of patients in remission meeting symptom severity criteria in five of the eight core symptoms, compared with 10% of patients who did not achieve remission (P < 0.001).

These findings confirm results from previous studies suggesting that, at the time of a first episode, “lesser symptom severity, particularly a lesser degree of negative symptoms, predict long-term remission in schizophrenic patients,” the investigators wrote.

Additionally, the results might provide evidence supporting a proposal from the Remission in Schizophrenia Working Group to define a subgroup of schizophrenia patients with milder symptoms at baseline who might have a higher chance of achieving long-term remission.

The investigators noted two limitations to the study. First, since schizophrenia is not a stable disorder, remission might be time limited, making it impossible to rule out the possibility of relapse. Second, it is important to consider that some patients might have been nonadherent to medications between monthly visits, they added.

Dr. Marchesi and his coauthors did not report any relevant financial disclosures.

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