Remission of positive symptoms according to the "remission in Schizophrenia Working Group" criteria: a longitudinal study of cognitive functioning

More haste less speed: A meta-analysis of thinking latencies during planning in people with psychosis

Cognitive impairment is a core feature of psychosis, with slowed processing speed thought to be a prominent impairment in schizophrenia and first-episode psychosis. However, findings from the Stockings of Cambridge (SOC) planning task suggest changes in processing speed associated with the illness may include faster responses in early stages of planning, though findings are inconsistent. This review uses meta-analytic methods to assess thinking times in psychosis across the available literature. Studies were identified by searching PubMed, Web of Science and Google Scholar. Eligibility criteria: 1) included a sample of people with non-affective psychosis according to DSM III, DSM IV, DSM V or ICD-10 criteria; 2) employed the SOC task; 3) included a healthy control group; and 4) published in English. We identified 11 studies that employed the SOC task. Results show that people with psychosis have significantly faster initial thinking times than non-clinical participants, but significantly slower subsequent thinking times during problem execution. These findings indicate that differences in processing speed are not limited to slower responses in people with psychosis but may reflect a preference for step-by-step processing rather than planning before task execution. We suggest this style of responding is adopted to compensate for working memory impairment.

Schizophrenia-spectrum patients treated with long-acting injectable risperidone in real-life clinical settings: functional recovery in remitted versus stable, non-remitted patients (the EVeREST prospective observational cohort study)

BACKGROUND

Previous studies showed functional improvement in stable patients with schizophrenia treated with risperidone long-acting injection (LAI). We therefore re-investigated functional improvement with risperidone LAI in remitted patients, in comparison with stable patients. The study was conducted in real-life conditions because of the high heterogeneity of the patients' situations.

METHOD

This was a multi-centre, prospective observational cohort study involving adult schizophrenia-spectrum chronic patients who were previously treated with risperidone LAI for 6 months. Remission was evaluated using the consensus criteria proposed by the Remission in Schizophrenia Working Group (RSWG). The primary endpoint was global functioning (assessed with the Global Assessment of Functioning scale, GAF) after one year of treatment. Social functioning was a secondary outcome.

RESULTS

The analysis included 1490 patients. Attrition rate was 9.1 % at the end of the study. 27.7 % of patients were in remission after one year of risperidone LAI treatment. The mean GAF rating score (62.5 ± 1.5) was higher than the cut-off previously used to identify patients with satisfactory functioning (60) and significantly higher than the mean GAF score in stable, non-remitted patients (48.3, p < 0.001). Social functioning was also high in remitted patients (21.0 ± 3.6 vs. 17.2 ± 3.7 in non-remitted patients, p < 0.001).

CONCLUSION

The results clearly show that after one year of treatment with risperidone LAI, RSWG-remitted patients have a high level of global functioning, which is significantly higher than in stable, non-remitted patients. Social functioning was also higher in remitted patients as compared with stable, non-remitted patients.

Remission criteria and functional outcome in patients with schizophrenia, a longitudinal study

BACKGROUND

The Remission in Schizophrenia Working Group (RSWG) has proposed remission criteria for schizophrenia, which were shown to be valid in terms of functional and clinical outcomes. However, studies investigating the association between dynamics in remission status in relation to longitudinal functional and clinical outcome are scarce.

METHODS

A total of 648 patients were allocated to four change-in-remission groups, i.e. remission/remission, remission/no-remission, no-remission/remission, and no-remission/no-remission. Remission status was based on PANSS ratings. Multilevel linear modelling techniques were used to investigate whether enduring remission was associated with more improvement in functional outcome at follow-up. Further, change in functional and clinical outcome at follow-up measurement was assessed for each remission category separately.

RESULTS

Both at baseline and at follow-up, remission status was associated with better functioning. At baseline, patients who subsequently moved out of remission status could be characterized by more severe psychopathology, disabilities, unmet needs and worse quality of life (QoL) compared with patients who continued to be in remission. The stable in-remission group was characterized by significantly better functioning and QoL, both at baseline and follow-up compared with all other remission groups. Nevertheless, QoL increased in all four patient categories.

CONCLUSIONS

In a large sample of patients with a non-affective psychotic disorder, stable remission or moving into remission over time, based on the RSWG criteria, was associated with a favourable functional outcome and QoL, providing further support for the clinical validity of the RSWG remission criteria. The findings also suggest growing adaptation and self-management over time, despite ongoing difficulties.