Recovery und Remission bei Schizophrenie

Psychosocial functioning in relation to symptomatic remission: A longitudinal study of first episode schizophrenia

OBJECTIVES

The aims of the study were: (1) to evaluate longitudinally symptomatic remission in first-episode (FE) schizophrenia, (2) to describe symptoms, social functioning and quality of life (Qol) in relation to remission status, and (3) to determine the long-term outcome of schizophrenia and its early predictors.

METHODS

Sixty-four patients were assessed 1 month after a first hospitalization (T1), 12 months (T2), 4-6 years (T3), and 7-11 years (T4) after T1. The patients were allocated to three remission groups according to their remission status over the whole observation period, e.g. stable remission (SR), unstable remission (UR) and non-remission (NR). The PANSS, Social Functioning Scale and WHOQoL were used to evaluate the patients' psychosocial functioning levels, symptomatic and functional remissions and satisfying QoL. A good outcome was defined as meeting, simultaneously, the criteria of symptomatic and functional remissions and satisfying QoL at T4, while failure to meet all of these criteria was defined as a poor outcome.

RESULTS

Among them, 17.2% patients were in stable remission, 57.8% in unstable remission and 25.0% were unremitted at all time points. The SR group had lower levels of psychopathological symptoms and reported better social functioning and QoL than the NR group. During the follow-up, the symptoms increased, social functioning slightly improved and QoL did not change. At T4, 53% of the sample had a poor outcome, which was independently predicted by the longer duration of untreated psychosis and a lack of satisfying QoL at T1.

CONCLUSIONS

Our results demonstrate that: (1) the long-term course in schizophrenia is heterogeneous and that three illness trajectories exist, (2) social functioning and QoL are only partially connected with symptomatic remission (3), the risk of a poor outcome may potentially be reduced by appropriate interventions at an early stage of the illness.

Symptomatic remission in schizophrenia patients: relationship with social functioning, quality of life, and neurocognitive performance

PURPOSE

To investigate whether symptomatic remission relates to better outcomes in schizophrenia.

METHODS

Seventy-six schizophrenia patients were assessed using measures of cross-sectional symptomatic remission, social functioning, subjective quality of life (QoL), and cognition.

RESULTS

Most patients (53; 69.7%) were not in remission. Remitted patients presented significantly better social functioning, better self-reported QoL, insight, and lower levels of depressive symptoms. They also showed a non-significant trend for better executive function, processing speed and verbal memory.

CONCLUSIONS

Symptomatic remission may be a good indicator of better clinical status, social functioning and QoL, but not so much for cognitive functioning.

Subjective well-being in schizophrenia as measured with the Subjective Well-Being under Neuroleptic Treatment scale: a review

OBJECTIVE

The Subjective Well-being under Neuroleptic Treatment scale (SWN) is the most widely used self-rating scale in recent research of subjective well-being in schizophrenia. We reviewed all available publications on relevant research of subjective well-being using the SWN, in order to evaluate measurement of subjective well-being with a single instrument.

METHOD

A MEDLINE and Embase search was performed for studies published between January 1994 and August 2010, analysing controlled and open clinical trials using the SWN.

RESULTS

A total of 52 publications were identified covering 44 studies. Strong evidence exists for improvement of subjective well-being during treatment. Atypical antipsychotics are associated with a higher level of well-being. However, dosage is more important than the kind of medication. Striatal dopamine D(2) receptor occupancy is correlated with subjective well-being. Early positive response of subjective well-being is predictive of a better outcome. Research on determinants of subjective well-being is rapidly expanding, focusing mostly on the effects of medication.

CONCLUSIONS

Subjective well-being of schizophrenia patients is a valuable outcome measure. It can be improved by optimizing antipsychotic treatment. More research on psychological and genetic predictors of subjective well-being is needed.