Remission in early psychosis: Rates, predictors, and clinical and functional outcome correlates

Robin Emsley; Jonathan Rabinowitz; Rossella Medori

doi:10.1016/j.schres.2006.09.013

Remission in early psychosis: Rates, predictors, and clinical and functional outcome correlates

Robin Emsley
, Jonathan Rabinowitz
, Rossella Medori

The Louis & Gabi Weisfeld School of Social Work

Stellenbosch University
Johnson & Johnson

Research output: Contribution to journal › Article › peer-review

178 Scopus citations

Abstract

Background: Recently, the "Remission in Schizophrenia Working Group" proposed remission criteria consisting of a reduction to mild levels on key symptoms for at least 6 months. Aims: This study applied these remission criteria to a large first-episode psychosis sample in order to (1) determine the rates of remission; (2) explore predictors of remission; and (3) test the external validity of these criteria. Methods: We analyzed data from 462 subjects with a first-episode of psychosis who participated in a long-term, multinational, randomized, double-blinded trial of risperidone and haloperidol over 2 to 4 years. Results: At some time point in the study 323 (70%) of the 462 subjects had a reduction to mild levels on the key symptoms as measured by the PANSS although only 109 (23.6%) maintained this level for at least 6 months thereby meeting remission criteria. The two strongest predictors of remission were shorter duration of untreated psychosis (p = 0.01) and treatment response at 6 weeks (p = 0.001). Compared to non-remitted patients, those in remission experienced greater improvement on all PANSS subscales (p < .0001), CGI-S (p < .0001), better quality of life (p = 0.006), fewer relapses (p < .0001), displayed a more favorable attitude towards their medication (p = .002), had lower EPS levels according to the ESRS (p = < .0001) and received lower doses of antipsychotic medication (p = 0.003). The remission and non-remission groups did not differ significantly regarding composite cognitive scores, suicidality and body mass index. Conclusions: The results suggest that the remission criteria, although based solely on core symptom improvement, can effectively identify patients who have a more favorable overall outcome.

Original language	English
Pages (from-to)	129-139
Number of pages	11
Journal	Schizophrenia Research
Volume	89
Issue number	1-3
DOIs	https://doi.org/10.1016/j.schres.2006.09.013
State	Published - Jan 2007

Bibliographical note

Funding Information:
The randomized controlled drug trial presented in this paper was funded by Johnson and Johnson Pharmaceutical Research and Development. The study included the following investigators and locations: Australia - P. McGorry (Melbourne); T. Lambert (Bentley); J. Kulkarni (Dandenong); Austria - W. Fleischhacker (Innsbruck); Canada - D. Addington (Calgary); L. Kopala (Halifax); R. Williams (Calgary); G. Chouinard (Montreal); A. Labelle (Ottawa); A. Malla (London); S. Purdon (Edmonton); M. Saxena (Hamilton); V. Nair (Montreal); R. Matte (Sherbrooke); S. Johnson (St. John's); L. Beauclair (Montreal); Finland - K. Lehtinen (Tampere); France - E.R. Lombertie (Limoges); J-A. Meynard (La Rochelle); Germany - H. Freyberger (Stralsund); H-J. Möller (Munich); Israel - A. Caspi; M. Davidson (Ramat-Gan); A. Elitzur (Bat-Yam); M. Kotler (Beer Sheva); I. Treves (Hod-Hasharon); A. Weizman (Petach-Tikva); Netherlands - P. Dries (Portugal); New Zealand - D. Codyre (Auckland); South Africa - R. Emsley (Cape Town); C. Gagiano (Bloemfontein); United Kingdom - M. Reveley (Leicester); T. Sharma (London); United States of America - J. Csernansky (St. Louis); L. DeLisi (Stony Brook); J. Lauriello (Albuquerque); T. Manschreck (Fall River); J. Pahl (Oklahoma City); N. Schooler, M. Keshavan (Pittsburgh); S. Schulz (Cleveland); S. Targum (Philadelphia); S. Risch (Charleston).

Funding

The randomized controlled drug trial presented in this paper was funded by Johnson and Johnson Pharmaceutical Research and Development. The study included the following investigators and locations: Australia - P. McGorry (Melbourne); T. Lambert (Bentley); J. Kulkarni (Dandenong); Austria - W. Fleischhacker (Innsbruck); Canada - D. Addington (Calgary); L. Kopala (Halifax); R. Williams (Calgary); G. Chouinard (Montreal); A. Labelle (Ottawa); A. Malla (London); S. Purdon (Edmonton); M. Saxena (Hamilton); V. Nair (Montreal); R. Matte (Sherbrooke); S. Johnson (St. John's); L. Beauclair (Montreal); Finland - K. Lehtinen (Tampere); France - E.R. Lombertie (Limoges); J-A. Meynard (La Rochelle); Germany - H. Freyberger (Stralsund); H-J. Möller (Munich); Israel - A. Caspi; M. Davidson (Ramat-Gan); A. Elitzur (Bat-Yam); M. Kotler (Beer Sheva); I. Treves (Hod-Hasharon); A. Weizman (Petach-Tikva); Netherlands - P. Dries (Portugal); New Zealand - D. Codyre (Auckland); South Africa - R. Emsley (Cape Town); C. Gagiano (Bloemfontein); United Kingdom - M. Reveley (Leicester); T. Sharma (London); United States of America - J. Csernansky (St. Louis); L. DeLisi (Stony Brook); J. Lauriello (Albuquerque); T. Manschreck (Fall River); J. Pahl (Oklahoma City); N. Schooler, M. Keshavan (Pittsburgh); S. Schulz (Cleveland); S. Targum (Philadelphia); S. Risch (Charleston).

Funders
Johnson and Johnson Pharmaceutical Research and Development

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Outcomes
Remission
Schizophrenia

Access to Document

10.1016/j.schres.2006.09.013

Cite this

@article{1a2c611bb0624eb696fc55d362ab7707,

title = "Remission in early psychosis: Rates, predictors, and clinical and functional outcome correlates",

abstract = "Background: Recently, the {"}Remission in Schizophrenia Working Group{"} proposed remission criteria consisting of a reduction to mild levels on key symptoms for at least 6 months. Aims: This study applied these remission criteria to a large first-episode psychosis sample in order to (1) determine the rates of remission; (2) explore predictors of remission; and (3) test the external validity of these criteria. Methods: We analyzed data from 462 subjects with a first-episode of psychosis who participated in a long-term, multinational, randomized, double-blinded trial of risperidone and haloperidol over 2 to 4 years. Results: At some time point in the study 323 (70\%) of the 462 subjects had a reduction to mild levels on the key symptoms as measured by the PANSS although only 109 (23.6\%) maintained this level for at least 6 months thereby meeting remission criteria. The two strongest predictors of remission were shorter duration of untreated psychosis (p = 0.01) and treatment response at 6 weeks (p = 0.001). Compared to non-remitted patients, those in remission experienced greater improvement on all PANSS subscales (p < .0001), CGI-S (p < .0001), better quality of life (p = 0.006), fewer relapses (p < .0001), displayed a more favorable attitude towards their medication (p = .002), had lower EPS levels according to the ESRS (p = < .0001) and received lower doses of antipsychotic medication (p = 0.003). The remission and non-remission groups did not differ significantly regarding composite cognitive scores, suicidality and body mass index. Conclusions: The results suggest that the remission criteria, although based solely on core symptom improvement, can effectively identify patients who have a more favorable overall outcome.",

keywords = "Outcomes, Remission, Schizophrenia",

author = "Robin Emsley and Jonathan Rabinowitz and Rossella Medori",

note = "Funding Information: The randomized controlled drug trial presented in this paper was funded by Johnson and Johnson Pharmaceutical Research and Development. The study included the following investigators and locations: Australia - P. McGorry (Melbourne); T. Lambert (Bentley); J. Kulkarni (Dandenong); Austria - W. Fleischhacker (Innsbruck); Canada - D. Addington (Calgary); L. Kopala (Halifax); R. Williams (Calgary); G. Chouinard (Montreal); A. Labelle (Ottawa); A. Malla (London); S. Purdon (Edmonton); M. Saxena (Hamilton); V. Nair (Montreal); R. Matte (Sherbrooke); S. Johnson (St. John's); L. Beauclair (Montreal); Finland - K. Lehtinen (Tampere); France - E.R. Lombertie (Limoges); J-A. Meynard (La Rochelle); Germany - H. Freyberger (Stralsund); H-J. M{\"o}ller (Munich); Israel - A. Caspi; M. Davidson (Ramat-Gan); A. Elitzur (Bat-Yam); M. Kotler (Beer Sheva); I. Treves (Hod-Hasharon); A. Weizman (Petach-Tikva); Netherlands - P. Dries (Portugal); New Zealand - D. Codyre (Auckland); South Africa - R. Emsley (Cape Town); C. Gagiano (Bloemfontein); United Kingdom - M. Reveley (Leicester); T. Sharma (London); United States of America - J. Csernansky (St. Louis); L. DeLisi (Stony Brook); J. Lauriello (Albuquerque); T. Manschreck (Fall River); J. Pahl (Oklahoma City); N. Schooler, M. Keshavan (Pittsburgh); S. Schulz (Cleveland); S. Targum (Philadelphia); S. Risch (Charleston). ",

year = "2007",

month = jan,

doi = "10.1016/j.schres.2006.09.013",

language = "אנגלית",

volume = "89",

pages = "129--139",

journal = "Schizophrenia Research",

issn = "0920-9964",

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T1 - Remission in early psychosis

T2 - Rates, predictors, and clinical and functional outcome correlates

AU - Emsley, Robin

AU - Rabinowitz, Jonathan

AU - Medori, Rossella

N1 - Funding Information: The randomized controlled drug trial presented in this paper was funded by Johnson and Johnson Pharmaceutical Research and Development. The study included the following investigators and locations: Australia - P. McGorry (Melbourne); T. Lambert (Bentley); J. Kulkarni (Dandenong); Austria - W. Fleischhacker (Innsbruck); Canada - D. Addington (Calgary); L. Kopala (Halifax); R. Williams (Calgary); G. Chouinard (Montreal); A. Labelle (Ottawa); A. Malla (London); S. Purdon (Edmonton); M. Saxena (Hamilton); V. Nair (Montreal); R. Matte (Sherbrooke); S. Johnson (St. John's); L. Beauclair (Montreal); Finland - K. Lehtinen (Tampere); France - E.R. Lombertie (Limoges); J-A. Meynard (La Rochelle); Germany - H. Freyberger (Stralsund); H-J. Möller (Munich); Israel - A. Caspi; M. Davidson (Ramat-Gan); A. Elitzur (Bat-Yam); M. Kotler (Beer Sheva); I. Treves (Hod-Hasharon); A. Weizman (Petach-Tikva); Netherlands - P. Dries (Portugal); New Zealand - D. Codyre (Auckland); South Africa - R. Emsley (Cape Town); C. Gagiano (Bloemfontein); United Kingdom - M. Reveley (Leicester); T. Sharma (London); United States of America - J. Csernansky (St. Louis); L. DeLisi (Stony Brook); J. Lauriello (Albuquerque); T. Manschreck (Fall River); J. Pahl (Oklahoma City); N. Schooler, M. Keshavan (Pittsburgh); S. Schulz (Cleveland); S. Targum (Philadelphia); S. Risch (Charleston).

PY - 2007/1

Y1 - 2007/1

N2 - Background: Recently, the "Remission in Schizophrenia Working Group" proposed remission criteria consisting of a reduction to mild levels on key symptoms for at least 6 months. Aims: This study applied these remission criteria to a large first-episode psychosis sample in order to (1) determine the rates of remission; (2) explore predictors of remission; and (3) test the external validity of these criteria. Methods: We analyzed data from 462 subjects with a first-episode of psychosis who participated in a long-term, multinational, randomized, double-blinded trial of risperidone and haloperidol over 2 to 4 years. Results: At some time point in the study 323 (70%) of the 462 subjects had a reduction to mild levels on the key symptoms as measured by the PANSS although only 109 (23.6%) maintained this level for at least 6 months thereby meeting remission criteria. The two strongest predictors of remission were shorter duration of untreated psychosis (p = 0.01) and treatment response at 6 weeks (p = 0.001). Compared to non-remitted patients, those in remission experienced greater improvement on all PANSS subscales (p < .0001), CGI-S (p < .0001), better quality of life (p = 0.006), fewer relapses (p < .0001), displayed a more favorable attitude towards their medication (p = .002), had lower EPS levels according to the ESRS (p = < .0001) and received lower doses of antipsychotic medication (p = 0.003). The remission and non-remission groups did not differ significantly regarding composite cognitive scores, suicidality and body mass index. Conclusions: The results suggest that the remission criteria, although based solely on core symptom improvement, can effectively identify patients who have a more favorable overall outcome.

AB - Background: Recently, the "Remission in Schizophrenia Working Group" proposed remission criteria consisting of a reduction to mild levels on key symptoms for at least 6 months. Aims: This study applied these remission criteria to a large first-episode psychosis sample in order to (1) determine the rates of remission; (2) explore predictors of remission; and (3) test the external validity of these criteria. Methods: We analyzed data from 462 subjects with a first-episode of psychosis who participated in a long-term, multinational, randomized, double-blinded trial of risperidone and haloperidol over 2 to 4 years. Results: At some time point in the study 323 (70%) of the 462 subjects had a reduction to mild levels on the key symptoms as measured by the PANSS although only 109 (23.6%) maintained this level for at least 6 months thereby meeting remission criteria. The two strongest predictors of remission were shorter duration of untreated psychosis (p = 0.01) and treatment response at 6 weeks (p = 0.001). Compared to non-remitted patients, those in remission experienced greater improvement on all PANSS subscales (p < .0001), CGI-S (p < .0001), better quality of life (p = 0.006), fewer relapses (p < .0001), displayed a more favorable attitude towards their medication (p = .002), had lower EPS levels according to the ESRS (p = < .0001) and received lower doses of antipsychotic medication (p = 0.003). The remission and non-remission groups did not differ significantly regarding composite cognitive scores, suicidality and body mass index. Conclusions: The results suggest that the remission criteria, although based solely on core symptom improvement, can effectively identify patients who have a more favorable overall outcome.

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KW - Remission

KW - Schizophrenia

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VL - 89

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JO - Schizophrenia Research

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IS - 1-3

ER -

Remission in early psychosis: Rates, predictors, and clinical and functional outcome correlates

Abstract

Bibliographical note

Funding

UN SDGs

Keywords

Access to Document

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