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RECOVERY AND ITS RELATION TO SYMPTOMATIC AND FUNCTIONAL REMISSION IN FIRST EPISODE PSYCHOSIS
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Abstracts / Schizophrenia Research 102/1–3, Supplement 2 (2008) 1–279
476 – RECOVERY AND ITS RELATION TO SYMPTOMATIC AND FUNCTIONAL REMISSION IN FIRST EPISODE PSYCHOSIS Alexander Wunderink 1 , Sjoerd Sytema 2 , Fokko Nienhuis 2 , Durk Wiersma 2 1 University Medical Center Groningen/Friesland Mental Health Services, Leeuwarden; 2 University Medical Center Groningen, Groningen, The Netherlands [email protected] Introduction: Generally agreed outcome criteria in psychosis are required to evaluate the effectiveness of new treatment strategies and surmount therapeutic pessimism. The aim of this study is to explore recovery and its relation to symptomatic and functional remission in first episode patients and to find predictors of recovery. Methods: In a sample of first episode patients (N = 125) symptomatic and functional remission during the last nine months of a two years follow-up period were examined, as well as recovery and its predictors. Recovery was clinically defined by the two dimensions of symptomatic and functional remission. Results: Half the patients (52.0%) showed symptomatic remission, a quarter (26.4%) showed functional remission, while one fifth (19.2%) met both criteria-sets and were considered recovered. Functionally remitted patients recovered in 72.7% (OR = 2.7), symptomatically remitted patients in 36.9% (OR = 0.6). Recovery was significantly associated with short duration of untreated psychosis (OR = 0.531, df = 1, p = 0.008). No recovery occurred in patients with long duration of untreated psychosis (>6 months). Another significant predictor of recovery was better baseline functioning (OR = 0.858, df = 1, p = 0.021). Conclusions: Functional remission is more selectively associated with recovery than symptomatic remission. Treatment delay reduces chance of recovery. Baseline functioning levels also significantly predict recovery. Our results clearly show that social functioning is an important parameter in schizophrenia outcome research, both as a predictor of future course characteristics, and as a more selective index of recovery than symptom remission. References [1] Andreasen NC, Carpenter WT, Jr., Kane JM, Lasser RA, Marder SR, Weinberger DR. Remission in schizophrenia: proposed criteria and rationale for consensus. Am J Psychiatry 2005 Mar;162(3):441-9
477 – TWO-YEAR REHOSPITALIZATION RATES OF FIRST-EPISODE SCHIZOPHRENIC INPATIENTS DISCHARGED ON ANTIPSYCHOTIC MEDICATION: A PRELIMINARY STUDY Won-Myong Bahk 1 , Young Sup Woo 1 , Ho-Jun Seo 1 , Bo-Hyun Yoon 2 , Jeong-Ho Chae 1 1 The Catholic University of Korea, Seoul; 2 Naju National hospital, Naju, Korea [email protected] Introduction: We compared the rehospitalization rate of first-episode schizophrenic inpatients who were discharged from a university hospital while being treated with risperidone, olanzapine, quetiapine, or the conventional antipsychotic haloperidol. We also assessed other possible predictors of rehospitalization. Methods: We monitored the rehospitalization status of all first-episode schizophrenic inpatients who were discharged from a university hospital between 1 January 2001 and 30 June 2003 while they were taking risperidone (n = 16), olanzapine (n = 26), quetiapine (n = 9), or haloperidol (n = 10). Rehospitalizations were tracked over a 2-year period using the Kaplan-Meier method. Risk factors associated with rehospitalization were examined using the Cox proportional hazards regression model. Results: The rehospitalization rates estimated using the Kaplan-Meier formula for patients taking haloperidol (60.0%) did not differ significantly from the rates for patients treated with risperidone (37.5%), olanzapine (34.6%), or quetiapine (33.3%) during the 24-month
follow-up period. The length of untreated illness before drug treatment predicted rehospitalization. Conclusions: The rehospitalization rates of first-episode schizophrenic inpatients taking risperidone, olanzapine, quetiapine, or haloperidol do not differ. However, the small number of patients who participated in this study made it difficult to establish significance. References [1] Rabinnowitz J. Lichtenberg P, Kaplan Z, Mark M, Nahon D, Davidson M. Rehospitalization rates of chronically ill schizophrenic patients discharged on a regimen of risperidone, olanzapine, or conventional antipsychotics. Am J Psychiatry 2001; 158: 266-269. Weiden P, Aquila R, Standard J. Atypical antipsychotic drugs and long-term outcome in schizophrenia. J Clin Psychiatry 1996; 57: 53-60. [2] Lieberman JA, Stroup TS, McEvoy JP, Swartz M, Rosenhack RA, Perkins DO, et al. Effectiveness of Antipsychotic Drugs in Patients with Chronic Schizophrenia. N Eng J Med 2005; 353: 1209-1223
478 – RECOVERY FROM SCHIZOPHRENIA: STABILITY OF FUNCTIONAL OUTCOME IN PATIENTS ON SYMPTOMATIC REMISSION IN A 1-YEAR EPIDEMIOLOGICAL STUDY Antonio Ciudad 1 , Luis San 2 , Julio Bobes 3 , Enrique Álvarez 4 , Pepa García de Polavieja 5 , Inmaculada Gilaberte 5 1 Lilly, S.A., Alcobendas; 2 Hospital San Rafael, Barcelona; 3 University of Oviedo, Oviedo; 4 Hospital Sant Pau, Barcelona; 5 Lilly Research Laboratories, Alcobendas, Spain [email protected] Introduction: Recovery from schizophrenia would require continued remission of symptoms and adequate functioning (AF) (1). Authors aimed to investigate how many outpatients who met severity criteria for symptomatic remission (SR) fulfill and maintain recovery criteria (SR plus AF). Methods: At baseline, 452 out of 1010 outpatients with schizophrenia (DSM-IV-TR) (44.8%) met the SAPS/SANS-based severity criteria for SR (2). Of these, 375 could be reevaluated after 1 year. Among others, evaluations included the PAS, GAF, MARDS and the GEOPT E Scale of Social Cognition for Psychosis. Frequencies and characteristics of patients on SR with and without AF (GAF score≥80) at both timepoints were compared using logistic regression. Results: Of 452 patients on SR at baseline, 103 (22.8%) fulfilled recovery criteria. Better premorbid adjustment (OR=1.56 per each 0.1-point decrease in PAS) and social cognition (OR=1.14 per each 1-point decrease in GEOPTE scale) were significant correlates of recovery at baseline. At endpoint, 37 out of 375 patients (9.9%) did not maintain SR. Of the remaining 338, 102 (30.2%) fulfilled recovery criteria at endpoint: 67 (19.8%) maintained; 35 (10.4%) gained and 16 (4.7%) lost them during follow-up. Increase (worsening) of MADRS score (OR=1.29) was significantly associated with losing AF among patients on SR. Conclusions: There was a net increase of individuals showing recovery among outpatients with schizophrenia that were found again on SR after 1 year. The aggravation of depressive symptoms was associated with losing recovery criteria. References [1] Liberman RP, Kopelowicz A: Recovery from schizophrenia: a concept in search of research. Psychiatr Serv 2005; 56(6):735-42 [2] Andreasen NC, Carpenter WT, Jr., Kane JM, Lasser RA, Marder SR, Weinberger DR: Remission in schizophrenia: proposed criteria and rationale for consensus. Am J Psychiatry 2005; 162(3):441-9
Abstracts / Schizophrenia Research 102/1–3, Supplement 2 (2008) 1–279
476 – RECOVERY AND ITS RELATION TO SYMPTOMATIC AND FUNCTIONAL REMISSION IN FIRST EPISODE PSYCHOSIS Alexander Wunderink 1 , Sjoerd Sytema 2 , Fokko Nienhuis 2 , Durk Wiersma 2 1 University Medical Center Groningen/Friesland Mental Health Services, Leeuwarden; 2 University Medical Center Groningen, Groningen, The Netherlands [email protected] Introduction: Generally agreed outcome criteria in psychosis are required to evaluate the effectiveness of new treatment strategies and surmount therapeutic pessimism. The aim of this study is to explore recovery and its relation to symptomatic and functional remission in first episode patients and to find predictors of recovery. Methods: In a sample of first episode patients (N = 125) symptomatic and functional remission during the last nine months of a two years follow-up period were examined, as well as recovery and its predictors. Recovery was clinically defined by the two dimensions of symptomatic and functional remission. Results: Half the patients (52.0%) showed symptomatic remission, a quarter (26.4%) showed functional remission, while one fifth (19.2%) met both criteria-sets and were considered recovered. Functionally remitted patients recovered in 72.7% (OR = 2.7), symptomatically remitted patients in 36.9% (OR = 0.6). Recovery was significantly associated with short duration of untreated psychosis (OR = 0.531, df = 1, p = 0.008). No recovery occurred in patients with long duration of untreated psychosis (>6 months). Another significant predictor of recovery was better baseline functioning (OR = 0.858, df = 1, p = 0.021). Conclusions: Functional remission is more selectively associated with recovery than symptomatic remission. Treatment delay reduces chance of recovery. Baseline functioning levels also significantly predict recovery. Our results clearly show that social functioning is an important parameter in schizophrenia outcome research, both as a predictor of future course characteristics, and as a more selective index of recovery than symptom remission. References [1] Andreasen NC, Carpenter WT, Jr., Kane JM, Lasser RA, Marder SR, Weinberger DR. Remission in schizophrenia: proposed criteria and rationale for consensus. Am J Psychiatry 2005 Mar;162(3):441-9
477 – TWO-YEAR REHOSPITALIZATION RATES OF FIRST-EPISODE SCHIZOPHRENIC INPATIENTS DISCHARGED ON ANTIPSYCHOTIC MEDICATION: A PRELIMINARY STUDY Won-Myong Bahk 1 , Young Sup Woo 1 , Ho-Jun Seo 1 , Bo-Hyun Yoon 2 , Jeong-Ho Chae 1 1 The Catholic University of Korea, Seoul; 2 Naju National hospital, Naju, Korea [email protected] Introduction: We compared the rehospitalization rate of first-episode schizophrenic inpatients who were discharged from a university hospital while being treated with risperidone, olanzapine, quetiapine, or the conventional antipsychotic haloperidol. We also assessed other possible predictors of rehospitalization. Methods: We monitored the rehospitalization status of all first-episode schizophrenic inpatients who were discharged from a university hospital between 1 January 2001 and 30 June 2003 while they were taking risperidone (n = 16), olanzapine (n = 26), quetiapine (n = 9), or haloperidol (n = 10). Rehospitalizations were tracked over a 2-year period using the Kaplan-Meier method. Risk factors associated with rehospitalization were examined using the Cox proportional hazards regression model. Results: The rehospitalization rates estimated using the Kaplan-Meier formula for patients taking haloperidol (60.0%) did not differ significantly from the rates for patients treated with risperidone (37.5%), olanzapine (34.6%), or quetiapine (33.3%) during the 24-month
follow-up period. The length of untreated illness before drug treatment predicted rehospitalization. Conclusions: The rehospitalization rates of first-episode schizophrenic inpatients taking risperidone, olanzapine, quetiapine, or haloperidol do not differ. However, the small number of patients who participated in this study made it difficult to establish significance. References [1] Rabinnowitz J. Lichtenberg P, Kaplan Z, Mark M, Nahon D, Davidson M. Rehospitalization rates of chronically ill schizophrenic patients discharged on a regimen of risperidone, olanzapine, or conventional antipsychotics. Am J Psychiatry 2001; 158: 266-269. Weiden P, Aquila R, Standard J. Atypical antipsychotic drugs and long-term outcome in schizophrenia. J Clin Psychiatry 1996; 57: 53-60. [2] Lieberman JA, Stroup TS, McEvoy JP, Swartz M, Rosenhack RA, Perkins DO, et al. Effectiveness of Antipsychotic Drugs in Patients with Chronic Schizophrenia. N Eng J Med 2005; 353: 1209-1223
478 – RECOVERY FROM SCHIZOPHRENIA: STABILITY OF FUNCTIONAL OUTCOME IN PATIENTS ON SYMPTOMATIC REMISSION IN A 1-YEAR EPIDEMIOLOGICAL STUDY Antonio Ciudad 1 , Luis San 2 , Julio Bobes 3 , Enrique Álvarez 4 , Pepa García de Polavieja 5 , Inmaculada Gilaberte 5 1 Lilly, S.A., Alcobendas; 2 Hospital San Rafael, Barcelona; 3 University of Oviedo, Oviedo; 4 Hospital Sant Pau, Barcelona; 5 Lilly Research Laboratories, Alcobendas, Spain [email protected] Introduction: Recovery from schizophrenia would require continued remission of symptoms and adequate functioning (AF) (1). Authors aimed to investigate how many outpatients who met severity criteria for symptomatic remission (SR) fulfill and maintain recovery criteria (SR plus AF). Methods: At baseline, 452 out of 1010 outpatients with schizophrenia (DSM-IV-TR) (44.8%) met the SAPS/SANS-based severity criteria for SR (2). Of these, 375 could be reevaluated after 1 year. Among others, evaluations included the PAS, GAF, MARDS and the GEOPT E Scale of Social Cognition for Psychosis. Frequencies and characteristics of patients on SR with and without AF (GAF score≥80) at both timepoints were compared using logistic regression. Results: Of 452 patients on SR at baseline, 103 (22.8%) fulfilled recovery criteria. Better premorbid adjustment (OR=1.56 per each 0.1-point decrease in PAS) and social cognition (OR=1.14 per each 1-point decrease in GEOPTE scale) were significant correlates of recovery at baseline. At endpoint, 37 out of 375 patients (9.9%) did not maintain SR. Of the remaining 338, 102 (30.2%) fulfilled recovery criteria at endpoint: 67 (19.8%) maintained; 35 (10.4%) gained and 16 (4.7%) lost them during follow-up. Increase (worsening) of MADRS score (OR=1.29) was significantly associated with losing AF among patients on SR. Conclusions: There was a net increase of individuals showing recovery among outpatients with schizophrenia that were found again on SR after 1 year. The aggravation of depressive symptoms was associated with losing recovery criteria. References [1] Liberman RP, Kopelowicz A: Recovery from schizophrenia: a concept in search of research. Psychiatr Serv 2005; 56(6):735-42 [2] Andreasen NC, Carpenter WT, Jr., Kane JM, Lasser RA, Marder SR, Weinberger DR: Remission in schizophrenia: proposed criteria and rationale for consensus. Am J Psychiatry 2005; 162(3):441-9