Do initial symptoms predict later remission in schizophrenia? Compre Psy. 2014

04.08.2014

Course of schizophrenia is highly heterogeneous. Predicting outcomes in schizophrenia is an extremely difficult task. The popular assumption of rule of thirds” ( in a group of schizophrenic patients one-third improves, one third deteriorates and one third has an intermediate course) do not have an empirical basis.

Some studies  show that 45% to 70% could be defined as remitters at some point during the course of the illness. Shorter duration of untreated psychosis (DUP), a better premorbid adjustment, lower illness severity at baseline, early symptomatic improvement, medication adherence and remitted substance abuse are thought to increase the likelihood for remission.

There are conflicting findings regarding predictability of outcome based on symptoms. Italian researchers Carlo Marchesi and colleagues  investigated whether the severity of positive, disorganized and negative symptoms assessed at onset in first-episode patients with schizophrenia predicted remission (using RSWG criteria) after several years of illness.

Results

56 patients admitted with first episode psychosis between 95-99 were followed up for average of 16 years.  These patients accessed   ‘reasonably comprehensive’ public mental health services. They were re-assessed in 2010  (blind to the baseline evaluation). Of the 56 patents enrolled, 48 were reassessed at follow up. Diagnosis remained same in all at follow up.

38% achieved remission criteria. Among remitted patents (18/48),  3 were in complete symptomatic recovery.

Remission and symptoms at onset: Remitters had milder positive and negative symptoms and a lower overall symptom severity at baseline.

Severity of positive symptoms at onset do not impact on later symptomatic remission. But recurrence of positive symptoms  ( = number of episodes and admissions) during the course of illness could prevent remission.

Negative symptoms remained stable throughout the course of the illness, and exerted a negative effect on the achievement of remission.

Conclusions:

Negative symptoms  present at the onset of schizophrenia appear stable and is associated with a poor long-term outcome (i.e. remission. Initial positive symptoms seem to have less prognostic value, but their recurrence during the course of the disorder can impede long-term remission.

Predictors of symptomatic remission in patients with first-episode schizophrenia: a 16years follow-up study.

Marchesi C, Affaticati A, Monici A, De Panfilis C, Ossola P, Tonna M. Compr Psychiatry. 2014 May;55(4):778-84.

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