Wolfgang Gaebel1, Mathias Riesbeck2, Wolfgang Wölwer2, Ansgar Klimke3, Matthias Eickhoff4, Martina von Wilmsdorff2, Isabella Heuser5, Wolfgang Maier6, Joachim Klosterkötter7, Peter Falkai8, Ralf Schlösser9, Andrea Schmitt10, Michael Riedel11, Stefan Klingberg12, Wolfgang Köpcke13, Christian Ohmann14, Hans-Jürgen Möller11. 1. Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany. Electronic address: wolfgang.gaebel@uni-duesseldorf.de. 2. Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany. 3. Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany; Department of Psychiatry and Psychotherapy, Vitos Waldkrankenhaus Köppern, Germany. 4. Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany; Department of Psychiatry, Westfalia Clinics, Warstein/Lippstadt, Germany. 5. Department of Psychological Medicine, Charité-Campus Benjamin Franklin, Berlin, Germany. 6. Department of Psychiatry and Psychotherapy, University of Bonn, Germany. 7. Department of Psychiatry and Psychotherapy, University of Cologne, Germany. 8. Department of Psychiatry and Psychotherapy, University of Göttingen, Germany; Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany. 9. Department of Psychiatry and Psychotherapy, University of Jena, Germany; AHG Römhild Clinic, Germany. 10. Central Institute of Mental Health, Mannheim, University of Heidelberg, Germany; Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany. 11. Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany. 12. Department of Psychiatry and Psychotherapy, University of Tübingen, Germany. 13. Department of Medical Informatics and Biomathematics, University of Münster, Germany. 14. Coordinating Centre for Clinical Trials, Heinrich-Heine-University, Düsseldorf, Germany.
Abstract
OBJECTIVE: Full and sustained symptom remission is a major treatment objective after a first-episode in schizophrenia. Findings regarding differences in remission between first- and second-generation antipsychotics are inconclusive. This study aimed to provide rates and predictors of remission in first-episode schizophrenia and to identify symptoms that prevent remission. METHODS:Prevalence rates of "symptomatic remission" (symptom criteria only) and "enduring remission" (symptom and 6-month time criteria), defined according to Andreasen et al. (2005), were determined in first-episode patients participating in a RCT by the German Research Network on Schizophrenia (GRNS) that compared post-acute, 1-year maintenance treatment with risperidone or haloperidol. Respective predictors at baseline were identified by logistic and Cox regression analysis. RESULTS:Prevalence rates were 91.5% for symptomatic remission (n=152/166 eligible patients) and 58.6% for enduring remission (n=65 of 111 patients who continued for at least 6 months; 39.2% of all 166 patients included), with no significant differences between risperidone and haloperidol in either type of remission. Enduring remission often was not reached because of negative symptoms: After 6 months, 40.5% of the patients had at least 1 negative symptom, whereas only 10.8% of the patients had "persisting" positive symptoms. Of the different predictors identified in univariate analyses, (lower) negative symptoms and participating in standardized psychological treatment remained significant in multivariate (stepwise forward) analyses for enduring remission. CONCLUSIONS: By far most of the first-episode patients reached a temporary state of full symptomatic remission within 1 year of antipsychotic treatment. However, only about 50% achieved sustained, enduring remission. Negative symptoms are still a major treatment obstacle to enduring remission in schizophrenia.
RCT Entities:
OBJECTIVE: Full and sustained symptom remission is a major treatment objective after a first-episode in schizophrenia. Findings regarding differences in remission between first- and second-generation antipsychotics are inconclusive. This study aimed to provide rates and predictors of remission in first-episode schizophrenia and to identify symptoms that prevent remission. METHODS: Prevalence rates of "symptomatic remission" (symptom criteria only) and "enduring remission" (symptom and 6-month time criteria), defined according to Andreasen et al. (2005), were determined in first-episode patients participating in a RCT by the German Research Network on Schizophrenia (GRNS) that compared post-acute, 1-year maintenance treatment with risperidone or haloperidol. Respective predictors at baseline were identified by logistic and Cox regression analysis. RESULTS: Prevalence rates were 91.5% for symptomatic remission (n=152/166 eligible patients) and 58.6% for enduring remission (n=65 of 111 patients who continued for at least 6 months; 39.2% of all 166 patients included), with no significant differences between risperidone and haloperidol in either type of remission. Enduring remission often was not reached because of negative symptoms: After 6 months, 40.5% of the patients had at least 1 negative symptom, whereas only 10.8% of the patients had "persisting" positive symptoms. Of the different predictors identified in univariate analyses, (lower) negative symptoms and participating in standardized psychological treatment remained significant in multivariate (stepwise forward) analyses for enduring remission. CONCLUSIONS: By far most of the first-episode patients reached a temporary state of full symptomatic remission within 1 year of antipsychotic treatment. However, only about 50% achieved sustained, enduring remission. Negative symptoms are still a major treatment obstacle to enduring remission in schizophrenia.
Authors: Richard J Drake; Merete Nordentoft; Gillian Haddock; Celso Arango; W Wolfgang Fleischhacker; Birte Glenthøj; Marion Leboyer; Stefan Leucht; Markus Leweke; Phillip McGuire; Andreas Meyer-Lindenberg; Dan Rujescu; Iris E Sommer; René S Kahn; Shon W Lewis Journal: Schizophr Bull Date: 2015-03-05 Impact factor: 9.306