Predictive factors of functional remission in patients with early to mid-stage schizophrenia treated by long acting antipsychotics and the specific role of clinical remission. (November 2019)

• Record Type: Journal Article
• Authors: Gorwood, Philip; Bouju, Sophie; Deal, Cécile; Gary, Charlotte; Delva, Catherine; Lancrenon, Sylvie; Llorca, Pierre-Michel
• Is Part Of: Psychiatry research. Volume 281(2019)
• Publication Date: 2019-11
• Subjects: Schizophrenia -- Functional remission -- Clinical remission -- Functioning -- Long-acting injectable antipsychotics -- Antipsychotics; CGI-I Clinical Global Impression-Improvement -- EGOFORS European Group On Functional Outcomes and Remission in Schizophrenia -- EQ-5D EuroQol-5D -- FROGS Functional Remission of General Schizophrenia -- GAF Global Assessment of Functioning -- LAI long acting injectable -- PANSS-8 Positive and Negative Syndrome Scale-8 items -- PSP Personal and Social Performance -- PSRS Psychosocial Remission in Schizophrenia -- RSWG Remission in Schizophrenia Working Group -- SWN Subjective well-being under neuroleptic treatment; Psychiatry -- Periodicals; Psychiatry -- periodicals; Psychiatrie -- Périodiques; 616.89
• DOI: 10.1016/j.psychres.2019.112560
• Languages: English
• ISSNs: 0165-1781

Abstract

Highlights: Long-acting antipsychotic could facilitate functional remission in schizophrenia. Half of patients with schizophrenia treated with LAI could achieve functional remission. Clinical and functional remission are tightly linked, especially in the early period of schizophrenia. Non-exclusive parental support could constitute an important predictor of functional remission. Abstract: Background: Functional remission has become a major therapeutic objective in schizophrenia, but the probability of such positive outcome has a large variability, ranging from 15% to 51%. Additionally, how clinical remission constitutes a prerequisite for functional remission also remains unclear. Methods: A prospective observational study was conducted in French schizophrenic patients who initiated treatment with a long-acting injectable (LAI) after an acute episode. Functional and clinical remissions were assessed using the FROGS and the Andreasen criteria, and the role of clinical remission and predictive factors of functional remission was evaluated. Results: Three hundred three patients with schizophrenia (DSM-IV criteria) were followed for 12 months. At 12 months, 45.1% of the patients reached functional remission while 55.1% obtained clinical remission. Clinical remission facilitated functional remission (OR = 14.74), especially in patients with psychosis for less than 5 years (OR = 23.73). Other predictive factors concerned the family environment, education level, employment status, baseline functioning levels and level of insight. Conclusions: About half of patients treated with LAI reached functional remission after one year of follow-up. Reduced clinical symptoms and reaching clinical remission largely favored functional remission. These results stress the importance of continuous and appropriate symptomatic treatment to reach functional remission and maximize recovery chances.