Remission in prognosis of functional outcome: a new dimension in the treatment of patients with psychotic disorders.

INTRODUCTION

The aim of the present study was to investigate whether or not the new concept of remission in the treatment of schizophrenia is of importance for functional outcome. The hypothesis was that patients having attained remission would function at a higher level and have a lower care requirement than those who had not attained remission.

MATERIALS AND

METHODS

Remission is defined through the application of the Positive and Negative Syndrome Scale (PANSS) instrument whereby none of the eight chosen items, representing core symptoms, should be found to present a value exceeding 3 points. The utility of attaining the severity criteria for remission, or not, was examined with regard to activity of daily living (ADL) ability, establishment of social functioning and social network, and amount of health care and community support that the patient consumed. Two hundred and forty-three patients were examined, of whom 93 patients (38%) had attained remission and 150 patients (62%) had not. The present patient population, consisting of 50% of all available patients with schizophrenia spectrum disorder within a homogeneous catchment area in NU Health Care, western Sweden, meeting the right diagnostic criteria, were in their habitual condition and were unaffected by any other functionally debilitating disorder, in particular dementia. As a control patients diagnoses were used as the independent variable to exclude that they better explain outcome than remission.

RESULTS

It was found that patients that attainted the specified remission criteria showed a significantly superior outcome in all assessed areas with regard to activity of daily life, social functioning in society and consumption of health care. Remission patients functioned more effectively in social contexts in association with superior education, more often had occupations, possessed more established social networks and were more likely to be found living under family-like conditions. They exhibited a lower need for support in order to fulfill their everyday activities. Also, patients in remission required markedly less health care resources, both in the form of psychiatric treatment and community habitation support. In contrast diagnoses only made difference in 4 of 14 outcome parameters.

DISCUSSION: The results suggest that the concept of remission has important implications for the treatment of patients with chronic psychosis. One possible conclusion is that if more patients attain remission, the patient's and society's burden resulting from the illness will decrease.